One success story of how the Medical Home is working for one primary practice doctor.  This is a pilot study to see how it could work by reducing the number of patients seen and a negotiated rate with insurers instead of the fee per service arrangement.  Somewhat similar to an HMO capitation arrangement in design, but again the emphasis is on the monthly payment and not per service. 

This doctor is also in a group so how it would perhaps work in a smaller practice might remain to be seen and perhaps piloted as well.  Due to economic conditions though at present, some of the practices have slowed down a bit though as patients are not going to the doctor as they have in the past to save money, but the medical home solution could too perhaps be a partial solution in that area for those who have insurance.   BD

Swedish's new clinic bypasses that problem by working with insurance providers who have agreed to pay monthly fees, instead of fees per service. Group Health circumvents the issue because it does payments in-house. Advocates say medical home pays for itself by reducing emergency room visits and preventing chronic conditions from worsening.

It also makes the practice more attractive for doctors. "If we don't burn out our doctors, they'll go into family medicine, they'll stay in the practice, and they won't retire at 50," Cordy said. That's true for Boiko, the Group Health doctor, who still takes work home. But the pace is more sustainable, and on a recent evening, after a long day seeing patients, it allowed her to do a home visit for an elderly couple dying on hospice care.

Doctors get the time they crave with patients


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