Diabetes Self-Management Blog

The Close Concerns blog recently reported on a health-care strategy that is receiving new prominence. Some insurance companies, employers, and state governments are experimenting with paying primary-care doctors more so they can better care for their patients.

With the extra money, doctors are able to spend more time with their patients, keep in touch with their patients between appointments via phone and e-mail, and hire new staff so that their office can take same-day appointments, keep electronic medical records, and check in more often with patients about necessary screening tests or treatment progress. The result of these changes is known as a “medical home.”

A medical home is different from a traditional doctor’s office, in which people are in contact with their doctors only during appointments (and often for only a few minutes). In a medical home, care is comprehensive and continues between appointments. Insurers and governments pushing the medical-home model believe that by spending more up front on this kind of care, they can decrease costs down the line both for patients and for themselves by heading off complications and catching disease risks early.

In an ideal medical home, a person with diabetes would spend extra time with the doctor to craft a detailed self-management plan and then would be able to contact the doctor between appointments to ask questions or to report on self-management progress.

There have been many trials of the medical-home model. In Philadelphia, three big insurance companies have teamed up with local Medicaid service providers to pay over 100 doctors to turn their offices into medical homes. A fuller description of the experiment in Philadelphia is available in this New York Times article.

In North Carolina, Medicaid has been using the medical-home model for many years. So far, the results have been promising. In 2005 and 2006, North Carolina Medicaid saved $231 million over projected costs.

And in Michigan, Blue Cross Blue Shield is planning to spend $30 million to help doctors set up medical homes.

You can read more about medical homes here, here, and here.

This blog entry was written by Assistant Editor David Golann.


  1. For years, medical students have been less and less inclined to enter a primary care specialty such as Internal Medicine or Family Practice. Only 2% of med students are considering primary care now.

    Your “medical home” provider will be a nurse practitioner or physician assistant, not a doctor.

    Better pay and/or tort reform could reverse the trend, but the lawyers will not allow tort reform in most states yet. The lawsuits are very lucrative for them.


    Posted by Steve Parker, M.D. |

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