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The promise of the medical home

September 19th, 2012

by Anthony Cirillo

Through a variety of circumstances, I was recently honored to present at Perspectives on Nutrition and Aging: A National Summit. I had seven minutes to articulate a possible solution to senior hunger and nutrition.

It's the 40th anniversary of the inclusion of Senior Nutrition Programs in the Older Americans Act. Since 1972, 8 billion meals have been served to seniors. But this is about more than meals. With 60 million people over age 60, the number of older adults facing hunger, obesity and chronic medical conditions will increase. This is a societal issue.

I presented a perspective that proposes to unite the continuum of care around this issue and I used the medical home as the foundation, while also including geriatric care managers, patient advocates, home health and even long-term care facilities in the mix. But the crux is the medical home.

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There is so much promise for the medical home if we truly shift it to wellness providers that care about people holistically. I shared with attendees that at Children's National Medical Center in Washington, D.C., people visiting the clinics are asked questions like, "Are you running out of food at the end of the month?" and "Do you have safe housing?"

When was the last time your physician asked you those questions? Probably never.

Rebecca Onie's TED video hit home for me as I was preparing my seven minutes. It contains a similar message. Essentially there are societal issues that transcend the physician office visit that few if any physicians address because there's simply not enough bandwidth or resources to do so.

Will the promise of the medical home change this? Maybe with Onie's help it can. She asks audacious questions: What if waiting rooms were a place to improve daily health care? What if doctors could prescribe food, housing and heat in the winter? At TEDMED she describes Health Leads, an organization that does just that--and does it by building a volunteer base as elite and dedicated as a college sports team.

Hunger, housing and heat are not the only issues.

A sedentary lifestyle is a common cause of obesity, and excessive body weight and fat are considered catalysts for diabetes, high blood pressure, joint damage and other serious health problems. But should lack of exercise itself be treated as a medical condition? Mayo Clinic physiologist Michael Joyner, M.D., argues it should be.

Physical inactivity affects the health not only of many obese patients, but also people of normal weight, such as workers with desk jobs, patients immobilized for long periods after injuries or surgery, and women on extended bed rest during pregnancies, among others, according to Joyner.

"I would argue that physical inactivity is the root cause of many of the common problems that we have," Joyner said in a recent commentary. "If we were to medicalize it, we could then develop a way, just like we’ve done for addiction, cigarettes and other things, to give people treatments, and lifelong treatments, that focus on behavioral modifications and physical activity."

If physical inactivity were treated as a medical condition itself rather than simply a cause or byproduct of other medical conditions, physicians may become more aware of the value of prescribing supported exercise, and more formal rehabilitation programs that include cognitive and behavioral therapy would develop, notes Joyner.

This is the promise of the medical home.

Whether acting this way is reimbursed or not is another issue.

But since I typically write about patient experience, if you really want to give your patient a great experience, help them achieve a life that is worth living. Now that would be an experience worth having.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities. He also is the expert guide in Assisted Living for About.com and Healthcare Channel Partner for CEO².

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