The term 'medical home' can have many meanings

Patients don't want to be 'managed'

When the Bend Memorial Clinic receptionist offered a 90-year-old patient a brochure describing the clinic's medical home model and a letter introducing the nurse care management program, the patient angrily threw the materials back.

To her and a number of other seniors identified for the program, the term "medical home" referred to some kind of an institution. They also were upset that somebody thought they needed a "manager."

"Our patients are an independent group, and they didn't like the idea of being managed by anybody. We found that we had to revise our approach in order to engage our population," says Georgene Siemsen, MS, RN, GNP-BC, a nurse case manager for PacificSource who is embedded in the clinic.

Siemsen persuaded one patient to agree to a home visit to check her blood sugar, blood pressure, and other vital signs. During the visit, the patient shared her concerns about the way she was recruited into the program.

"She said that she would have preferred for her primary care provider to discuss it with her first. She had a lot of recommendations and agreed to be a consultant and help us change the way we handled referrals," Siemsen says.

As a result, the primary care physician staff called patients to introduce the program because patients connect them with their primary care providers. As time went by, Siemsen made the calls, introducing herself as a nurse for their physician.

"I tell them I'm available to help them manage their chronic health condition through a benefit offered by their insurance company at no additional charge to them. Once we changed the way we described the program, the patients have been very receptive. Knowing that their primary care provider is supportive and kept informed is reassuring to patients and gives me credibility," she says.