These scenarios may not be as far-fetched as you believe. And, with the implementation of patient-centered Medical Home pilot programs at Bethesda, they may soon be on the horizon.

The National Naval Medical Center recently began reorganizing its Internal Medicine department into Medical Home treatment teams in May 2008. The delivery of health care has not advanced in pace with technological improvements, said Cmdr. Kevin Dorrance, the head of Bethesda’s Internal Medicine Department and the primary implementer of the Medical Home pilot program in 2007.

Lt. Cmdr. Sunny Ramchandani, staff physician in Bethesda’s Internal Medicine Department and Project Manager of the Medical Home Initiative, is also a staunch supporter of the concept.

''We must transform our current model to be more patient-centered and evidence-based while also ensuring world-class care,'' Ramchandani said.

Dorrance said the vision of the Medical Home is to re-engineer primary care to achieve and sustain high quality patient-centered health care using modern information technology and information management, which will be accountable for achieving measurable improvement in the quality of care provided.

‘‘The ‘Medical Home’ is based on the fundamental concept that the best quality health care is provided through patient-centered, physician-guided, cost-efficient, longitudinal care,” he added.

‘‘The original concept of a patient-centered Medical Home was introduced in 1967 by the American Academy of Pediatrics in an effort to enhance the medical treatment of children with special needs,” Dorrance, said.

He said since that time it has evolved to the Patient Centered Primary Care Collaborative, which is a tremendously large organization. It includes many medical organizations, the insurance industry, and corporate organizations that are all signed on to back the concept.

‘‘All have agreed...that this is the future of health care and what we need to rescue the health care industry in the United States,” said Dorrance.

Dorrance admits it’s often difficult to define in few words exactly what patient-centered Medical Home is.

‘‘It is essentially taking the medical organization and the provider out of the center of care and putting the patient there,” he said.

‘‘In this way we’re taking care of their needs in a much more holistic way, Dorrance said. ‘‘We’re providing enhanced communication methods, easier access by telephone; and, hopefully in the future, easier electronic access with the Care Team. These enhancements create a proactive management of disease and prevention, he said.

In the September 2007 Family Practice Management article entitled ‘The Medical Home – An Idea Whose Time Has Come Again,’ managing editor, Leigh Ann Backer said, ‘‘the consumer decides who is on his or her team, and the primary care physician makes sure they are working together to meet all of the patient’s needs in an integrated, ‘whole person’ fashion.”

Dorrance said they are completely renovating the front of the Medical Home Clinic. ‘‘We’re striving for the ‘Ritz Carlton’ look,” he said. ‘‘We don’t want to call our waiting rooms, waiting rooms -- that indicates you must wait; we want to call them lounges.”

Dorrance said the problem with any change at this level is there are upfront costs. Staffing, enhanced Information Technology, and renovations all cost money,” he added.

‘‘In order to get the insurance companies to pay for this, they will have to see that there will be a return on their investment and that has to be pretty-well proven,” said Dorrance.

‘‘So our goal in our pilot model is to take half of our patient population and put them in the patient-centered Medical Home, leave the other half in traditional care and then compare the outcomes,” Dorrance said.

‘‘I do believe it is the right model to sure-up our primary care not only in the military but the entire country and to really improve quality while reducing cost and, most importantly, for greater patient satisfaction,” he said.