The new concept, which is being pushed nationally as a way to improve quality and reduce costs, appoints a health care team to orchestrate a coordinated approach to care that emphasizes prevention and constant monitoring of patients. The new program is open to Emory employees and their adult family members and to those covered by an Aetna Medicare Advantage plan, an alternative to traditional Medicare coverage.
The concept, known nationally as the "patient-centered medical home," revolves around an ongoing relationship with patients that extends beyond office visits. The "care teams" include nurses, medical assistants and behavioral health specialists who are led by a physician. The team will stay in contact with a patient before and after a visit and will offer educational materials while also coordinating care with specialists and making sure that the right follow-up care takes place if a patient goes to the emergency room or has a hospital stay.