In today's health care system, most of us spend little time with our primary-care physicians. Patients are sent to specialists for problems and chronic conditions, and unfortunately primary-care physicians rarely communicate with these specialists.

New York Times' Jane E. Brody shares that her "81-year-old friend with multiple health problems complained recently that she was seeing an orthopedist, a rheumatologist, an oncologist, an ophthalmologist and an endocrinologist but had no doctor to oversee and coordinate her overall care." Maybe her conditions are being addressed but where is the coordination? More importantly, who is taking care of the patient?

There have been numerous articles over the past week about a new approach to patient care called the medical home or the patient-centered medical home. Don't let the name confuse you – the approach has nothing to do with doctors making house calls. According to Catherine Arnst in Business Week's The Family Doctor: A Remedy for Health Care Costs?, "It's more like doctoring 1950s style, when a Marcus Welby figure handled all the family's medical needs. This time it's juiced up with medical technology."

Body explains the medical home in her article, A Personal, Coordinated Approach to Care,

…it is an approach in which each person has a primary care doctor who heads a team of professionals — perhaps including a physician assistant, a nurse practitioner, a dietitian, a social worker and a pharmacist — to provide round-the-clock access to care.

It is unlike managed care, in which primary doctors act as gatekeepers to specialists and the overriding goal is not managing care but managing costs. In a medical home, the family doctor helps patients get specialty care when they need it and, through electronic records, keeps careful track of treatments and informs specialists of the patients’ progress. The connections between the professionals who work on each case are seamless and convenient. Doctors and patients have easy access to medical information, and patients with chronic ailments are called regularly to reinforce treatment regimens and see how they are doing.

This is a team approach where nurses spend more time on the record keeping work that has generally been done by the doctor. This frees up the doctor's time to spend with patients discussing management of conditions and discussing cases with specialists and other members of the team.

According to Arnst, only 27% of physician practices currently qualify as medical homes, and only 17% of doctors offices have electronic medical record systems.

The medical home concept is a significant change, and one that doesn't currently sync with Medicare and insurers reimbursement policies. According to Arnst,

As sensible as this routine may sound, it goes against the grain of most primary-care practices. Medicare and other insurers pay doctors on a fee-for-service basis that rewards quantity of care over quality. There are no reimbursements for discussing diabetes management with a patient, say, or talking over a case with a specialist. "The main hurdle to getting the medical home accepted more widely is the lack of compensation for cognitive work," says Harvard Business professor Clayton M. Christensen, co-author of The Innovator's Prescription: A Disruptive Solution for Health Care.

The concept has the endorsement of 500 large employers including IBM as well as four medical societies, and most importantly, President Obama has said that any health care bill should "encourage and provide appropriate payment for providers who implement the medical-home model."

According to the PriceWaterhouseCoopers Health Research Institute's Behind the numbers Medical cost trends for 2010, health spending continues to grow and medical costs are expected to increase in 2010. This information presents challenges for Americans and employers. Employers are planning strategies for next year, including growing wellness and disease management programs, changing employee contributions, and increasing cost sharing.

The report focuses on many of the issues facing employers, and provides information on strategies to cope with the challenges of another increase in health care costs in 2010. Behind the numbers Medical cost trends for 2010 includes the following data:

• Growth in medical costs for 2010 is expected to be 9 percent, slightly lower than in previous years; however, it will still outpace inflation and increases in worker earnings.

• As the recession pounded corporate profits in early 2009, employers surveyed said they were ready to push more of the costs of health insurance to their workers in 2010 while expecting more responsibility from workers for managing their personal health. Regarding which strategies employers were planning to implement over the next two years, improving wellness and increasing cost sharing led all responses.
– More than two-thirds of employers are expecting to expand wellness and disease
management programs.
–– Forty-two percent of employers surveyed said they would increase employee contributions, up from 38 percent in 2008.
–– In addition, 41 percent said they expect to increase medical cost sharing through plan
design changes.

• Increased cost sharing could squeeze workers, many of whom took wage cuts in 2009 because of the recession. In the last five years, health insurance premiums have increased four times faster than wages, a trend that is expected to continue in 2009 and 2010. If employers follow through on plans for increased cost sharing, the affordability gap could grow even larger.

• The economy is creating both positive and negative pressures on medical costs.
–– An unprecedented number of workers are in high-deductible health plans (HDHPs), which are expected to see lower utilization among cash-strapped workers who lack the resources to pay for medical procedures. This trend is expected to slow the rate of medical cost increases.
–– The workers who have retained their jobs, but are fearful of losing them, may be using more services while they still have health insurance.

You can download the report on the PriceWaterhouseCooper's web site by clicking here.

According to the US Centers for Disease Control and Prevention, adults generally need seven to nine hours of sleep each night. Many adults do not get this much sleep, and in addition to feeling drowsy there are health consequences.

Today's Boston Globe's Too little sleep may raise risk of hypertension article shares information about a sleep study's results that middle-aged adults who don't enough enough sleep are more likely to develop high blood pressure. According to the article,

"The team studied 578 adults with an average age of 40. They took blood pressure readings and measured how long each person slept. Only 1 percent slept eight hours or more.

The volunteers slept six hours on average. Those who slept less were far more likely to develop high blood pressure over five years. And each hour of lost sleep raised the risk."

There are numerous benefits of getting enough sleep, including keeping your heart healthy. According to Mark Stibich, P.h.D., 

"Sleep is important for concentration, memory formation and the repair of damage to your body’s cells during the day. Chronic lack of sleep increases the risk for developing obesity, diabetes, cardiovascular disease and infections."