LEBANON - Laughter comes easily to Walt Rebman, who is known around town as "the tractor guy" because he enjoys tilling the school district's Planting Seeds of Change vegetable gardens.
But the nearly 80-year-old former contractor recently found himself a bit blue when his wife of 62 years suffered serious health problems.
Instead of having to wait weeks to see a doctor, Rebman called the Medical Home clinic. In less than two days, Rebman had an appointment at the clinic in the Mid-Valley Medical Plaza building south of Samaritan Lebanon Community Hospital.
"After my wife got sick, I decided to become healthier," Rebman said. "This clinic looks at me as a whole person. Really, it's more like a big family. Everyone is very friendly, accommodating. It's hard to believe; it's far more personal."
The Medical Home concept - also known as Patient-Centered Medical Home - is a pilot project within Samaritan Health Services and is one of 26 similar projects under way nationwide.
Unlike in the usual health care model in which a patient may be handed off to a variety of specialists over several weeks, the Medical Home concept is patient-centered and team-oriented.
Instead of seeing only a nurse and the doctor during an appointment, Rebman now may talk with all of the Medical Home team members including family physician Dr. Rick Wopat; medical assistant and health care coach Samantha Spencer; family nurse practitioner Danette Giboney; behavioral health counselor Lea Schmidt and others.
And perhaps more important, patients must take an active role in managing their own health care, whether it is controlling their diabetes, losing weight, stopping smoking, developing an exercise plan or working to improve their mental health.
Although the concept appears new, it's actually much like health care that was provided decades ago by family practitioners, who often made house calls and knew every patient by name. The American Academy of Pediatrics developed the concept of medical home health care In 1967.
"The Medical Home is not a building, it's a concept based on partnership in health care," said Wopat, a family physician for 31 years. "The guiding principle is right care, right place, right time."
Wopat said that in terms of any individual's health, about 20 percent can be attributed to biology and genetics; 50 percent to lifestyle; 10 percent to medical care and 20 percent to environment.
"More than 17 percent of our country's gross national product is spent on health care that affects 10 percent of our population," Wopat recently told the Lebanon Community Hospital Foundation. "We are spending money on medical care that is taking money from our schools, public safety and our nation's infrastructure."
Wopat's goal is to provide "barrier-free access" to his patients within 24 hours.
The Medical Home team members share some cramped quarters, but that close proximity works because although they have formal weekly staff meetings, they also consult each other daily about individual patient needs. It's common for them to share information about every patient who visits on any given day.
Currently, a physician might see 25 to 35 patients for about 15 to 20 minutes each per day. At the Medical Home, there may be 15 to 20 patients per day and the amount of time spent with any of them varies by the number of team members who spend time with them.
Wopat said another part of the concept is re-educating people about where they go for health care. Many people put off health care maintenance and then end up at the hospital's urgent care or emergency room.
If a patient makes an urgent-care visit, a member of the Medical Home team will make a follow-up phone call.
"We let them know how we could have helped them and we listen to them," Wopat said. "What are there needs, goals, values? I actually give some patients my personal phone number - which they are to use only in an emergency."
Patients have to feel comfortable before they open up about their personal issues, Giboney said. "But, it's amazing to see their transformation. They are excited to have a new home. There are many patients who felt turned around in the health care system."
Giboney said that, at first, the patients may require more resources to help get them on track, but as they gradually take more responsibility for their health, they will have to spend less money and time on treatment.
"It's kind of like restoring a classic car," Giboney said. "At first, it takes quite a bit of money to get it back into pristine shape. Then, you only have to bring it in for a tune-up now and then."
Tedisch said that patients don't want to be scolded, they want to be listened to and treated with respect.
Medical Home team members joke that they provide health care for all ages - from diapers to Depends. Patients range in age from a few months to 100 years old.
Samaritan Health Services has committed to supporting the project for at least a year, but a major factor in whether the Medical Home concept catches on nationwide boils down to money.
Currently, insurance companies pay for health care after a person becomes ill - to reimburse for hospitalization or emergency care.
Long-term, the Medical Home concept would require compensation to keep patients healthy, versus paying to fix problems.
Currently, the Lebanon Medical Home bills for services rendered, for example, an office visit. Wopat is on salary through Samaritan Health Services.
A similar concept has worked well in Alaska, according to Dr. Douglas Eby, vice president of medical services for the Alaska Native Medical Center in Anchorage. It has 1,500 employees who provide health care to about 50,000 people in the Anchorage area and another 140,000 Native Alaska clients.
Eby, whose parents Dr. Lawrence S. and Mary Jane Eby, live at the Mennonite Village in Albany, told the Democrat-Herald in December that 12 years ago, the system where he now works was in a "hopeless" situation.
Now, in large part due to the Medical Home concept, emergency care is down 50 percent and health outcomes have improved so the area is now among the top 25 percent in the country.
Patients are guaranteed same-day service and if elective surgery is needed, the average wait is just three to 10 days. Although the primary cost care is about 50 percent more, the overall costs per person are less than for other systems, according to Eby.