Regarding your recent cover story on medical homes “Finding their way home,” Oct. 7, p. 6), it's fascinating to see the divergence of findings. A major Blues plan is moving ahead with wider implementation of medical homes, based on its calculation of savings, while other studies show little or no savings. One of the frustrations is that we have no formal definition of a health home, either in terms of the staff and other resources that are committed, or the specific services delivered. There is no standard way of budgeting for such homes, and no way of comparing their results in a credible manner. In addition, there's the question of establishing a baseline for known and projected claims costs; notoriously, current or recent experience is not a good guide for future costs, since many acute episodes are not repeated at all, or are not regularly repeated. When these kinds of variables and definitions are in hand and paired with good claims data, we'll have much more to go on.
Robert Moore,Robert Moore Consulting, Seattle