The Role of Specialists in the Medical Neighborhood Model

Many Starling physicians have questioned where specialists fit into what seems like a very primary-care centered care model. Around the country, specialists are emphasizing the concept of a “medical neighborhood” surrounding the “medical home”.   Here’s an overview of the concept.

A patient-centered medical home is led by a personal physician who works with patients and the care team to coordinate all health services in a high-quality, cost-effective, and accessible manner. A medical neighborhood fosters shared accountability by linking specialty care and primary care physicians together to provide integrated, patient-centered care.

The “medical neighborhood” provides a framework for structured, reciprocal relationships that integrate specialty care and extend the principles of the medical home to all practicing physicians. The foundation of the medical neighborhood is the collaborative care agreement, which outlines mutual expectations for primary care physicians and specialists as they care for patients together. These expectations include a pre-consultation exchange between the referring physician and the consultant, the consultation, and subsequent co-management of patients over time. JAMA Intern Med 2014 Mar; 174(3)

The primary activity of a well-functioning medical neighborhood is delivery of coordinated care, which requires regular communication, collaboration, and shared decision-making across various actors in the system (Meyers et al. 2010). Ideally, the neighborhood encourages population health and shares resources and infrastructure (for such efforts as health information technology (IT) and performance measurement).