Medical Home

Individualized Care 
A transformation in care has taken place at Lakewood Health System, through the adoption of a medical home model that applies 21st-century technology to old-fashioned, personalized medical care. Through the implementation of the Medical Home, Lakewood Health System has taken on an advocacy role, both in the state of Minnesota, and nationally.

Medical Home is a progressive model of comprehensive care that takes an integrated, whole person approach to health management. Medical Home was developed by the American Academy of Family Physicians, the American College of Physicians and the American Academy of Pediatrics. As of July 1st, 2010, state funding for Medical Home reimbursement became available in Minnesota.

There is no additional charge to the patient to be part of a Medical Home. The state of Minnesota and most insurers have agreed to pay a monthly fee to Lakewood Health System for the patients they are insuring. They are of the belief that this medical home will decrease their expenses by improving the health of their insured. 

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Lakewood Health System’s Medical Home has become an accelerating force of quality care. All of Lakewood's Family Medicine physicians participate.

Other benefits of the program include:

  • Physicians are able to focus on complex health issues.
  • Patients are assured of swift communication and assistance, with care coordinated by their chosen medical home provider.
  • Pharmacists, therapists, educators, counselors, and home care nurses are able to communicate their recommendations in a timely, effective fashion, usually via the care coordinator.
  • Administration sees an efficient pattern of care delivery using a team of doctors, physician assistants, nurse practitioners, nurses and ancillary personnel working at the highest level of their training.
  • Medical Home patients greatly benefit from the program’s individualized care planning, team approach and whole person orientation.

In order to aid the successful implementation of medical home programs at other facilities, Lakewood Health System has developed a comprehensive training package available for purchase. It includes:

  • The book “Putting the Principles into Practice,” written by Dr. John Halfen, Medical Director and founder of Lakewood Health System’s Medical Home Program
  • Patient perspectives
  • Training presentation (in Power Point) by Dr. Halfen
  • Frequently asked questions with Dr. Halfen and Niki, Medical Home Care Coordinator at Lakewood Health System
  • Necessary documents for implementation, including steps for developing a medical home, program benefits, recommended team structure and principles, criteria for admission, consultation requests, and examples of patient communication materials
  • Dr. Halfen’s book “Putting the Principles into Practice” is also available for separate purchase ($30).

The cost of the package is $250; however bulk discounts are available. For more information, or to purchase a training package, contact Lois at 218-894-8311.

The Healthcare Revolution is Here

What is a Medical Home?
Medical Home is a new, innovative way to provide healthcare and is designed for patients with several chronic or complex health conditions. It takes an integrated, whole-person approach to health management, and involves a team of health professionals who work together to provide a more comprehensive type of care.

How is it different from the type of healthcare people receive now?
Medical Home provides patients with direct access to a team of registered nurses, or “care coordinators”, along with more immediate access to their personal physician and other healthcare providers as needed. Care is delivered in a team approach so that everyone on a patient’s “team” is kept informed and up-to-date on the health status of that patient.

Who is typically part of a Medical Home “team”?
The team will typically include a patient’s primary doctor, Medical Home care coordinators, a pharmacist, social worker, physical therapist, family members, caregivers, and specialists. The patient is considered a critical part of the team and is encouraged to play an active role in their ongoing care.

How do patients communicate with their Care Coordinators?
When a person is enrolled in Medical Home, they are given the direct telephone number and email address of our Medical Home Care Coordinators. Care Coordinators are available Monday through Friday during regular clinic hours, and anytime after hours for urgent needs.

Can anyone request to participate in Medical Home?
At Lakewood, we utilize a set of criteria to determine if someone’s healthcare would be best delivered within the Medical Home program. Those with multiple diagnoses (typically three or more requiring treatment), or who take multiple medications (usually four or more prescriptions) or those who have a severe or chronic illness like diabetes or heart disease, or an illness that requires frequent visits (every two months or less) typically fi t the Medical Home criteria. Age is not a determining factor. Medical Home is available for anyone (children, adults, seniors) who meets the criteria.

How much does it cost?
There is no additional charge or fee for participating in Medical Home. The State of Minnesota and most insurers have agreed to pay a monthly fee to Lakewood for the patients they are insuring. Medicare in Minnesota has also agreed to pay for accredited patients being seen under the State of Minnesota criteria.

How can I find out if I’m a candidate for Medical Home?
Talk to your medical provider, they will let you know if they feel you should be a Medical Home patient. They will then notify the Care Coordinators who will contact you. If you are not currently a patient at Lakewood, simply call to schedule an appointment with a doctor of your choice to establish care. Lakewood is a pioneer in the Medical Home movement and was one of the first in Minnesota to receive Medical Home Certification.

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Medical Staff
Family Medicine
Christine Albrecht, MD
Family Medicine
Berit Amundson, MD
Family Medicine
Arden Beachy, MD
Family Medicine and Palliative Care
Julie Benson, MD
Neil Bratney, MD
Family Medicine
David Freeman, MD
Family Medicine
John Halfen, MD
Family Medicine
Gerald Henrickson, MD
Family Medicine
Sarah Israelson, MD
Family Medicine
William Mennis, MD
Family Medicine
Jordan Moe, MD
Family Medicine
Chad Norris, MD
Family Medicine
Katie Norris, MD
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