‘Medical home’ seen as way to improve care, cut costs

When Dr. Paul Grundy’s cat was due for an immunization, he got a notice. And that, Grundy said, illustrates a key flaw in the nation’s health care system: His pet’s care was better coordinated than his family’s.

“My cat had a registry. My wife didn’t,” Grundy, director of health care, technology and strategic initiatives for IBM, told an audience of doctors and insurers Tuesday. “Nobody is paid to actually manage the population that they’re responsible for.”

Grundy is working to change that, promoting the concept of the patient-centered medical home as a way to transform the way medical care is delivered, improve health and save money.

The patient-centered medical home has become a favored topic in health policy circles. Insurers and large employers are experimenting with–and in some cases, embracing–the model. The federal government is offering funds for demonstration projects on the concept, and Connecticut has applied to conduct one, proposing a medical home pilot for close to 77,000 state employees and Medicaid and Medicare recipients.

But it’s not always clear to consumers, and even those in the medical field, just what a patient-centered medical home is.

Grundy, president of the Patient-Centered Primary Care Collaborative, offered some answers Tuesday as part of a conference sponsored by St. Francis HealthCare Partners.

The conference marked the launch of the Connecticut Institute for Primary Care Innovation, a partnership between UConn and St. Francis Hospital and Medical Center meant to serve the primary care providers who will be critical to the major changes policymakers envision.

The institute is aimed at educating medical students and residents, researching the best ways to deliver primary care and helping practicing primary care doctors stay up to date with concepts that emerged or evolved since they were trained, such as the patient-centered medical home.

In a patient-centered medical home, Grundy’s family – not just the cat – would hear from the doctor’s office when they are due for tests. More broadly, the model would move the health care system away from paying by the procedure and toward rewarding health care providers for coordinating patients’ care, improving quality and reducing hospitalizations.

The idea is to ensure that patients get the care they need, when they need it.

Doctors in medical homes work in teams that take responsibility for patients’ health; rather than waiting for a diabetic patient to schedule an appointment, for example, the medical team would keep track of patients’ blood sugar levels and call in patients whose levels fall outside the target range. The same team would be involved in coordinating the patient’s visits to specialists, aware of admissions to hospitals or nursing homes, and central in managing the patient’s health when he or she goes home.

And the team would be more available to patients than typical practices, with expanded hours and ways for patients to communicate with their doctors outside office visits.

All that will keep patients healthier, reducing the need for complex treatment and hospitalization, and saving money, Grundy said.

“It isn’t rocket science,” he told the conference audience. “There’s a trusting relationship that exists between patients and the doctors and they’re doing stuff like making sure that the medication is managed. They’re doing stuff like making sure that the aspirin is taken, that the cholesterol is managed, that the blood pressure is managed.”

The concept has been around for decades, but has gained new attention in recent years. Medical groups including the American College of Physicians and the American Academy of Family Physicians developed principles for patient-centered medical homes in 2007.

Several insurers have launched medical home pilots. The Tricare health plan that serves the U.S. military uses medical homes, as does the Veterans Health Administration.

Earlier this week, two South Carolina BlueCross health plans announced that they would expand the patient-centered medical home model across the state after a yearlong pilot project for people with diabetes produced better health outcomes at a lower cost – including 10.7 percent fewer hospital admissions and 32.2 percent fewer emergency room visits compared to a control group.

In Connecticut, officials have applied to the federal Centers for Medicare & Medicaid Services to conduct a three-year medical home demonstration project for state employees and Medicaid and Medicare recipients whose doctors are part of ProHealth Physicians, the state’s largest primary care practice.

Doctors would receive additional payments to coordinate care and work on meeting goals such as reducing hospital readmissions and emergency room use. To get there, ProHealth would take on a variety of coordination functions that doctors’ offices do not typically do.

To avoid problems that occur when patients leave hospitals or long-term care facilities – a major source of errors, unnecessary costs and hospital readmissions – ProHealth would work out a way to be notified when its patients are hospitalized. The practice would then assign a care coordinator to develop a plan for the patient’s discharge with the hospital, schedule a follow-up primary care visit and check on the patient soon after discharge.

ProHealth has 74 sites, but would centralize the coordination of patient care and have nurse care coordinators who focus on patients with multiple chronic conditions, working with them and as liaisons with other doctors and hospitals. The practice would also establish facilities that would be open for extended hours and could increase capacity for patients during regular business hours.

Ultimately, the model could expand to other medical practices and insurers.

Thomas Woodruff, director of health care policy and benefit services for the state comptroller’s office, said the state could find out if it was selected within the month.

Some critics have noted that the aims of medical homes sound similar to the goals of managed care 20 years ago. Even supporters of medical homes say the aims sound similar, but say there are key differences.

Grundy said one is that medical homes will rely heavily on data, using information about patients from electronic health records and systems that can track important health indicators and outcomes. That didn’t exist 20 years ago, he said.