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Primary Care Finds a (Medical) Home

Joe Cantlupe, for HealthLeaders Media, June 13, 2013
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This article appears in the June issue of HealthLeaders magazine.

As the nation pushes toward value-based care, there is an explosive demand to launch medical home models among physicians, hospitals, and insurers. From the patient care side, the emphasis is on refining treatment—especially for complex conditions—and on the practice management side, the impetus is to offset costs through accountable care organizations and other mechanisms.

The idea of the patient-centered medical home is a model for strengthening primary care through reorganization of existing practices to provide patient-centered, comprehensive, coordinated, and accessible care. The effort is not only to improve access to care, but also to focus on patients with complex health conditions who need more intensive medical services that are then coordinated among a variety of clinicians.

Healthcare leaders are involved in creating PCMHs in a myriad of ways. Some insurers are partnering with hospitals and physician groups. Some physician groups are developing medical homes on their own. Others are developing ACO structures with incentives for healthcare providers to work together to treat individual patients across care settings, including doctors' offices, hospitals, and long-term care facilities.

Some states are prepping to get these plans in motion within the next few years. It's likely to be a complicated and eventful journey with many potential pitfalls along the way: transitioning to electronic medical records, facing physician shortages, getting a viable patient base, coordinating care, evaluating the need for specialists to care for patients with chronic conditions.

The medical home concept has been around for decades and has gained momentum in recent years as hospitals and healthcare systems focus on value-based quality care, with the primary care practices serving as a significant focal point.

The National Committee for Quality Assurance has recognized nearly 5,000 PCMHs nationwide for coordinating patient care and meeting specific quality standards, and that number is expected to increase significantly. In light of growing concern about primary care physician shortages, many medical homes are offering incentive bonuses for physicians to become involved in their programs.

"What we're seeing now is really a transformative approach," Jonathan Harvey, MD, chief medical officer of Martin's Point HealthCare in Portland, Maine, says of the medical home's role in the transition from fee-for-service to value-based care. Martin's Point includes a health plan and more than 75 primary care providers at nine health centers. "We're seeing a coming together of our ability to manage populations in a delivery system that has enabled primary care to look at communities in a different way," Harvey says. "It's such an exciting time in so many ways."

Like other medical homes, Martin's Point's primary care delivery system provides overall care that includes multidisciplinary teams with care managers and nurses, often focusing on chronic conditions, such as diabetes, coronary artery disease, congestive heart failure, and asthma.

By using electronic medical records and monitoring results, the Martin's Point medical home is improving outcomes and reducing costs. Martin's Point and other healthcare providers are working to engage patients more in their own care, reminding them to take medications, keep their appointments with physicians, and enroll, if necessary, in weight-, exercise-, and stress-management programs.

Martin's Point's patient-centered medical home program has had a noticeable impact, with a 6.2% reduction in hospital readmission rates, with monthly admissions per 1,000 members reduced from 161 in 2011 to 151 in 2012.

There also was a 9.7% decrease in emergency department visits (the rate of ED visits per 1,000 members, 308 in 2011 and 278 in 2012) for patients who were included in the PCMH and Martin's Point insurance program. Those figures compared rates from April and November 2011 to April and November 2012, according to David Stearns, director of informatics at Martin's Point.

Philadelphia-based Independence Blue Cross, which serves 7 million people in 19 states, has established medical homes by collaborating with at least 150 physician practices and other insurers. The program was initiated by the state's Chronic Care Commission in 2007 as a pilot project "intended to change the way care was delivered so we could better manage the chronically ill," says Richard Snyder, MD, chief medical officer for Independence Blue Cross. Over time, it accomplished its mission, he adds.

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