How to Make a Medical Home Deliver
Subsequent programs include integrating pharmacists into the clinics for direct consults with physicians and patients, and case managers come to the clinics regularly to help coordinate inpatient and outpatient care. Affinity even has developed a house-call program that not only provides care at home, but serves the additional purpose of assessing the patient's home situation and environment. That's probably where the change in routine is most obvious to the patient, says Loch, but how does he know patients are improving in outcomes and satisfaction?
"We put the care back closer to the patient and the primary care provider," he says. "Everything else has metrics."
And the metrics are impressive, especially in financial terms. Affinity's decision to adopt the medical home was perhaps easier to make than for other providers because its own health plan was involved. Any savings would be guaranteed to return to the overall organization.
"For two pilots the health plan invested $300,000 and got a return in excess of a million. That's proof of concept," says Loch. "Not every practice is like that, but those trends are in place and show medical costs are down and quality and patient satisfaction are up."
But even more impressive have been the cost results. Affinity broke out its outpatient costs into primary care, specialist care, and overall outpatient costs, and while the non–medical home practices' overall costs rose 9.7% over two 12-month periods in 2009–2010, those with medical homes rose only 0.62% during the pilot period. In its component parts, specialist care costs dropped 11.97% among medical home patients while rising 8.51% among non–medical home patients. When including both inpatient and outpatient cost information, the results were even more dramatic. Inpatient costs for patients in the medical home practices dropped 43.66% over the same time period while they fell only 6.38% among non–medical home patients. Overall, costs dropped by 14.22% among medical home patients while they rose 6.6% for non–medical home patients.
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