New model aims for old-fashioned care
Joe McDonald, 70, of Fairfax, Va., really likes his primary-care doctor. And it’s no wonder.
The retired finance manager can get same-day appointments at the Fairfax Family Practice, e-mail his physician or drop by the practice’s walk-in clinic, even on weekends. On a secure website, McDonald renews prescriptions and reviews test results. Everything is “right at my fingertips,” he said.
McDonald’s doctor alerts him when he’s due for a colonoscopy or other screening. While the physicians in the practice refer the tough cases to specialists, they help patients manage chronic conditions, from diabetes to heart disease. And they perform some procedures right in the office, such as the removal of moles and the casting of broken bones.
Most important to McDonald: His physician has taken the time to get to know his patient. “I get that one-on-one personal relationship with him,” he said.
Fairfax Family Practice is one of 12 offices of Fairfax Family Practice Centers, which includes 120 providers, among them nutritionists and physical therapists.
FFPC is at the forefront of a growing trend called “patient-centered medical homes.” Studies indicate that this approach to primary care saves money, reduces unnecessary services and improves health.
Coordinated care
Medical homes are a modern-day version of the old-fashioned family doctor, who performed a wide range of medical services, and offered emotional, as well as clinical, support.
This updated model of primary-care delivery organizes all facets of a patient’s care. Doctors, nurses, care managers and medical assistants typically work as a team to oversee a patient’s care.
Medical homes coordinate all referrals to specialists, and then track those visits. They help patients manage medications prescribed by all doctors.
Medical homes also coordinate care among facilities, following the patient from hospital to rehabilitation facility to home. They use electronic medical record systems to track their own performance and their patients’ health and outcomes, and to provide patients with online access to their physicians and personal medical records.
To call itself a medical home, a practice must get certification from the National Committee for Quality Assurance (NCQA), a nonprofit healthcare accreditation organization. There are 6,800 certified medical homes throughout the country, up from 28 in 2008.
“Medical homes are the fastest-growing delivery system innovation,” said Andy Reynolds, an assistant vice-president at the NCQA.
A big reason for the surge: After noting evidence that the patient-centered approach pays off, insurers and health plans are willing to pay primary-care doctors in these practices a bit more. Today, it’s common for insurers to pay primary-care practices $50 or more per patient each year to give more personalized care.
Among the positive research, a study of a medical home pilot at some of the 26 medical centers of Seattle-based Group Health Cooperative — which combines hospitals, medical practices and health plans — found that the quality of care was higher and patients were more satisfied than at the cooperative’s other centers.
The study evaluated chronic illness care, medication monitoring and other quality measures. And for every $1 invested, Group Health saved $1.50 by reducing emergency-room and hospital use. The results persuaded the cooperative to expand the medical home model to all of its medical centers.
[Ed’s note: However, a recent study, which tracked 32 medical home practices in Pennsylvania and compared them to 29 regular practices over three years, found quality improvement in only one of 11 areas, and no statistically significant reductions in hospitalizations, ER use or costs from the medical home model. The study was reported in the Journal of the American Medical Association.]
A boost from government
The federal Affordable Care Act has “provided a lot of oomph” to medical homes, said Marci Nielsen, chief executive officer of the Patient-Centered Primary Care Collaborative, an association of healthcare providers.
The law is spurring changes to how healthcare is paid for — away from fee-for-service payments that encourage more services, and toward models that promote cost efficiencies while improving medical outcomes.
The new law is financing demonstration programs that pay providers a single payment for “bundles” of services during an episode of care.
Pilots also are testing extra payments to providers who can prove better outcomes on selected measures. And they’re evaluating team-based approaches, such as medical homes, by paying doctors more to cover patient education and care coordination.
Medicare is testing the value of medical homes. In one program, Medicare is paying 1,200 medical practices in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont to provide healthcare in a medical home to more than 900,000 beneficiaries.
In another, Medicare is paying 500 medical practices in Arkansas, Colorado, Kentucky, New Jersey, New York, Ohio, Oklahoma and Oregon an average of $240 a year per patient.
In Vermont, medical homes have been taken to a new level, thanks to a state-organized effort called Blueprint for Health. Medicare, Medicaid and private health insurers are making per-patient payments each month to support medical homes. As a result, all Vermonters have access to a medical home, which includes roaming “community health teams.”
Vermont’s community health teams are made up of nurses, health coaches, nutritionists, social workers and mental health professionals. Doctors can refer a patient to a team, which visits patients at home if, for example, the patient is newly diagnosed with depression or diabetes.
The team can arrange for a patient’s transportation to a doctor’s appointment or pay for new prescriptions for patients who can’t afford them.
To find a medical home near you, make sure the practice is recognized by the NCQA. Go to http://recognition.ncqa.org to search medical homes by type and state. There are hundreds throughout the Greater Washington area.
If you live in a state where Medicare is piloting medical homes, you can ask your primary-care doctor if he or she participates in the Comprehensive Primary Care Initiative or the Multi-Payer Advanced Primary Care Practice demonstration.
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