DESIGN OF THE MEDICAL HOME
The Medical Home pilot at Group Health Cooperative’s Factorial Medical Center advanced the organization’s primary care model by improving access, enhancing continuity, proactively coordinating care, and engaging patients in their health in the following ways:
- Reducing panel size (patient load) from 2,300 to 1,800 patients.
- Lengthening appointment times from 20 minutes to 30 minutes.
- Expanding staffing in multidisciplinary clinical teams consisting of physicians, physician assistants, nurses, medical assistants, and clinical pharmacists.
- Improving proactive staff-to-patient contact, including clinical team analysis days before each appointment, pre-visit patient communication as appropriate, and detailed follow up after the visit.
- Maximizing use of e-health technology and communication, including electronic medical records and increased contact with patients through secure e-mail and telephone.
After NEARLY two years
Group Health Research Institute compared 7,018 continuously enrolled patients in the Medical Home pilot to a control group. Preliminary analyses of data after nearly two years shows:
- Continued high performance on key measures such as patient experience and management of chronic disease, as well as success lowering costs of care.
- Compared to controls, patients in the Medical Home had significantly lower costs for all-cause hospitalization and significantly shorter lengths of stay. Lower hospitalization costs are important because they typically account for 25 percent of the total cost of patient care.
- Total patient-care costs were lower per patient per month in the Medical Home compared to patients in the control group.
- More specific information about the two-year evaluation will be publicly available after it is peer-reviewed.
Earlier POSITIVE FINDINGS PERSIST
Positive results after one year-reported in the September 2009 American Journal of Managed Care[1]-persist. According to this report, patients in the Medical Home, when compared to controls after one year:
- Had 29 percent fewer emergency room visits, 11 percent fewer hospitalizations that primary care can prevent, and 6 percent fewer but longer in-person visits.
- Reported higher ratings on six scales of patient experience.
- Used 94 percent more e-mail, 12 percent more phone, and more group visits and self-management support workshops.
- Received better care, including needed screening tests, management of their chronic illnesses, and monitoring of their medications.
- Indicators of chronic care management showed improvement on top of Group Health’s already high levels:
- Better control of cholesterol levels in patients with coronary artery disease and diabetes.
- Better control of blood pressure for hypertensive patients.
Group Health leadership is confident that advancing the Medical Home model allows:
- Higher quality care
- More easily predicable costs
- Improved patient and staff satisfaction
Group Health Cooperative leaders believe that this evaluation reflects a strong business case for expanding the Medical Home model to all 26 of its primary care medical centers.
[1] One-year data appear in Reid RJ, Fishman P, Yu O, Ross TR, Tufano JT, Soman MP, Larson EB. Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation Am J Manag Care 2009. 15(9):71-87. Epub 2009 Sept.1. Available online at:
http://www.ajmc.com/articles/managed-care/AJMC_09sep_ReidWEbX_e71toe87
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