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Why health insurance companies are pushing for "medical homes"


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Besides revamping health insurance laws, health care reform is also trying to encourage medical centers that promote preventive care. Under a new health care reform model called the “patient-centered medical home,” your primary care doctor's office is encouraged to serve as an efficient medical-coordination hub, using technology, a team approach and evidence-based medicine to help you stay healthy.

patient-centered medical homesIt works something like this. When you visit your doctor's office, you could join other patients for a presentation on health education, or attend a support group to help you manage a chronic condition. Overdue for a lab test or forgot to pick up your prescription? A new electronic health records system can detect the oversight and alert a staff member to call you. When you're referred for specialty care, your doctor sends your health records electronically, giving the specialist instant access to your medical history. Then your primary care doctor follows your progress and coordinates further care if necessary. Same-day appointments and quick telephone or e-mail response from the office are part of the deal, too.

Led by the American Academy of Family Physicians, four major primary-care physician organizations endorsed this model three years ago, and now a growing number of health insurance companies are touting the benefits of patient-centered medical homes.

"We're moving out of the experimentation and pilot-project phase and looking at where we can have the greatest impact in markets to implement this on a wider scale," says Christopher Corbin, director of physician strategies at Humana.

Humana has been launching pilots with medical groups since late 2007 in central and south Florida and Atlanta, and is working with other insurers on pilot projects in Cincinnati and Denver.

So far the pilots have resulted in lower emergency room, inpatient and radiology expenses; shorter hospital stays; increased primary care visits; and improvements in key clinical measures. After a 15-month medical-home pilot in Atlanta by the WellStar Health System, patient and physician satisfaction improved across the board, Corbin says.

More than two dozen other pilots are underway in 20 states, according to the Patient Centered Primary Care Collaborative, and many report encouraging results.

Health insurance plans see cost-savings in medical homes

Preliminary analysis of 2009 insurance claims data by Blue Cross Blue Shield of Michigan shows medical-home practices in its pilot project have lower per-member costs for adult radiology, emergency room visits and adult inpatient admissions compared to non-medical home practices.

The model also has potential to attract more doctors to primary care, which now suffers an alarming shortage. This is partially due to the wide disparity in earning potential between primary-care doctors and specialists. Health insurance plans typically reimburse doctors for medical procedures rather than  coordinating care and outreach to patients. Thus, the medical home model is structured to compensate physicians for taking a proactive approach -- which is what doctors want to do anyway, Corbin explains.

Embracing a new health care vision

So if the medical home model has proven successful, why hasn’t it been adopted nationwide?

For one thing, it's a giant departure from the way this country has approached health care in the last several decades, says Dr. Roland Goertz, a family physician in Waco, Texas, and president-elect of the American Academy of Family Physicians. Until recently, “efficiency” wasn't a crucial part of the equation in health care, and the focus has been more on treating sickness rather than promoting wellness, he says.

"Change takes time," he adds. That's especially true for something as massive as this country’s health care system.

"Only now are you seeing rather rapid adoption," he says.

The National Committee for Quality Assurance sets nine standards for what constitutes a patient-centered medical home. Meeting the standards requires substantial work and investment by a medical practice, not the least of which is using an electronic medical records system.

Humana announced in August it would subsidize Athenahealth’s cost of implementing an electronic health record system in 100 practices, which represent about 1,000 physicians.

Questions about medical homes

No one has officially opposed the medical home idea, but some doctors outside of primary care have raised practical concerns.

"The medical home must be truly patient-centered and can't function as a gatekeeper," says Dr. Bret Nicks of the American College of Emergency Physicians. His organization agrees with the basic tenets of the medical home idea, as long as the system doesn't shift financial resources away from emergency services, which already are vastly underfunded, Nicks says.

"The emergency department will always be the medical home away from home," predicts Nicks.

More from Barbara Marquand here

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