Going Home...

More Businesses Promote 'Medical Homes'

Feature 2: Going Home
Scott Hammond, M.D., reviews a patient's record. He is among scores of Colorado physicians who participate in medical home projects to manage overall health care for patients.
By Sandy Graham
Photograph by James Chance

When Paul Grundy, M.D., M.P.H., and his colleagues at IBM looked at the quality and cost of the health care that Big Blue was buying for its workers, they knew they had to find another way.

"We wanted to move from episodic care to integrated, coordinated and accessible health care," says Grundy, who is IBM's global director of health care transformation. "It was like going to the bank and paying by the amount of time we spent with the teller, when what we really wanted was comprehensive banking services."

So in 2006, IBM helped create the Patient-Centered Primary Care Collaborative, a national organization that in a single year grew to 400 participants, including major employers and business groups, professional health organizations, consumer groups and health insurers. Its objective: to promote the medical home concept to deliver comprehensive primary care. The collaborative does this through sharing information and launching pilot projects such as Colorado's Multi-Payer, Multi-State Patient-Centered Medical Home Pilot. (See At 'Home' in Colorado below.)

A medical home is a concept, not a place. It is an approach to providing continuous, comprehensive, coordinated physical, mental and dental care through a partnership between patients and their personal health care teams. A medical home takes primary responsibility for coordinating the vast majority of a patient's care across the health care continuum. Some proponents have begun referring to it as a health home.

Think of a medical home as a general contractor for your total well-being.

"This is clearly the preferred delivery system for health care," says Edwina Rogers, executive director of the collaborative, which now has 55 organizations on its executive committee and 700 general members.

Employers who invest in a medical-home-based system "have employees who are happy, healthy and at work – and not in the emergency room," Rogers says. The medical home concept is endorsed in the federal health care reform bill, too, she notes.

Underlying the medical home is a realigned payment system.

Typically, health professionals are paid for "things" such as office visits, blood tests, X-rays and MRIs. In a medical home practice, health professionals are given incentives for results such as managing care and focusing on wellness and prevention to stave off expensive complications or hospital stays.

"You know, my cat gets a notice when it's due for immunizations," says Grundy, who also chairs the collaborative. "My wife doesn't. The medical home allows patients to have the kind of relationship where they are at least as empowered as my cat."

Patient-centered medical home pilot projects have been under way long enough to provide some encouraging data, Grundy and Rogers note. In Colorado, a pilot that assigned children in the Child Health Plan Plus and Medicaid programs to medical homes had average median health costs of $785 per child compared with $1,000 per child outside the medical home pilot. And even greater savings are seen in children with chronic conditions (such as asthma or diabetes) in medical homes, whose annual median costs declined to $2,275 versus $3,404.

A Washington state pilot saw a 20 percent drop in emergency room visits. A North Carolina project experienced a 40 percent drop in hospitalizations for asthma and a 16 percent drop in emergency room visits. A Pennsylvania health care system reported $3.7 million in net savings in its pilot.

The Dow Chemical Company, another early supporter of the collaborative and medical homes, participates in a multi-stakeholder collaborative that is advancing the medical home as one of its initiatives in the community around its Michigan headquarters. While it doesn't have hard data yet on the project, Dow hears anecdotally from employees that the medical home is "appealing," says Catherine Baase, M.D., Dow global director of health services and a member of the Patient-Centered Primary Care Collaborative board of directors.

Medical homes fit well with the chemical giant's health care strategy. Since 2004, it has emphasized prevention, quality, effective care, health management and advocacy for its 52,000 employees worldwide. That has helped keep its increase in total health care costs to 9 percent during the past four years – that's total, not per year, Baase adds. Dow self-insures, providing services primarily through a national health plan, and also offers an array of health-promoting programs and services.

"As part of our continual pursuit of better health for our people and improved value for the dollar spent, we look for the best approaches," Baase says. "The concepts incorporated into the patient-centered medical home are very appealing, and the early studies show much promise that the medical home is a superior model."

Dow has no Colorado employees, but IBM employs thousands in the state. None of them is required to choose a medical home practice, "but we find they're migrating to those practices," Grundy says. Those choosing medical home practices also are telling colleagues about their good experiences, leading more IBM employees to consider signing up.

Grundy says a company does not have to be big to benefit from the medical home movement. He says the collaborative has plenty of information that will help small- or medium-size employers learn how they can be involved.

While IBM sells technology, including the kind used in health information systems that enable the patient data-gathering needed for medical home practices, that's not why it started the medical home journey, Grundy adds.

"Medical homes provide the kind of care we want to buy," Grundy says. "It's the kind of care you'd want for your mother. It's the kind of care you'd want for yourself."


At 'Home' in Colorado

Colorado's Multi-Payer, Multi-State Patient-Centered Medical Home Pilot is a national model, says Edwina Rogers, executive director of the Patient-Centered Primary Care Collaborative.

"It is having great success," says Rogers, "and it is often called on for advice and guidance for startup medical home pilot projects."

The Colorado pilot, begun in 2009, will run another year in 16 Front Range primary care practices with 51 physicians as well as practices in Cincinnati, the project's partner region. All practices must meet certain standards as medical homes to receive enhanced payment for managing care and meeting or exceeding quality goals. While the practices can receive those payments for up to 30,000 patients covered by participating health plans, the benefits of the medical home concept will extend to all 100,000 patients in those 16 practices. Major employers in the pilot include Centura, IBM, McKesson Corp. and the Colorado government.

Businesses like the concept because "they get value for their employees. And those employees are present and productive because they receive care from a delivery system that is constantly looking at them as whole people," says Julie Schilz, M.B.A., manager of the Colorado pilot at HealthTeamWorks.

Funded by The Colorado Trust and The Commonwealth Fund, the pilot will have an independent, third-party evaluation of its outcomes, Schilz says.

It's not the only medical home effort in the state. Others are the Colorado Medical Home Initiative in the Colorado Department of Public Health and Environment, the Safety Net Medical Home Initiative for clinics serving under- and uninsured people, the Systems of Care Grant and the Family Medicine Residency Patient-Centered Medical Home Project. The latter two receive funding from the Colorado Health Foundation.

"Is the medical home the only answer to fixing America's health care system?" Schilz asks. "No. This is one component of a systems approach to reform. All of the pieces and parts have to work together."