Meet the concept of the medical home. It is a managed-care delivery model that charges physicians with coordinating overall care for patients with chronic illnesses. Since its’ inception just a few years ago, it has spread nationwide. Medical home demonstration projects now operate in 22 states. Two states, Rhode Island and North Dakota, have implemented statewide programs.
By design, the medical home is a patient-centered, integrated care model. An important goal is to create a strong, long-term relationship between the physician and the patient. It does this by replacing episodic care based on illness with proactive, coordinated care provided by a physician-led team.
In 2008, the National Committee for Quality Assurance (NCQA) introduced standards to determine if a medical practice operates as a Patient-Centered Medical Home (PCMH). These standards meet the definition of a medical home as defined by a consortium that includes the American Academy of Pediatrics, American College of Physicians, American Academy of Family Physicians and American Osteopathic Association.
PCMH standards reflect existing standards for NCQA’s Physician Practice ConnectionsÒ program, but raise the bar (See PCHM Standards). Practices must meet five of nine standards to qualify as a medical home. Elements of the medical home practice include:
- coordination and scheduling of tests and specialty referrals
- tracking patient conditions
- physician access through open scheduling and expanded hours
- ongoing communications between patients, physicians and staff.
Probably the leading advocate for the PCMH is the Patient Centered Primary Care Collaborative. This 200-member group includes a full range of stakeholders. It contends this care model could improve the health of patients and reduce costs through shorter hospital stays and fewer readmissions and emergency department visits.
Medicare is jumping aboard the medical home movement. The Tax Relief and Health Care Act of 2006 mandated that Medicare establish a nationwide medical home demonstration project by 2010. In particular, this medical home demonstration project will target the nearly 60% of beneficiaries with two or more chronic illnesses. By achieving better coordination of care, Medicare expects this healthcare delivery model to improve quality and reduce costs.
Currently there is limited data documenting the benefits of PCMHs. Pennsylvania’s Geisinger Health System, however, attributes a 20% reduction in hospital admissions and 7% decrease in medical costs in 2007 to the medical home, according to a report in the September-October 2008 issue of the journal Health Affairs. North Dakota’s MediQHome Quality Project, a medical-home pilot focused on diabetes care, also demonstrated $102,000 in savings for care of 192 diabetes patients.
Optimistic about the benefits, insurers, including 32 Blues plans, offers those medical practices that qualify as PCMHs a care-management fee. This fee compensates them for the extra time professional staff spend coordinating patient care. Fees vary by plan and location. For example, North Dakota Blue Cross Blue Shield pays practices $50 per patient semiannually. Tennessee Blues offers primary care doctors $5 per month for each patient they recruit into the medical-home program, while medical specialists get $30 for email and telephone consultations.
The expansion of medical homes will accelerate development of a nationwide electronic health information network (EHIN), because PCHM standards require electronic communication and coordination of care. As physicians begin making referrals and ordering tests electronically, laboratories and other services that want their business will need to be connected to the EHIN to receive orders and respond with digital results.
Clinical laboratories will see changes in test ordering patterns as the medical home care model is used with large numbers of patients. To be proactive at early detection of disease, physicians will be ordering more screening tests. Similarly, the medical home concept will require physicians to be more consistent and timely about ordering the laboratory tests needed to monitor the progress of their patients’ and the effectiveness of treatments.