As Evidence Grows, the Medical Home Spreads Throughout the Healthcare System
By Emily Mullin
September 11, 2012
As implementation of the medical home model increases, better care and lower costs are being achieved. According to a new study by the Patient-Centered Primary Care Collaborative, medical home expansion has reached a tipping point with broad private and public sector support.
The study, released Sept. 6, shows evidence that the medical home model improves health outcomes, enhances the patient and provider experience of care, and reduces expensive, unnecessary hospital and emergency department utilization.
“The evidence is clear, convincing and compelling,” PCPCC executive director Marci Nielson said in reference to the report at a Sept. 6 briefing in Washington, D.C.
As the nation shifts its focus back to primary care and as state and federal initiatives encourage medical home creation, 90 commercial insurance plans, multiple employers, 42 state Medicaid programs, hundreds of safety net clinics, and thousands of small and large clinical practices nationwide are now participating in some kind of medical home program.
WellPoint is one private health insurer that has embraced the medical home model. With a network of 100,000 primary care doctors covering 43 million patients, the company announced in January that it would invest in the medical home across its entire network.
Aetna, Humana, UnitedHealthcare, Kaiser Permanente and numerous Blue Cross Blue Shield plans are also offering medical home participation to millions of consumers.
In addition to efforts in the private sector, federal health reform has made advancing primary care and the medical home model a top health priority. With its emphasis on creating Accountable Care Organizations, or ACOs, the Patient Protection and Affordable Care Act is helping to advance the growth of the medical home model, which serves as a foundation for ACOs.
The Department of Defense, Department of Veterans Affairs and the federal Office of Personal Management are also implementing versions of the medical home model – all with promising results.
As of May 2012, many states are making efforts to advance the medical home in their Medicaid and Children’s Health Insurance Program. The recently announced Comprehensive Primary Care Initiative, operated by the Center for Medicare & Medicaid Innovation, adds to the momentum of the medical home by fostering collaboration between public and private healthcare payers along with healthcare consumers.
“We believe the combined result of these public and private initiatives propel the PCMH to the tipping point for the care delivery system to embrace full implementation of the PCMH,” the PCPPC report says.
The PCPPC outlines numerous medical home programs across the country that have already seen positive outcomes. For example, from 2009 to 2011, the Air Force medical home program resulted in $300,000 in annual savings through improved diabetes care management at Hill Air Force base in Utah. The program also saw 14 percent fewer emergency department and urgent care visits and 77 percent of diabetic patients at Hill Air Force Base has improved glycemic control.
Another medical home at the Alaska Native Medical Center saw a 50 percent reduction in urgent care and ER utilization, 53 percent reduction in hospital admissions and 65 percent reduction in specialist utilization over a 10-year span.
Another medical home operated by Blue Cross Blue Shield of Idaho Health Service experienced a $1 million reduction in single year medical claims after implementation.
WellPoint predicts that it could reduce its projected medical costs in 2015 by up to 20 percent based on analysis of its current medical home programs. Meanwhile, UnitedHealthcare estimates that its new efforts will save twice as much as they cost.
Despite these promising figures, Nielson says that as the medical home is implemented on a wider scale, consumers need to be more educated on the benefits of the medical home.
“The public still has yet to fully understand this model and so public engagement needs to become a higher priority,” Nielson said at the briefing.
While patients may not be familiar with the term “medical home,” Nielson said they know when they’re receiving better coordinated and higher quality care.
The PCPCC report notes that further research is needed to better understand the most effective partnership strategies and to build commitment to these collaborative approaches. To access the report, click here