By Richard Scott
December 30, 2011

• Decreased hospitalizations. From 2008 to 2010, practices that implemented the medical home model saw a decrease in total hospitalizations between 16-18 percent. Practices that did not implement the model saw no decrease.
   
• Improved clinical outcomes. Looking at the diabetes population, primary care practices using the medical home model witnessed a jump in several quality indicators, including a 20 percent rise in patients showing blood glucose levels below 8 percent and a 14 percent rise in patients who have undergone blood glucose testing.
   
• Enhanced access. By implementing patient-centered strategies, practices saw improved access to care, with one practice reducing their average wait times from 17 to three days, and another reducing missed appointments by 20 percent.
   
• Reduced cost differential. Traditionally, a small portion of patients make up a large percentage of costs and this was no different for CareOregon. Prior to its medical home initiative, 12 percent of enrollees accounted for approximately two-thirds of cost utilization. After implementation, the average cost of a high-risk member who is treated in a medical home practice is now equal to the cost of a “regular risk” member in a clinic not using a medical home.
   
• Boosted patient satisfaction. As of November 2011, nearly two-thirds of patients (61 percent) would rate their patient care experience as a “9” or “10” on a scale of one to 10.

1. Team-based, customer-driven care. All providers created team-based care units consisting of four individuals – a clinician (primarily a doctor, but occasionally a nurse practitioners or physician assistant), medical assistant, care manager, and a behaviorist. Each team provides care for a specified panel of patients, and daily meetings between all team members ensure that appointments are kept and any looming care gaps are addressed.
    
2. Barrier-free access. According to the research, “Participating clinics agree to offer same-day appointments and telephone contact with patients, thus reducing the incentive to use more expensive sites such as the ED for primary care.” Strategies to optimize access varied by site, though most have adopted an “open-access” model, which limits advance scheduling, reduces unnecessary visits, decreases the size of the patient population, or another strategy aimed at streamlining care.
    
3. Continuous, collaborative improvement. Taking a page from the Institute for Healthcare Improvement’s book of quality, practices subscribed to the concept of “max-packing” every patient visit. “The goal,” says researchers, “is to use every encounter as an opportunity to bring the patient up to date on his or her preventive services and screening needs and to review and reconcile all medications being taken to boost compliance with an appropriate regimen.” This may involve the medical assistant pre-screening a patient’s medical records prior to a visit to identify needed services, for example, or hands-on medication reconciliation during the visit itself.
    
4. Integrated behavioral health. Key to bridging any gaps in care is the integration of behavioral health services, which the majority of these practices offered through an onsite clinician. Smaller practices, on the other hand, often collaborated with an offsite provider. The behaviorist is part of the “core team,” addressing problems related to anxiety, depression, tobacco use, chronic pain and other behavioral health issues.

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