Large Physician Groups Score Low On Key Measures Of “Medical Home” Approach To Care

Bethesda, MD -- Nearly everybody agrees that the U.S. health care delivery system is broken -- but there’s no clear consensus on how to fix it. One leading alternative is the “patient-centered medical home,” designed to put primary care doctors in charge of coordinating care. But despite the growing promise that this health care model offers, even many large physician practices lack the essential elements to create a medical home for patients to receive care, according to a new study published today in the journal Health Affairs When researchers examined large medical groups with at least 20 physicians, they found that these physician practices are lagging on key measures of what it takes to create a “medical home,” a model of health care delivery that emphasizes comprehensive primary care to ensure the best outcomes for patients. The medical home model is now widely recognized by health care providers, large employers such as IBM, and increasingly patients as a promising blueprint for delivering comprehensive care over a patient’s lifespan.

The study, by researchers at the University of California at San Francisco (UCSF), UC Berkeley, and the University of Chicago, appears in the September/October issue of Health Affairs ( http://content.healthaffairs.org/cgi/content/abstract/27/5/1246 ). The issue, funded by the California HealthCare Foundation, focuses on competing models of innovation in health care delivery. http://content.healthaffairs.org/current.shtml .

A separate Health Affairs analysis reveals that a pilot test of the PCMH model at two sites in the Danville, Pa.-based Geisinger Health System resulted in a 20% reduction in hospital admissions and a 7% total reduction in medical costs. Under the pilot project, Geisinger provided monthly incentive payments of $1,800 to participating physicians and $5,000 monthly stipends for every 1,000 Medicare patients served to help practices finance additional staff and extended hours. Geisinger’s model included around-the-clock access to primary and specialty care, physician and patient access to EMRs, and the use of nurse care coordinators and a “personal care navigator” to answer patient questions. Reflecting on the success of the program—which Geisinger plans to expand to include 10 other clinical sites—the health system’s president commented that the results are “probably one of the most dramatic things I’ve seen in 30 years of practice and leadership” and “point to the potential for innovative and integrated delivery systems to improve health care quality” Paulus et al., Health Affairs , September/October 2008 [subscription required];

See the Health Affairs Press Release for the series here ( http://www.healthaffairs.org/press/septoct0801.htm ). See related stories in HealthDay , 9/10. (SOURCE: Advisory Board Daily Briefing , www.advisory.com, September 11, 2008)