Patient-Centered medical homes may reduce health care costs and improve patient health

By: Michele A. Masucci & Brooke A. Santeramo, Law Clerk

The “medical home” model of patient care has been the subject of much attention in recent years, as many experts believe it has the potential to simultaneously reduce the cost of health care and improve the overall health and well-being of patients.

The foundation of the medical home model is the primary care physician, who is responsible for coordinating all aspects of an integrated treatment plan for patients with chronic conditions, from ordering laboratory tests to seeking consults from subspecialists. Proponents of the medical home model believe that centralization of care will substantially reduce the ordinary expenses incurred under the fragmented patient care system that currently exists in America. Under the existing American patient care model, patients typically visit several different physicians, hospitals, and specialists throughout their lives, often resulting in expensive and unnecessary duplicative tests, and even more seriously, in contraindicated medications and treatments. The theory behind the medical home model is that by providing a central base, or “home,” for the coordination of patient care, doctors can improve rapport and relationships with patients as well as prevent unnecessary visits to the emergency room or hospital.

In 2007, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association released the “Joint Principles of the Patient-Centered Medical Home,” which set forth the key characteristics of the medical home model. The following are examples of these principles which illustrate the commitment to quality centralized patient care:[1]

• Personal physician: each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous, and comprehensive care.
• Physician directed medical practice: the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
• Whole person orientation: the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end-of-life care.
• Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange, and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
• Enhanced access to care is available through systems such as open scheduling, expanded hours, and new options for communication between patients, their personal physician, and practice staff.

The Adirondack Region Medical Home Pilot, scheduled to commence in January of 2010, will be New York State’s first large scale medical home program. Participants in the program include physicians, physician assistants, nurse practitioners, hospitals, and commercial health plans. Participating primary care physicians will design integrated care plans for improving their patients’ health, with particular emphasis on preventative care. Participating physicians must use an electronic system for maintenance of records as well as prescriptions, must coordinate treatment plans with other physicians within the provider group, and must meet established standards of care with regard to specific indicators of patient health including blood sugar and blood pressure.

The Adirondack program, which will be the largest program of its kind in the country, will receive $4.5 million in assistance from New York State, through enhanced Medicaid reimbursements. Primary care physicians will receive approximately $7 per patient on a monthly basis to offset the cost of implementing the program. Supporters of the medical home concept hope that the Adirondack program will serve as a national model for centralized, patient-centered care.

In 2008, the National Committee for Quality Assurance established criteria for recognition of existing physician practices as medical homes. The “Physician Practice Connections—Patient-Centered Medical Home” recognition program sets forth several aspects of patient care, based upon the “Joint Principles of the Patient-Centered Medical Home,” which are necessary for establishing a medical home, including electronic prescribing and record keeping, referral tracking, and overall care management. Physician practices receive a score on a scale of 100 points for each element of the medical home model, and this score determines whether the practice will be recognized as a Level 1, 2, or 3 medical home. Research by the NCQA indicates that public and private health care plans appear willing to provide compensation to physician practices organized as medical homes in an effort to improve patient health and reduce avoidable costs.

Current health care reform legislation includes substantial funding for medical home pilot programs. All health care reform legislation, including the House Bill, “America’s Affordable Health Choices Act of 2009,” the Senate Finance Committee Bill, “America’s Healthy Future Act,” and the Senate Health, Education, Labor, and Pensions (HELP) Committee Bill, “Affordable Health Choices Act,” include provisions for implementing medical home model care systems.

Existing multispecialty group physician practices are well-poised to be players in the medical home revolution. For independent practitioners, the challenge will be one of how to achieve appropriate integration to be an effective medical home.