A pilot program that used a patient-centered medical home model has improved primary care and cut costs after two years, according to Group Health Cooperative, the not-for-profit Seattle-based health system.
After its finding, Group Health expanded its medical home model to all 26 of its medical centers. A comparison of the medical home prototype to Group Health’s other medical centers showed that:
The quality of care was higher, patients reported having better experiences, and clinicians said they felt less burned out.
Patients had 29 percent fewer emergency visits and 6 percent fewer hospitalizations, resulting in a net savings of $10 per patient per month.
For every dollar Group Health invested, mostly to boost staffing, it recouped $1.50.
“A medical home is like an old-fashioned family doctor who really knows you as a person,” says Robert J. Reid, MD, PhD, an associate investigator at Group Health Research Institute and Group Health’s associate medical director for preventive care. “The fresh twist is that the doctor leads a team of professionals.”
A big change associated with Group Health’s medical home model was lowering the number of patients each salaried primary care doctor could see — down to 1,800 from 2,300.
Reid says that left more time for planning, outreach, coordination, staying in touch with patients by e-mail or phone, and longer office visits — 30 minutes instead of 20 minutes.
“Nationally, the patient-centered home is emerging as a key way to improve health care and control costs,” says Reid.
Most physicians in the United States are paid per office visit. Group Health pays primary care doctors a salary to care for a group of patients.
For policymakers, Reid recommends reforming health care financing so that primary care physicians realize the savings associated with avoiding hospitalization and emergency room use.
He suggests training more primary care physicians, physician assistants, nurses, nurse practitioners, and other health care providers to work in coordinated teams and take advantage of most health information technology.
In addition, he suggests paying physicians not only for office visits but also for outreach, coordination, planning, and team-based care.