The medical home model needn't be limited to primary care but can include specialty-focused medicine. For example, the concept already has been applied to oncology and succeeded in cutting costs, reducing hospitalizations and providing greater accountability for care delivery. In North Carolina, with a higher than average rate of infant deaths and premature births, 800 of the state's 1,000 obstetricians already have signed up to participate in a pregnancy medical home for Medicaid patients.
According to the Seattle Times, it took 18 months to get all participants, including the federal government, to agree on the pregnancy medical home experiment. But according to project director Kate Berrien, details fell into place quickly once the doctors overcame their initial resistance to change. "No one wants to have sick babies," Berrien told the newspaper, "and sick babies cost a ton of money."
In the first nine months of the program, about 60 percent of all pregnant women in the Medicaid program were screened. Of those, 70 percent were deemed to have high-risk pregnancies. Although final results for the first year of the program won't be available until next month, North Carolina expects to save nearly $1 million in the first year and $9 million by the second year.
As incentive to participate, the Medicaid program pays doctors an additional $200 per patient in the pregnancy medical home. The practice receives the first $50 once the patient completes the risk questionnaire. Medicaid pays the rest after the woman has had her first postpartum visit, in which doctors must screen for depression, discuss plans for future pregnancies and direct the woman to further medical care when necessary.
In turn, participants must agree not to perform elective deliveries prior to 39 weeks of gestation, aim for a cesarean delivery rate of no more than 20 percent and provide the drug 17 alpha hydroxyprogesterone caproate to all women at risk of preterm delivery.
To become a medical home of any type, most practice organizations must undergo "wrenching cultural and system changes," according to a paper from the Commonwealth Fund aimed at helping aspiring medical home practices improve quality, engage leadership and more.