medical home

MedPAC urges medical home research

Anne Zieger — Wed, 17 Sep 2008 14:42:44 -0400

To date, the medical home model seems to have racked up some encouraging research support. But at least some policymakers are urging caution, suggesting that it's too soon to move ahead with any large-scale implementation of this approach.

The head of the Medicare Payment Advisory Commission hit the Hill this week to advocate research on the medical-home model of care to see if it can cut hospitalizations. This follows the release of a MedPAC report in June that suggested testing of the model, particularly testing focused on patients with multiple chronic conditions.

In the long run, medical homes could be applied to all patients, not just chronically-ill ones, but it would be better to begin testing the concept on the chronically-ill population, Mark Miller, executive director of MedPAC, told the Senate Finance Committee. To make sure the tests are reliable, they'll need to be done over a relatively brief testing period with a large enough group to provide statistically-valid results. Just as important, any tests should include clear, specific results thresholds which will allow policymakers to determine whether the approach should be applied in the Medicare program or not, he said.

To learn more about Miller's remarks:
- read this Modern Healthcare piece (reg. req.)

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Trend: Medical home funding sources grow

Anne Zieger — Mon, 21 Jul 2008 14:35:22 -0400

While the notion of a "medical home" has been bubbling up through the healthcare industry for some time, it's still something of a new idea for many consumers, who've never lived in an era when primary care physicians had the time for leisurely visits. However, with the passage of the new Medicare bill--which authorizes funding for a three-year medical home project--and a growing list of state and federal projects fostering this approach, consumers may yet find out.

One example of the coming changes can be found in Philadelphia's metro, where 100 physicians are getting extra payments from some of the region's largest insurers to work more closely with 8,400 patients. (Participating health plans include Independence Blue Cross, Aetna and Cigna.) That includes not only traditional visits, but also e-mail and telephone care. Insurers are running similar pilot programs in several states, in programs impacting nearly 2 million patients and thousands of doctors.

What's more, many other health plans expect to roll out similar programs in the future. For example, Blue Cross Blue Shield of Michigan, which has 4.7 million members, will spend $30 million this year to help PCPs offer medical home-style services. The program should impact about 4,900 primary care physicians.

Government health organizations are playing with this concept too. In one example, a Medicaid-based medical home project under way in North Carolina saved about $162 million in 2006, 11 percent less than the state would have previously spent. And, of course, there's the Medicare medical home program, which has $100 million in funding.

To learn more about this trend:
- read this article from The New York Times

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Trend: ED 'super users' generating big expenses

Anne Zieger — Tue, 15 Jul 2008 12:28:17 -0400

Everyone in the hospital business knows about the emergency department's "frequent fliers"--folks who show up a few times a month due to one pain or another, either because they're uninsured, fearful or maybe just lonely. While ED nurses and administrators may be used to such folks, they're a big problem, one that researchers are beginning to look at more closely. Researchers, who have named such people "super users," are trying to understand how to cope with the most extreme behavior--and by doing so, take significant costs out of the healthcare system as a whole.

One way to approach the problem is to look at one community's patterns, which professionals are doing in Camden, N.J. In the small, impoverished city, researchers estimate that that hospitals could save $46 million by reducing ED overuse. A Camden physician, family physician Dr. Jeffrey Brenner, began earlier this year to document how Camden residents used the area's EDs. Having analyzed five years of records from the city's three hospitals, he concluded that the top 1 percent of ED and hospital users (about 1,000 patients) between 2002 and 2007 accounted for about 10 percent of total admissions. These patients came to the city's EDs more than 39,000 times over the five year period, with one patient using a record $3.5 million in services.

When he saw these figures, Brenner took action, creating a "medical home without walls" with a $300,000 grant from the Robert Wood Johnson Foundation. With the money, he built a small team including a nurse practitioner, community health worker and social worker that goes to homes and homeless shelters to find super users and keep them well. Other cities--such as San Francisco--have developed similar programs.

To learn more about this trend:
- read this piece in The Star-Ledger

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