Patient-centered

Following a successful pilot, Group Health Cooperative is diving headlong into the so-called medical home model of patient care. By 2010, all 26 of its medical centers throughout Washington state are expected to use the medical home approach, which facilitates partnerships between patients, their personal physicians, and when appropriate the patient’s family. The nonprofit healthcare system is hardly alone in its interest in the medical home model: The Centers for Medicare & Medicaid Services (CMS) last month entered in to a multiyear contract for management of the Medicare medical home demonstration.

“There are many definitions for the term ‘medical home,’” says Shirley Reitz, associate director for pharmacy clinician services at Seattle-based Group Health. “When we implemented a pilot, the medical staff asked that pharmacists be an integral part of the team. You won’t see that elsewhere; you don’t see the others talking about pharmacists.”

The medical home concept initially referred to a central location for archiving a child’s medical record, as coined by the American Academy of Pediatrics (AAP) a half century ago, according to the American Academy of Family Physicians. The AAP more recently expanded the concept to include such care qualifiers as accessible, continuous, comprehensive, family-centered, coordinated, and compassionate.

The medical home involves a team quarterbacked by a personal physician who partners with a patient to manage all aspects of the patients’ medical care—from preventive care and healthy lifestyles to specialty care and hospitalization. “The MD is the lead,” says Reitz, of the Group Health setup. “An RN is on team and maybe an LPN, a pharmacist, and a medical assistant. That’s the core team.”

Group Health’s two-year medical home pilot, conducted at its Factoria Medical Center in Bellevue, concluded with members and staff expressing their satisfaction with the approach over the traditional patient/healthcare-system relationship, and with patients saying that the approach strengthened their relationship with their doctors. Medical home addresses one of the chief impediments to quality healthcare: limited patient/doctor time, the result of unwieldy patient loads. In the Factoria pilot, physician workloads were trimmed by adding the equivalent of one-and-a-half doctors to the staff. Personal physicians saw their caseload drop nearly 50%, to 12 to 14 patient visits per day. The lighter visit load gave them more time to spend with patients during visits, and to respond to and check in with them between visits via e-mail or phone, according to Group Health.

“The goal is to keep people healthy for longer periods, with the MD serving as a hub for needs, to keep people out of hospitals and emergency rooms,” says Reitz. “This could mean, for an asthmatic patient, that the pharmacist on the team works to make sure medications are taken properly, having an anti-inflammatory as well as a bronchodilator.” The pharmacist can stress to the patient the importance of using the medications, of adhering to the drug regimen to reduce long-term consequences. “Adherence is a big issue, and that’s something the pharmacy staff is involved in.”

Medicare’s medical home demonstration

The Group Health Cooperative is spending $9 million to reshape its 26 clinics into medical home practitioners. On an even grander scale, the Centers for Medicare & Medicaid Services (CMS) have initiated a demonstration that will span as many as eight states and involve about 400 medical practices, 2,000 physicians, and 400,000 Medicare beneficiaries. Participating practices will provide medical home services to patients from January 2010 through December 2012 and receive additional monthly care management fees from CMS, according to an announcement.

CMS has contracted with the healthcare business of Thomson Reuters to manage implementation. The project involves physician-based office practices delivering medical home services to Medicare fee-for-service beneficiaries. Thomson Reuters will recruit and qualify physician practices to participate in the demonstration, and will monitor beneficiary enrollment and participation. The National Committee for Quality Assurance (NCQA) will conduct the practice application and qualification processes to certify that participating practices have core medical home capabilities.