Study: Medical home model increases quality of care, reduces cost
A study done by the Group Health Cooperative has demonstrated that a new care model coupled with the use of health information technology could serve as a solution to the nation’s primary care physician shortage.
The study results show that a “patient-centered medical home” model has many benefits to both patients and medical staff. This model gives patients more one-on-one time with the physician, improves caregiver cooperation, and provides more preventative care.
“A medical home is like an old-style family doctor’s office, but with a whole team of professionals,” explained evaluation leader Robert J. Reid, MD, an associate investigator at Group Health Center for Health Studies and Group Health’s associate medical director for preventive care. “Together, they make the most of modern knowledge and technology—including e-mail and electronic medical records—to give patients excellent care and reach out to help them stay healthy.”
The study suggests that this particular model empowers the patient and actively engages the patient in their health. A “medical home” approach is a way that is expected to improve health outcomes, control costs, and help deal with the growing shortage of primary care physicians.
In comparing a sample of 9,200 patients from Group Health’s medical home to a control group, after one year patient visits to emergency room decrease by 29 percent. The rate of hospitalizations dropped by 11 percent and the medical home had 6 percent fewer in-person visits.
By employing the use of technology such as email and mobile phones, physicians in the medical home were able to provide better care that included screening tests, management of chronic illnesses, and monitoring of their medications. Using these methods also helped physicians ease the workload and reported that only 10 percent of medical home doctors and staff felt “burnt out” or emotionally exhausted – a large contrast to the 30 percent reported from the control group.
“Many primary care providers work so hard, they feel like they’re on a hamster wheel,” Reid said.
Primary care physicians also earn less than specialists do. To add to that, medical students are leaving school with heavy debts, which may influence their focuses away from small primary care practices to larger health systems.
“The cost and pricing demands are reinforcing medical graduates adversity to going into primary care because of the paycheck. Graduates are leaving school with substantial debt and need the money provided by high paying specialties,” said Jordan Battani, a principle researcher at CSC.
During the medical home pilot, each primary care doctor was responsible for fewer patients. Each doctor claimed responsibility for a total of 1,800 patients as opposed to 2,300. The reduction in the number of patients allowed physicians time to coordinate care, have daily “team huddles” and allow for extended 30-minute office visits per patient.
The reduction in patient-to-physician ratio also created a need to invest in extra staffing. As a result the study found that the medical home was investing $16 more per patient over the following year. This meant the need for 72 percent more clinical pharmacists, 44 percent more physician assistants, 18 percent more medical assistants, 17 percent more registered nurses, and 15 percent more primary doctors.
“Our evaluation showed these costs were recouped within the year,” Dr. Reid said. The main reason was emergency room savings of $54 per patient in the course of the year.”
“These findings are important because they provide a 'proof-of-concept' that investments in a medical home can achieve relatively rapid returns across a range of key outcomes." Impressed by the return on investment, Group Health is expanding the medical home model from its Factoria medical center in Bellevue, WA, to all 26 of its medical centers.
As it stands now, approximately 25 medical home projects are active across the nation in 17 states.