Medical homes prove worth, in U.S. and abroad

By Mike Miliard
10:04 AM

A new Commonwealth Fund international survey finds that chronically and seriously ill adults who received care from a medical home were less likely to report medical errors, test duplication and other care coordination failures.

The survey, which polled patient experiences in the U.S. and 10 other high-income countries, also found that patients connected with medical homes – accessible primary care practices that help coordinate care – had better relationships with their doctors and rated their care more highly.

The 2011 survey of more than 18,000 sicker adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States included people who reported they were in "fair" or "poor health," had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury, or disability in the past year.

The report identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible and helps coordinate care received from other providers.

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Sicker adults in the U.K. and Switzerland were most likely to have a medical home, with nearly three-quarters connected to practices that have characteristics of a medical home, compared to about 33 percent to 65 percent in the other nine countries. U.K. and Swiss patients also reported more positive health care experiences than sicker adults in the other countries: they were more likely to be able to get a same- or next-day appointment when sick and to have easy access to after-hours care, and they were less likely to experience poorly coordinated care.

Sicker adults in the U.S. stood out for having the highest rates of problems paying medical bills and going without needed care because of the cost, the poll found. Forty-two percent reported not visiting a doctor, not filling a prescription or skipping medication doses, or not getting recommended care – a significantly higher proportion than in all the other countries, and more than double the rates in Canada, France, the Netherlands, Norway, Sweden, Switzerland and the U.K. Moreover, U.S. patients had among the highest rates of self-reported medication, lab, or medical errors, as well as gaps in coordination of care.

Across the diverse healthcare systems included in the study, patients who were connected to a medical home in general had more positive care experiences, including better support for managing chronic conditions, better communication, and better care coordination. Patients with medical homes were also less likely to report medical mistakes and far more likely to rate their care highly.

“We found that to varying degrees in all countries, chronically ill or sicker patients encounter failures of providers to communicate with each other or coordinate care,” said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the study. “Yet in each country, patients with primary care practices that help them navigate the care system and provide easy access are far less likely to encounter duplication, delays, and failures to share important information.”

Schoen says the study highlights the critical importance of patient-centered primary care as a foundation for a high-performing health system.

[See also: Medical Home model receives $1.7M shot in the arm.]

Sicker adults in the U.S. stood out as the most likely to have problems getting needed care because of the cost, or to have medical bill or debt problems. More than two of five sicker adults in the U.S. (42 percent) went without care because of costs. More than one of four (27 percent) said they could not pay, or had serious problems paying, medical bills, compared with between 1 percent and 14 percent of adults in the other 10 countries. And more than one-third (36 percent) spent more than $1,000 on medical costs, compared with fewer than 10 percent in France, Sweden, and the U.K., the countries with the lowest rates – a reflection, the authors say, of high cost-sharing and high uninsured rates in the U.S.

In the U.S., cost-related access problems and medical bill burdens reported in the survey were concentrated among adults under age 65. Compared to adults 65 or older with Medicare coverage, under-65 adults were far more likely to go without care because of costs, compared to 19 percent of adults age 65 or older; 35 percent of those under 65 had problems with medical bills, compared with only 6 percent of adults 65 or older. Whether insured all year or uninsured, under-65 sicker adults in the U.S. were at high risk for access problems, bill concerns or high out-of-pocket costs.

“Despite spending far more on health care than any other country, the United States practically stands alone when it comes to people with illness or chronic conditions having difficulty affording health care and paying medical bills,” said Commonwealth Fund president Karen Davis. “This is a clear indication of the urgent need for Affordable Care Act reforms geared toward improving coverage and controlling health care costs. It is crucial that as reforms are implemented, we control costs in ways that ensure those facing serious and chronic illness have affordable access to the health care they need and that preserve the gains made by Medicare.”

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