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Benefits Column

Home, Sweet, Home

The Patient-Centered-Medical-Home model has the potential to enhance employee healthcare -- and a company's healthcare costs. The model is designed to offer comprehensive, coordinated and timely care.

Monday, March 14, 2011
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I returned from a recent family vacation to Disney World with great memories and swollen glands. My inflamed throat seemed like a fair exchange for frequent hugs from children recovering from colds.

But, a combination of two factors drove me to seek medical care. First, my swollen glands were an unusual symptom for me. Second, after 10 days, I was getting worse.

So, on day 11, I placed a call to my primary-care physician's office. There were several challenges with that action.

I telephoned at 7:30 a.m. In response, I received a message indicating that office hours were from 8:30 a.m. until 5:30 p.m. Further, instructions directed that I shouldn't attempt to call again until 9 a.m., and that I should not phone during the lunch break.

Prior experience told me I could work around these restrictions and get an appointment with one of the practice's physicians, but I knew it would take diligence and persuasion on my part.

While I was again dialing my PCP's office, I was reading my Twitter stream, viewing yet another tweet from Ben Miller, an assistant professor at the University of Colorado-Denver School of Medicine, about the patient-centered medical home.

My physician does not use a PCMH-model, which is described by Dr. Paul Grundy, director of healthcare transformation at IBM, as "comprehensive care where you [and] your employees ... receive coordinated care in a timely manner, at a day and time that works with your schedule. Communication comes to you in a variety of formats, including e-mail."

I realized that I might be able to get some comprehensive, timely care from my local pharmacy chain that offered a walk-in clinic. Perhaps, I thought, it would be better for everyone if I used that service.

I was seen by the clinic's nurse practitioner at 8 a.m., and walked out with a course of treatment within 30 minutes. I essentially created my own version of patient-centered treatment -- care that met my schedule and needs, and was 20-percent cheaper than a visit with my physician. I even extracted a commitment to have my records sent to my PCP.

Grundy, who is president of the Patient-Centered Primary Care Collaborative, says that employers that piloted the PCMH model with their employees experienced beneficial healthcare outcomes as well -- including: approximately 10 percent lower overall healthcare costs; a 30-percent reduction in unnecessary hospitalizations and emergency room visits; and patient-reported satisfaction rates that have quadrupled to the mid-80s, from rates as low as 20 percent.

In Grundy's experience, one of the challenges of the current healthcare-delivery system is that only 26 percent of employees can access physicians after work hours. "That leads to expensive and, sometimes, dangerous care."

For Grundy, the PCMH model changes the "covenant [from] episodic, uncoordinated and inaccessible care [to] comprehensive, integrated and accessible care."

The concept of a patient-centered medical home is not new. Ben Miller explains that it dates back to 1967 when the American Academy of Pediatrics introduced the idea of housing a child's medical records in a central place. This was particularly important for youths with special healthcare needs.

According to Miller, AAP expanded the medical-home concept to include comprehensive care that operated under the mantra that "to treat the child, you needed to treat the family."

The PCMH didn't expand beyond pediatrics until March 2007, when the American College of Physicians, the American Academy of Family Physicians and the American Osteopathic Association joined AAP to issue the "Joint Principles of the Patient-Centered Medical Home."

The document describes seven principles, which comprise the PCMH: a personal physician; a physician-directed medical practice; whole-person orientation; coordinated or integrated care; quality and safety; enhanced access to care; and payment for value instead of episodes.

The National Committee for Quality Assurance modified these original joint principles with the specialty societies and interested stakeholders to create three levels of recognition for a range of primary-care practices.

In the 2011 guidelines, NCQA revised the standards further to include "a stronger focus on integrating behavioral healthcare and care management."

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This is music to Larry Green's ears. Green is the Epperson Zorn chair for innovation in family medicine and primary care in the department of family medicine at the University of Colorado School of Medicine.

"Employers should focus particularly on PCMHs with integrated behavioral health because of the major bump in expenditures for people with expensive chronic conditions like diabetes and heart failure," he says. "[Costs increase by] at least 30 to 70 percent when one of their employees also has a substance use, mental health or behavioral health condition in addition to the 'medical' chronic disease."

Since everything I heard about the PCMH sounded like an ideal solution, I wondered how an insurance company would respond to the concept.

Dick Salmon is the national medical officer for what CIGNA (a client of mine) calls their "collaborative accountable-care program." This initiative combines the PCMH along with the concepts of accountable-care organizations and enhanced collaboration between the health plan and physicians' practices.

"We believe that driving fundamental change to improve quality, affordability and satisfaction with healthcare is extremely challenging," Salmon says. "It only makes sense to partner with physicians' practices since we have many resources that can help them be successful."

So, the patient-centered medical home may be a boon to HR executives who want to improve the quality, accessibility and affordability of the healthcare they offer to their employees and their dependents. The Patient-Centered Primary Care Collaborative's Center for Employer Engagement provides step-by-step guidance on how to get started.

The patient-centered medical home might possibly be the most promising benefits-plan change HR leaders can provide to their employees and their companies.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.

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