Patient-centered medical homes could define future

By Cherry Sokoloski
North Forty News

When Bob Molison went back to his doctor's office recently for an annual physical exam, he noticed a difference. "There's something new here," Molison said to himself.

Since his last physical, a subtle transformation had taken place at the Internal Medicine Clinic in Fort Collins. Not that the medical care hadn't been excellent before, Molison said, but now there is more emphasis on the relationship between doctor and patient. "It was completely different," he stated.

This time, his doctor had more time to talk to him, he used electronic connections to see what other doctors were doing for him, and he was more interested in the steps Molison was taking himself to control his disease.

"I felt that the doctor wanted it to be a quality experience," Molison commented.

A Fort Collins resident, Molison suffers from Type I diabetes. His primary care physician at the Internal Medicine Clinic is Dr. Neil Stafford.

The changes that Molison observed were not in his imagination. The Internal Medicine Clinic is part of a statewide pilot program geared to providing better care for patients – at lower cost.

The new approach is called the "patient-centered medical home," a model that emphasizes primary care and prevention.

Colorado has 16 medical groups in the pilot program, and these pioneers are dedicated to transforming health care delivery. The pilot project began in 2009 and runs through 2012.

According to HealthTeamWorks, a national nonprofit that coordinates the pilot project, the goal is for medical care to be thorough, unhurried and personal. In addition, a practice must be easily accessible to patients via telephone or e-mail, and it must coordinate each patient's care among all medical providers.

Better coordination, Stafford pointed out, should lead to a decrease in the number of unnecessary, duplicative tests – with resulting cost savings for the health care system.

HealthTeamWorks reports that medical practices in the program are already showing improvements on quality measures, coordination of care and patient satisfaction.

New, old-fashioned

Some describe patient-centered medical homes as a "new, old-fashioned" approach to providing medical care.

In some ways, the idea is similar to that of the family doctor of decades ago, when the physician was very familiar with each patient, his medical history and his family. The doctor was acquainted well enough to know each patient's health habits, his political persuasion and maybe even his golf scores.

The "new" part of the formula is technology. Doctors pursuing the medical home model are using technology to keep better track of each individual patient as well as their patient populations as a whole. They're also using technology to stay in touch with patients and remind them of appointments they need to make.

At Stafford's office, for instance, doctors stay in touch with patients via e-mail, phone and letter. Stafford sends out "hundreds of letters a week," he said, a task made easier with electronic templates. He can use a template for general information and personalize the letter for the particular patient.

Special software also helps physicians keep better track of patients with chronic diseases. "It's easier to identify people who need extra attention," Stafford said. Clinic staff spend a good deal of time doing follow-up and reminder calls.

"We're combining old-fashioned customer service with new-fangled technology," said Dr. Janet Seeley, past president of the Larimer County Medical Society. She recalled that when she was a child with asthma, the doctor or nurse would call her mother on a regular basis to ask how she was doing.

"The ability to have that relationship is the reason why many doctors go into the field," Seeley said, so she is pleased to see the doctor/patient relationship making a comeback. "We've gotten so technical that we've kind of lost sight of that."

Patient responsibility

"Patient-centered" also means more responsibility for the patient regarding his own treatment. This is especially important with chronic diseases such as diabetes and heart disease, since they require regular monitoring.

Debbie Childress, business administrator for the Internal Medicine Clinic, has been involved in the project from the start and said the approach is very good for patients.

"As we watch people more carefully and make them more accountable, they're a little resistant at first but the outcome is good," she noted. "We're giving them more control of their health care."

Chronic diseases create huge costs for society, Childress noted, both in terms of costs to the system and the general health of the population. The medical home model seeks to reduce emergency room use and hospital admissions – another way of saving money.

"This is the trend for the future," Childress said of the new model.

Help from insurers

An interesting aspect of the pilot program is its funding. Among its funders are seven health care payers: five private health insurance companies plus Medicaid and CoverColorado. These plans pay practices for participating in the pilot, and they also pay bonuses for positive outcomes. Participating clinics must send in regular reports about their patients.

"It's good to see the insurance companies interested in prevention," Stafford said. "It's a win-win for patients and insurance companies."

Seeley said that in order for the medical home model to succeed, doctors must be reimbursed for their extra time and effort, as well as their investments in technology. The flip side of this investment is greater fulfillment for medical professionals.

"Doctors who have embraced this model talk about tremendous satisfaction," Seeley said. "They're providing the kind of care they dreamed of providing."

But it's a difficult, expensive process. "It's like retooling an entire factory," she said.

Stafford said he definitely likes the patient-centered medical home model, and he thinks the concept could "reinvigorate primary care." There's a crisis looming from too few primary care providers, and Stafford hopes the new model will encourage more medical students to go into primary care.

A patient-centered medical home, according to state Rep. John Kefalas, D-Fort Collins, is the "central concept" in redesigning the health care delivery system. In the last legislative session, Kefalas introduced a bill that would have defined just what "patient-centered medical home" means for adult patients, but the legislation died in committee.

Miramont Family Medicine in Fort Collins and Wellington is also involved in the pilot project. A local residency program, the Family Medicine Center, is participating in a similar pilot geared to residency clinics.

With the medical home experiment, Stafford said, "We're making the community of Fort Collins healthier."