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A 2008 survey by the National Association of Public Hospitals of 46 “medical home” programs initiated by its members revealed significant patient-care improvements that included improved care coordination and a resultant reduction in emergency department (ED) utilization, per-patient cost, and hospitalizations. In addition, the various medical home programs were found to decrease inpatient days, increase the number of appropriate primary care visits, and increase patient appointment “show rates”.
Of the medical homes surveyed, 80% employed case managers and/or care coordinators. Reasons given for implementing the programs included “improving patient health and increase access to high quality health care” (33%) and “explicitly working to reduce ED overcrowding and the inappropriate use of ED services for primary care” (20%). Other reasons were to address “unmet medical needs of a growing uninsured patient population” and the establishment of programs “in anticipation of proposed federal health reform legislation, which includes language emphasizing primary care and medical home model.”
“More than three quarters (76%) of the programs were collaborative in nature, with the hospitals initiating these relationships in 69% of the cases.”
More than three quarters (76%) of the programs were collaborative in nature, with the hospitals initiating these relationships in 69% of the cases and community organizations being the initiators 31% of the time.
Most of the medical home programs were intended to target “specific vulnerable populations”, including: pediatric patients; the elderly; the uninsured, underinsured, and Medicaid patients; patients with no primary care physician; frequent users of the ED for primary care services; and the homeless. Additionally, the researchers found that pediatric medical homes often targeted particular sub-groups, such as: children with chronic diseases or developmental delays; those in foster care; and those who are homeless.
Fully 80% of the medical homes offered specialty care, either on-site or through coordinated referrals with contracted specialists. Further, 63% of the programs offered chronic disease management programs for conditions including: asthma, cardiovascular disease, chronic renal disease, diabetes, HIV/AIDS, hyperlipidemia, obesity, pain management, and substance abuse. In order to improve access, 39% of the medical home programs offered “open-access” scheduling, allowing patients to make same- or next-day appointments.
While 57% of the respondent programs reported use of health information systems, a majority did not have fully-integrated electronic medical records (EMR), with 41% using or in the process of implementing EMRs.
The surveyed programs all shared universal characteristics of a medical home, however “each one was tailored to the needs of its patient population.” For instance, a geriatric program relied heavily on social workers to health patients navigate the system. A program targeting the homeless employed mobile medical vans to reach out across the community. Another program for children in foster care coordinated all health care services, “regardless of a child’s placement with new foster families.”
With respect to specific improvements in care, “nearly 40% of programs could offer either anecdotal or quantitative evidence of reduced ED usage.” The Broadlawns Medical Center in Des Moines, Iowa, reduced annual ED visits by 4,000 and resulted in a $190-per-patient reduction in cost of care.
“Nearly 40% of programs could offer either anecdotal or quantitative evidence of reduced ED usage.”
Carolinas Medical Center reduced hospitalizations and ED visits by 80% among their targeted group of high-risk patients. Further, the Carolinas program increased patient appointment show rates by 39% between 2001 and 2005 through the use of “open access scheduling”. In addition, diabetic patients not participating in the Carolinas medical home program “cost the hospital 31% more per day and 67% more per admission than their counterpart medical home patients.”
Finally, the research team noted that recently passed health care reform legislation calls for “new federal financial assistance to community-based collaborative care networks that operate as medical homes… seeking to reduce unnecessary ED use, strengthen care coordination for patients with chronic illness, and increase access to primary care.”
Source: Safety Net Hospitals Establish “Medical Homes”, Research Brief, National Association of Public Hospitals and Health Systems, February 2010.
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