Medical homes: A new kind of health care

Until about six months ago, Jeff Giannetto never really had a doctor.

If the 50-year-old Cedar Rapids resident was having health problems, he'd just go to a nearby emergency room.

Giannetto is the kind of patient Corridor hospitals and clinics want to reach.

Health systems are reorganizing their practices to implement the Medical Home concept, which they say is more patient friendly and cost effective. The strategy centers on giving patients better access to health care through a team-based approach.

Now Giannetto works with his primary care doctor, Brad Archer, executive medical director of MercyCare Community Physicians.

'I've never had a doctor that cares as much as he does,” Giannetto said.

After Giannetto had his fourth heart attack in April, he said Archer came to visit him in the hospital. Archer had Giannetto begin to work with a psychiatrist because he was feeling depressed, which is frequently linked to heart disease.

In 2013, all MercyCare Community Physician's primary care clinics received a three-year medical home recognition. UnityPoint Health is working to get its 16 primary care clinics in Cedar Rapids certified as medical homes by 2015, and the University of Iowa Hospitals and Clinics also is implementing the strategy.

The certification process is not an easy one, said UnityPoint Health's Dr. Clayton Schuett. Clinics are graded on 137 different types of criteria, he said, on everything from care coordination to a patient's access to his or her doctor.

Connecting the dots

Better care coordination is a key component of the Medical Home model, Mercy's Dr. Tim Quinn said.

'We (doctors) have to recognize that we can't do everything,” he said. 'We have to be willing to hand off duties.”

That may mean a nurse looks through patient records every morning to see what incoming patients need health screenings and services such as mammograms or tetanus shots.

'We can extract more contact out of the visit,” he said.

Schuett said part of UnityPoint Health's transition to a medical home will have teams co-locate to pods to improve communication. That way, the team can huddle once a day to see what patients need certain tests or screenings as well as to see who is coming in for what.

'It was much more fractured in the past,” he said.

Care coordinators are able to connect the dots better, said UnityPoint Health-St. Luke's Hospital President and CEO Ted Townsend. This allows for fewer mistakes and misses.

Part of connecting those dots means giving patients electronic access to health records, an endeavor MercyCare and UnityPoint have undertaken. This allows patients to see lab results, request refills on prescriptions and communicate with their physician's office.

Another dot is creating a care team, made up of medical professionals such as physicians, nurses and psychiatrists and non-medical professionals, including social workers and other employees, to help with financial assistance if needed.

'With the patient at the center of care, we can build a team around them to better manage their care and improve quality and lower costs,” Schuett said.

This also helps break down barriers, Quinn said.

'A small percentage of the population creates a lot of costs in health care,” Quinn said, adding that some patients use the emergency room between 20 to 30 times a year. 'A lot of that is because of accessibility - they can't get to a clinic.”

Cutting Costs

Medical professionals say this new kind of care also will help decrease costs - the theory being that if doctors work to prevent illness rather than treat it, patients will see a decrease in costs.

'As deductibles increase, so does that kind of exposure to cost,” Mercy's Archer said. 'Consumers want to know what kind of value they are getting.”

But a February report by the not-for-profit research group RAND Corp. found that it didn't save on costs compared with normal primary care practices.

Bloomberg News reported that the study looked at 32 medical homes in the Southeastern Pennsylvania Chronic Care Initiative. It compared the medical homes with other provider practices from 2008-2011 and found significant improvement in one of 11 quality metrics.

Even still, the hospitals say that focusing on preventive care can help reduce readmission rates and cut down on the number of frequent emergency room users.

Insurers traditionally pay physicians by the number of services they conduct. But the Patient Protection and Affordable Care Act is pushing insurers and doctors to move away from this system.

Both Mercy and St. Luke's have started this transition. Quinn said Mercy has begun to focus more on patient satisfaction, hiring a company to survey patients after visits and offering bonuses to physicians who score well.

'Under the Affordable Care Act, more people have insurance and access to care, while there's also an aging population,” St. Luke's Townsend said. 'We're increasing the utilization of incentive, moving away from volume to outcome satisfaction.”

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