There's No Place Like a Medical Home

Joe McDonald, 70, of Fairfax, Va., really likes his primary-care doctor. And it's no wonder. The retired finance manager can get same-day appointments at the Fairfax Family Practice, e-mail his physician or drop by the practice's walk-in clinic, even on weekends. On a secure Web site, McDonald renews prescriptions and reviews test results. Everything is "right at my fingertips," he says.

McDonald's doctor alerts him when he is due for a colonoscopy or other screening. While the physicians in the practice refer the tough cases to specialists, they help patients manage chronic conditions, from diabetes to heart disease. And they perform some procedures right in the office, such as the removal of moles and the casting of broken bones.

Most important to McDonald: His physician has taken the time to get to know his patient. "I get that one-on-one personal relationship with him," he says.

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Fairfax Family Practice is one of 12 offices of Fairfax Family Practice Centers, which includes 120 providers, among them nutritionists and physical therapists. And it is on the forefront of a growing trend called "patient-centered medical homes." Studies indicate that this approach to primary care saves money, reduces unnecessary services and improves health.

Medical homes are a modern-day version of the old-fashioned family doctor, who performed a wide range of medical services and offered emotional as well as clinical support. This updated model of primary-care delivery organizes all facets of a patient's care. Doctors, nurses, care managers and medical assistants typically work as a team to oversee a patient's care. Medical homes coordinate all referrals to specialists, and then track those visits. They help patients manage medications prescribed by all doctors. Medical homes also coordinate care among facilities, following the patient from hospital to rehabilitation facility to home. They use electronic medical record systems to track their own performance and their patients' health and outcomes, and to provide patients with online access to their physicians and personal medical records.

To call itself a medical home, a practice must get certification from the National Committee for Quality Assurance, a nonprofit health care accreditation organization. There are 6,800 certified medical homes, up from 28 in 2008. "Medical homes are the fastest-growing delivery system innovation," says Andy Reynolds, an assistant vice-president at the committee.

A big reason for the surge: After noting evidence that the patient-centered approach pays off, insurers and health plans are willing to pay primary-care doctors in these practices a bit more. Today, it's common for insurers to pay primary-care practices $50 or more per patient each year to give more personalized care.

Among the positive research, a study of a medical home pilot at some of the 26 medical centers of Seattle-based Group Health Cooperative—which combines hospitals, medical practices and health plans—found that the quality of care was higher and patients were more satisfied than at the cooperative's other centers. The study evaluated chronic illness care, medication monitoring and other quality measures. And for every $1 invested, Group Health saved $1.50 by reducing emergency-room and hospital use. The results persuaded the cooperative to expand the medical home model to all of its medical centers.

Getting a Boost From Government

The federal Affordable Care Act has "provided a lot of oomph" to medical homes, says Marci Nielsen, chief executive officer of the Patient-Centered Primary Care Collaborative, an association of health care providers. The law is spurring changes to how health care is paid for—away from fee-for-service payments that encourage more services and toward models that promote cost efficiencies while improving medical outcomes.

The new law is financing demonstration programs that pay providers a single payment for "bundles" of services during an episode of care. Pilots also are testing extra payments to providers who can prove better outcomes on selected measures. And they're evaluating team-based approaches, such as medical homes, by paying doctors more to cover patient education and care coordination.

Medicare is testing the value of medical homes. In one program, Medicare is paying 1,200 medical practices in Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont to provide health care in a medical home to more than 900,000 beneficiaries. In another, Medicare is paying 500 medical practices in Arkansas, Colorado, Kentucky, New Jersey, New York, Ohio, Oklahoma and Oregon an average of $240 a year per patient.

In Vermont, medical homes have been taken to a new level, thanks to a state-organized effort called Blueprint for Health. Medicare, Medicaid and private health insurers are making per-patient payments each month to support medical homes. As a result, all Vermonters have access to a medical home, which includes roaming "community health teams."

Vermont's community health teams are made up of nurses, health coaches, nutritionists, social workers and mental health professionals. Doctors can refer a patient to a team, which visits patients at home if, for example, the patient is newly diagnosed with depression or diabetes. The team can arrange for a patient's transportation to a doctor's appointment or pay for new prescriptions for patients who can't afford them.

Sheila Sharp, 64, of Shelburne, Vt., was referred to a health team when she wanted to lose weight and start exercising after she retired last summer. "My doctor was concerned about my weight," says Sharp, a retired preschool owner, who has high blood pressure and cholesterol.

The community health team's health coach and nutritionist helped Sharp to plan menus and create an exercise regimen. The exercise plan includes a fitness app for her smart phone. Sharp, who has lost 20 pounds, says she "wouldn't have made this change without" the team's help.

If you'd like to find a medical home, make sure the practice is recognized by the National Committee for Quality Assurance. Go to http://recognition.ncqa.org for a list of medical homes in your state. If you live in a state where Medicare is piloting medical homes, you can ask your primary-care doctor if he or she participates in the Comprehensive Primary Care Initiative or the Multi-Payer Advanced Primary Care Practice demonstration.

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