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Full Promise of Medical Homes Could Be Years Away, Experts Say

By Kerry Young, CQ HealthBeat Associate Editor

May 20, 2014 -- Paying doctors to coordinate the care of their patients seems a likely path to both better health and some cost reductions. But creating the systems needed to support the approach will take time, planning and money, speakers at a conference said last week.

The Alliance for Health Reform briefing focused on the concept of patient-centered medical homes, in which doctors are paid flat fees to spot gaps in patients' care, keep tabs on whether people are getting needed medicines and screenings and prevent unnecessary visits to the emergency room.

"From a very diverse set of stakeholders, there was universal optimism about the medical-home model, and what it can do for patients and quality, but it is not without challenges," said Amy Cheslock, vice president of payment innovation at WellPoint Inc., one of the nation's largest health insurance companies. "It's a substantial transformation. It's an evolution. It's a journey."

A study in the Journal of the American Medical Association raised questions about the potential benefits of the medical home model. Rand Corp. research found few improvements in quality of care and no reductions in hospitalizations, emergency department visits or total costs of care when it compared results from a Pennsylvania medical home project to those from practices not involved in the project.

Doctors involved with the medical-home project, the Pennsylvania Chronic Care Initiative, responded in a HealthAffairs blog.

"We believe that the reaction to this publication has oversimplified our rich and multidimensional experience with medical home transformation," they said.

They noted that blood pressure, cholesterol and blood-sugar control in diabetic patients " far exceeded comparable results from conventional interventions."

"These outcomes simply weren't captured in the study," they wrote in the blog.

WellPoint's Cheslock said that her company has published research in Health Affairs that show positive results connected with medical homes, such as a reduction in emergency room visits. It's to be expected that there will be some mixed signals, though, as doctors and insurance companies work through major changes in the coordination and delivery of care.

"This isn't like a light switch where you turn it on and it is universally better," she said.

The concept of a medical home has been kicked around for decades. The American Academy of Pediatrics introduced the concept of a medical home in 1967. By 2008, the National Committee for Quality Assurance launched its Patient-Centered Medical Homes program, which now involves more than 34,600 medical professionals at 6,800 sites.

The focus is to head off complications from chronic conditions. Patients are more likely to get reminders to get needed medical screening, to be able access the practice by email and get treatment during evenings and weekends.

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