Foundations Set for Medical Homes in Louisiana
Blue Cross and Blue Shield of Louisiana has answered the call for new and innovative healthcare delivery and payment models by embracing the concept of the Patient-Centered Medical Home. As the nation prepares for landmark changes in the U.S. healthcare system, we see the need to improve healthcare payment and delivery. The medical home delivery model effectively does both by providing accountable, coordinated and collaborative care that result in better health, better care at a better cost.
What is a Patient-Centered Medical Home?
A Patient-Centered Medical Home is a model of care that encourages and strengthens the doctor-patient relationship by replacing fragmented, episodic and reactive disease focused care with organized, continuous and proactive care that is focused on preventing disease and preserving and restoring health. Each patient has a relationship with a primary care physician who leads a team with shared medical service duties, providing for the patient's entire spectrum of healthcare needs in a holistic manner while working with other medical providers in a coordinated and collaborative fashion.
The medical home is meant to result in a more "patient-centric" approach to care delivery that promotes high quality, personalized and effective care. A medical home achieves these goals through enhanced access to medical providers and services. It adds more coordination of care marked by heightened communication and engagement between patients and doctors by taking advantage of the latest technology to prescribe, communicate, track test results, get medical support information and measure and reward performance for improving outcomes while containing and reducing costs.
Why do we need medical homes and a new delivery model?
The medical home is not a place or a building, but it is a force of change and a way to coordinate our fragmented, uncoordinated system. This force is centered on strong primary care services. Our primary care system must be transformed to meet current and future demands from the challenges it faces from widespread chronic disease and a rapidly aging population. With a looming shortage of primary care physicians coupled with a growing burden of chronic disease, the need for a well-organized and effective primary care system of care is paramount to reaching the goals of better health, better care at a better cost.
Key challenges facing primary care, healthcare delivery
- Emergency room visits increased by 36 percent between 1996 and 2006; 47 percent of ER visits could have been avoided by receiving treatment in a physician’s office.
- Twenty percent of patients are readmitted within 30 days of the hospital stay; most of these readmissions are avoidable.
- Fifty percent of patients who are readmitted do not see a physician for follow-up care after their first hospital stay.
- Seventy-five percent of healthcare spending is for patients with chronic diseases and 50 to 70 percent of chronic disease is linked to lifestyle and is preventable.
- Millions of added Americans will enter this already dysfunctional primary care system with healthcare reform.
New primary care delivery models can give the coordination mechanisms and judgment to improve quality, cost and satisfaction. This is at the base of the medical home – providing better value to patients by making healthcare not only more affordable, but achieving better quality outcomes. The value of primary care to affect these sort of improvements is well known and reported in the peer reviewed literature.
The proven value of primary care driven emphasis
- Lower per-person costs
- Decreased emergency room visits
- Reduced hospital admissions
- Fewer unnecessary tests and procedures
- Less preventable illness and injury
- Higher patient satisfaction
- Enhanced longevity and quality of life
Collaborative Care initiatives in Louisiana
In the coming calendar year, Blue Cross will launch new products rooted in the concepts of the Patient-Centered Medical Home. Working through "Accountable Coordinated and Collaborative Care Organizations," we will offer cost-effective products that do not come with sacrifices in quality of care.
Dr. Ken Phenow, Blue Cross chief medical officer, has valuable experience in the development and operation of medical homes. While serving as senior market medical executive of CIGNA HealthCare of Texas and Oklahoma, he was instrumental in the planning, development, implementation and establishment of the first commercial payer-sponsored medical home in Texas, consisting of a group of 140 doctors across 45 practices.
"The patient-centered medical home is not a "cure-all fix," but it is a part of the solution," Dr. Phenow says. "The bottom line is we're going to get higher quality, lower cost, with increased patient satisfaction. The medical home approach will take care of so many problems in the current system: fragmentation, lack of coordination, quality and affordability and really improve the patient experience."
