Medical Home Monitor
March 16, 2009
Vol. I, No. 12
Medical Home Monitor Archives
Medical Home Q&A:
Aligning Incentives Between
Payors and Providers
Q: Have any medical home models implemented a shared risk pool to align incentives between payors and physicians?
A: Humana's structure is based upon expectations of savings associated with the medical home. So in a sense, it is shared savings in that we look at what we’d expect to find through application of the medical home as a reduction in inpatient utilization, ER utilization, pharmacy, radiology and other services. Then we offset that with expectations and increases that we’d expect associated with promotion of preventive care and chronic care management. We look at the overall savings opportunities offset by increases and expected costs and provide reimbursement for the majority of that savings to the PCP as the care coordination reimbursement. We do this using retrospective data and we make the payments prospectively. We haven’t approached any type of annual reconciliation to do any further gain-sharing, but it is something that we’re talking about and contemplating. (Chris Corbin, Humana program manager for physician strategies.)
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Medical Home Without Walls Deters ER Frequent Flyers
A pilot program in Camden, N.J. — dubbed "a medical home without walls" by its creator — has successfully reduced ED admissions and costs by targeting a small number of patients responsible for "racking up huge medical bills and straining already crowded" EDs. Led by Jeffery Brenner, a professor at the University of Medicine and Dentistry of New Jersey's Robert Wood Johnson Medical School, the program intervened in the lives of 35 patients who together accounted for $1.2 million in hospital charges each month. The intervention teamed a nurse practitioner, a social worker and a community health worker, who tracked down frequent ED users in homeless shelters to help find them places to live. The team made sure patients checked their blood sugar, if necessary, and took their medications.
As a result of their efforts, the average number of hospital and ED visits each month for the 35 patients dropped from 61 to 37, and total hospital charges were reduced to $531,000. The effort cost about $300,000 annually, and Brenner believes the model could be valuable for other patient groups, such as the chronically ill elderly. He plans to publish data on the pilot program when the coalition has followed enough patients for a full year.
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HealthSounds Podcast: Daily Contact Engages the Underserved in Health Improvement Programs
Providers that engage Medicaid beneficiaries in daily telephonic self-care health monitoring find that these individuals are very receptive to the daily contact and more likely to engage in health improvement programs, explains Pharos Innovations CEO Dr. Randall Williams.
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ACP Supports Demos of Nurse Practitioner-Led PCMH Practices
While the American College of Physicians (ACP) believes that
care for patients in the PCMH model is best served by a physician-led multidisciplinary team, PCMH demo
projects that include evaluation of physician-led PCMHs
could also test the effectiveness of NP-led PCMH practices, providing certain criteria are met, the ACP states in a new policy statement.
"PCMH demonstration projects present a unique opportunity to examine
not only best practices for collaboration between healthcare professionals,
but also the performance and effectiveness of NPs as members of the multidisciplinary
healthcare team," says the ACP. "Payments and evaluation metrics for both physician-
and NP-led PCMH practices must account for differences
in case mix, including differences in health status, socioeconomic status, cultural
background and other patient factors that may contribute to differences in
cost and quality outcomes."
Although at this point the nursing and medical practices remain separate,
the distinctions among the types of care being provided by PCPs
and NPs appear to be fading, notes the ACP in this statement.
To read the executive summary of this policy statement, please visit:
HIN Survey of the Month: Medical Homes in 2009
In recent years, the PCMH has quickly grown from a pediatrics-based concept to a care model embraced by thousands of healthcare organizations. Complete HIN's third annual survey on the PCMH's role in your organization by March 31 and get a FREE executive summary of the compiled results with important benchmarks on PCMH utilization.
Complete the survey by visiting:
Medical Home Monitor Readership Survey Results
Thanks to everyone who responded to the Medical Home Monitor Readership Survey. Your comments are appreciated, and we are working hard to tailor future issues to your information needs. The free copy of
Simple Steps to a Patient Registry: Ticket to Care Coordination, Quality Reporting and Pay for Performance, was won by Gary Peat, general partner at Council Ventures.
Treating ER Overcrowding: An Emergency in Urgent Care
As rising numbers of unemployed and underemployed flood the nation's ERs in search of non-urgent care, many healthcare organizations are turning to the medical home model of care for relief. In this new HIN white paper, learn how medical home assignment and 16 other strategies can reduce ED overcrowding.
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Medical Home Improvement Guide: FAQs on Patient-Centered Care
To provide essential background on the PCMH model, the Healthcare Intelligence Network has assembled responses to the most frequently raised questions on this topic in a single comprehensive resource. In the Medical Home Improvement Guide: FAQs on Patient-Centered Care, 13 early adopters of the PCMH provide answers on the practicalities of the PCMH, from their perspectives as health plans, healthcare providers, case managers, physician practices and medical directors.
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