Medical Home Monitor
Medical Home Monitor
March 16, 2009
Vol. I, No. 12

Medical Home Monitor Archives

Medical Home Q&A:
Aligning Incentives Between
Payors and Providers

Medical Home Monitor

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 wed 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 wed 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 havent approached any type of annual reconciliation to do any further gain-sharing, but it is something that were talking about and contemplating. (Chris Corbin, Humana program manager for physician strategies.)

For information and advice on the assignment of patients to medical homes, please visit:

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.

For more information, please visit:

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.

To listen to this complimentary HIN podcast, please visit:

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.

To download this complimentary white paper, please visit:

Save 10 percent when you order by March 24:

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.

Reserve your specially priced copy today by visiting:

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at where you can also learn about our other news services.
Contact HIN:
Editor: Patricia Donovan,;
Sales & Marketing Coordinator: Deirdre McGuinness,;
Publisher: Melanie Matthews,;

HIN's Medical Home Monitor Archives put at your fingertips complimentary video, podcasts, white papers and blog posts on the advancement of the PCMH — plus back issues of this e-newsletter and links to additional medical home resources. Please bookmark this site and check back often for new content:
There are other free email newsletters available from HIN!

The Health Coach Huddle monthly e-newsletter brings you the most up-to-date news on health coaching, from coaching strategies to interviews and quotables from the industry's leading health coaches.

For products and services available from the Healthcare Intelligence Network, contact us at (888) 446-3530 / (732) 528-4468, fax (732) 292-3073 or email us at

All contents of this message Copyright 2009