Medical Home Monitor
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September 8, 2009
Vol. II, No. 9

Medical Home Monitor Archives

Medical Home Q&A:
Care Coordination Codes
in Medical Home Contracts

Medical Home Monitor

Q: In the Dartmouth-Hitchcock-CIGNA medical home collaborative, how did you develop codes for non-visit care not covered by CPT codes?

A: We werenít able to do that with CIGNA because its claims payment software didnít have the ability to add codes that were G codes at that time or dummy codes. That is why in our contracting structure with CIGNA we agreed to do a statistical model and increase the E&M codes for primary care office visits instead of using the non-visit billing codes. We havenít gotten to that level with Medicaid yet, but because of the design of the Medicaid program there are several codes to use for an e-visit or care coordination. (Dr. Barbara Walters, senior medical director at Dartmouth-Hitchcock Medical Center.)

For more advice on negotiating a solid contract for the medical home model of care, please visit:

Study First to Show Medical Home Produces
Better Care at No Added Cost

A new study published in the September 2009 American Journal of Managed Care provides some of the nation's first empirical evidence of the benefits of the patient-centered medical home (PCMH) model, including significantly fewer ER visits and hospitalizations and an enhanced patient experience. The study compared a random sample of the 9,200 patients at Group Health Cooperative's medical home to a control group. At one year, patients at the Group Health medical home reported:

  • 29 percent fewer ER visits, 11 percent fewer preventable hospitalizations and 6 percent fewer in-person visits;
  • Higher ratings on six scales of patient experience;
  • A 94 percent increase in e-mail use, 12 percent more phone consultations, and more group visits and self-management support workshops;
  • Better healthcare, including needed screening tests, management of their chronic illnesses and monitoring of their medications.

Group Health's retooled approach reduced the number of patients per PCP from 2,300 to 1,800 and invested $16 more per patient over the year in extra staffing: 72 percent more clinical pharmacists, 44 percent more physician assistants, 18 percent more medical assistants, 17 percent more RNs and 15 percent more PCPs. On average, patients at the medical home used $37 more specialty care, perhaps because the enhanced primary care detected previously hidden health problems.

However, Group Health recouped this investment within the year due to ER savings of $54 per patient during the year, according to evaluation leader Robert J. Reid, M.D., Ph.D., an associate investigator at Group Health Center for Health Studies and Group Health's associate medical director for preventive care.

For more information on the study, please visit:

HealthSounds Podcast: Patient Engagement and Education in the Medical Home: Perspectives from Several Pilots

Looking to jump-start patient outreach in the medical home? The appointment calendar is a great place to start, recommends Barbara Wall, a healthcare consultant who advises organizations on adoption of the patient-centered model of care. She describes the simple steps that medical home staff can follow to turn the appointment calendar into a patient teaching, recall and outreach tool.

To listen to this complimentary HIN podcast, please visit:

Quantifying the Benefits of Care Coordination

A new analysis comparing a group of Medicare Advantage plans to traditional fee-for-service (FFS) Medicare quantifies how coordinating and integrating care can lower the rate of avoidable hospital readmissions (a hospital admission within 30 days following a patient's hospital discharge), as well as preventable hospital admissions and ER visits.

Dr. Gerard Anderson, professor at Johns Hopkins University, compared the rates of hospital readmissions and preventable hospitalizations in FFS Medicare to those in Medicare Advantage plans offered by the Alliance of Community Health Plans (ACHP) members — regional and community-based health plans across the country that emphasize coordination of care, integrated systems and close plan/provider relationships.

The study found that:

  • For 2007, the Medicare FFS hospital readmission rate for the country was 18.6 percent. The average readmission rate across the ACHP plans was 13.6 percent — 27 percent less than the national rate of readmissions.
  • On average, ACHP member plans had preventable inpatient hospitalization rates in 2007 that were only 13 percent of the national average. The lowest plan had a rate that was 2 percent of the national average; the AHCP plan with the highest rate was only 28 percent of the national FFS average.
  • The Medicare FFS rate of preventable ER visits was 15.5 visits per 100 beneficiary months in 2007. The range across the 13 ACHP plans was from 0.5 to 7.8 with a mean of 2.2 — 86 percent fewer preventable ER visits than the Medicare FFS program had.
The study also estimates that if the Medicare FFS program had similar rates of hospital readmissions within 30 days and preventable hospitalizations and preventable ER visits as the Medicare Advantage plans offered by ACHP members, the Medicare program would save approximately $10 billion.

For a copy of the report, please visit:

HIN Survey of the Month: Telehealth in 2009

The appropriate use of health IT to optimize patient care is wired into the widely endorsed PCMH joint principles. And as rising healthcare costs fuel much of the healthcare reform debate, healthcare organizations are turning to telehealth to lower costs and improve efficiencies while expanding patients' access to services. Complete HIN's Survey of the Month on Telehealth in 2009 by September 30 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

Complete the survey by visiting:

Healthcare Trends in Mid-2009: A Six-Month Adjustment

Some healthcare organizations have seized the economic downturn as an opportunity to test new programs and services. In a new white paper from HIN, learn some of the surprising programs emerging in a leaner business environment, why the first half of 2009 was better than the previous six months for almost half of responding organizations, the top three issues impacting the industry mid-year and much more.

To download this complimentary white paper, please visit:

MHM Readers Save 10% on Any Session in Medical Home
Open House Webinar Series

  • 10/6/09: Adopting and Implementing Evidence-Based Guidelines in the Medical Home

Other upcoming Open House sessions:

  • 9/9/09: Group Health's Staffing and Roles of the Care Team
  • 9/16/09: Baptist Health Explores Bundled Payments
  • 9/24/09: Practice Transformation Tips from Taconic IPA
For more information on any Medical Home Open House session, click here.

Medical Home Monitor subscribers can use ordering code MHMP for specially priced admission to one or more sessions in the Medical Home Open House series.

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Publisher: Melanie Matthews,;

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