Call it Medical Home 2.0.
Baylor’s Health Texas Provider Network, Village Health Partners of Plano, and consulting firm Mercer are teaming up to create a medical home for high-risk patients, or what could be called a chronic patient-centered medical home.
Mercer is working with an unidentified 6,000-employee Dallas-area firm to stratify the top 20 percent of workers who are likely to spend the most on healthcare. According to the federal Agency for Healthcare Research and Quality, the top 20 percent of patients incur 80 percent of healthcare costs.
According to Eric Bassett, a consultant in health and benefits in Mercer’s Dallas office, the patients have conditions amenable to intensive primary care, such as diabetes, high blood pressure, congestive heart failure, and heart disease. He said these employees have a high rate of hospital emergency-department usage and suffered complications because of poorly coordinated care.
Bassett said 40 percent of the identified employees participate in the program, which he said is nearly triple the normal rate. In some cases, employees had to change primary-care doctors.
The model is based a pilot project at Boeing Co. in Seattle by Mercer, the Robert Wood Johnson Foundation, and the California Health Care Foundation in the late 1990s. Called the Intensive Outpatient Care Program, it lowered healthcare costs by 20 percent, increased physical and mental functioning by about 15 percent, and cut absenteeism by more than half.
Bassett said the 20 percent savings is unprecedented in his 26 years of experience. The Dallas pilot, which is being replicated in Richmond, Va., should have results by this spring.
Bassett said the most popular program component is having a nurse assigned to each program participant to coordinate care. Participating physicians also agree to around-the-clock call coverage, with a 30-minute guaranteed callback.
Physicians are reimbursed at higher-than-normal rates through a management fee paid by the employer. Bassett said he hopes the program evolves to where the employer is sharing cost savings with the providers.
He is talking to other DFW employers about adopting similar strategies.
“I haven’t met an employer who doesn’t like (the program). The fundamentals make sense,” he said.
According to Christopher Crow MD, founder of Village Health Partners, “this ‘extra caring’ means being accessible to the patient—through extended evening and weekend hours and ‘virtually’ via online access. It means using a physician-led team of healthcare providers to coordinate the care of patients to achieve high-quality outcomes at reasonable costs.”
It’s a win-win, said Cliff Fulerton, MD, chief quality officer with Baylor’s Health Texas Provider Network.
“Providing new resources and new incentives to mature primary care practices allows them to better serve the most at-risk patients, while creating the value we need from our healthcare system,” he said.
Steve Jacob is editor of D Healthcare Daily and author of Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected].
