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Study Finds Few Benefits in 'Medical Home' Care Model
02/27/2014   Reported By: Patty B. Wight

A study published this week in the Journal of the American Medical Association found that one of the first, longest-running "medical home" health reform pilots in the U.S. has yielded few improvements in quality and no reduction in costs. The study has created a bit of a stir among health reform advocates. Patty Wight tells us how it applies to Maine, which is considered one of the pioneers in the medical home movement.

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Patient Centered Medical Homes are more about an idea than an actual place, as the name suggests. And the idea is that primary care providers should take a more proactive approach with their patients. Lisa Letourneau, the executive director of Maine Quality Counts, says the theory goes something like this:

"I communicate with them in a way that encourages them to come in and talk with me about their health problems before they get acutely ill," she says.

Think of those post cards veterinarians send to pet owners reminding them about preventative shots and appointments. It's kind of the same idea for people, but it mobilizes everyone in the primary care practice - from physicians to nurses - to more actively engage in a patient's health.

The goal is to provide better quality, coordination, and access to care. But when RAND Corporation scientist Mark Friedberg studied a medical home in Pennsylvania over a three-year period, he found different results.

"What we found - and we looked at measures of both the quality of care, the utilization of care and costs of care - what we found is, among the 11 quality measures we examined, the medical home implementation was associated in a statistically significant way with improvement on one of the 11 measures."

Quality improvement in just one area and no reduction in costs. Friedberg says he's surprised at the results that run counter to evidence going back decades that a strong primary care system is good for patients on multiple levels. It's the very evidence that led to the creation of medical homes, which debuted around 2008.

"I think that the trouble is when you take that theoretical model and try to apply it to primary care practices," Friedberg says. "And what that means is taking real life primary care practices that are busy, they're under all kinds of pressures, and asking them to transform into medical homes, which is a fair amount of work. That's actually quite hard to do."

Friedberg cautions against drawing broad conclusions about all medical homes from this particular study. Lisa Letourneau of Maine Quality Counts points out that the study examined just one pilot program for three years in the earliest phases of medical home reform.

"Like anything, we learn as we go," Letourneau says, "and I think we've learned a lot about what works to better support primary care transformation efforts since that time."

Letourneau says Maine's approach is a bit different from the one studied. Here, she says, medical homes have a stronger focus on reducing waste, emergency room visits and hospital readmissions. And she says Maine's medical homes integrate behavioral health in primary care practices, something not usually found in other models.

There are about 160 medical homes in the state. One is Orono Family Medicine. Practice Manager David Ako-Annan says six months in to the new model, he's convinced. "I personally believe that it's a promising model for transforming the organization and delivery of primary care," he says.

Ako-Annan says shifting to this model has reduced waiting times. Providers know their patients better. And care has improved through things like having a staff social worker visit patients in their homes. And he says they've gotten positive feedback.

"We cannnot do anything without this," he says. "We need to know our patients. We need to build relationships with patients, so this is one of the ways to do that."

The takeaway from the study, says scientist Mark Friedberg, is not that medical homes are a failed idea. It's how you implement the model and evolve that matters. A University of Southern Maine Muskie School evaluation of Maine's medical homes is expected this spring.

Learn more about medical homes study in the current issue of the Journal of the American Medical Association.


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