Home Is Where The Health Is
An ongoing criticism of the current health care system is that it’s fragmented. The pieces don’t fit together, there are duplicate pieces and other pieces are missing. For many patients, this leads to a disjointed service experience at best, and a clinically ineffective or harmful experience at worst. For employers, it means higher bills, because someone ultimately has to pay for all the inefficiencies.
One possible answer to the problem is the patient-centered medical home, or PCMH. PCMHs are medical practices or clinics that essentially become supervisors of their patients’ entire and ongoing interaction with the health care system. They develop care plans for patients based on their immediate and long-term health care needs and coordinate the care their patients receive not only from their practice but from other providers like pharmacies, medical specialists, hospitals and rehab facilities.
A PCMH’s goal is giving patients a seamless experience and providing them with the right care at the right time in the right setting. In theory, that should save everyone money, including employers. PCMHs may charge more up front for the comprehensive services they provide. But that extra cost should be more than offset by savings accrued from PCMHs eliminating duplicative, unnecessary and avoidable use of other health care services by their patients.
Nearly 60 percent of the 359 health care homes serving Minnesota residents at the end of 2014 were located in the greater Twin Cities area.
Source: Minnesota Department of Health
To be recognized as a PCMH, a medical practice must meet certain criteria that enables it to do what it’s supposed to do. There are a number of national private-sector accreditation organizations that will do so for a price if the practice or clinic meets their standards. Among them are the National Committee for Quality Assurance (bit.ly/XECdsf), which accredits more than 10,000; the Accreditation Association for Ambulatory Health Care (bit.ly/1ob2Sbl), which accredits 447; Joint Commission (bit.ly/1KWagx7), which accredits 151; and URAC (bit.ly/1JGdDri), which accredits one.
Always on the leading edge of health care innovation—and believing that it can do anything better than anyone else—Minnesota launched its own certification program for PCMHs in 2010. Minnesota calls its PCMHs “health care homes” or HCHs. To date, there are 384 HCH-certified medical practices in the state or in neighboring states that treat Minnesota residents, according to the latest data from the Minnesota Department of Health (bit.ly/1LSWAZa). That’s up from 359 at the end of last year. Of those 359, nearly 60 percent were located in the greater Minneapolis-St. Paul metropolitan area (see chart).
More important than numbers to patients and employers who pay their health care bills, though, is whether PCMHs work. A new study and one of the most comprehensive looks at PCMHs says yes.
Researchers studied the three-year impact of a PCMH project serving the northeast Pennsylvania market. They compared enrollees in two health plans cared for by 27 PCMHs and 29 non-PCMHs. Patients in PCMHs got better diabetes and preventive care, were hospitalized less frequently, went to the ER less frequently and saw medical specialists less frequently than patients in non-PCMHs (bit.ly/1QMYEB4).
The physicians in the PCMHs got bonuses of up to 50 percent of the savings they generated from controlling their patients’ use of other health care services as long as quality of care didn’t suffer. The bonuses are important financial incentives, as the cost of becoming a PCMH and maintaining the staff and resources to operate as a PCMH can be quite high. One recent study said being a PCMH adds nearly $40 in cost to each patient office visit (bit.ly/1iOrBBL).
For employers, PCMHs may be a bargain, especially if they’re available through their health plans for workers with chronic medical conditions like asthma, cancer, diabetes, heart disease and obesity. With the right incentives in place, PCMHs can help those employees manage their illnesses, keep them as healthy as possible and appropriately access healthcare services when needed.
A new study looked at the influence of workplace food factors on the weight-related health of young employees. The latest data from the Centers for Disease Control and Prevention peg the number of obese adults at 78.6 million, or nearly 35 percent of the adult U.S. population (1.usa.gov/1jLJkId). Obesity is tied to a host of health problems, including heart disease, stroke and diabetes. Health researchers from the University of Minnesota wanted to know whether office life is adding to those numbers and making employees sick (bit.ly/1jvrlrY). They examined the impact of five workplace food factors on the obesity rates of more than 1,500 employed young adults:
- Proximity to fast-food restaurants
- Availability of sweets and other snacks
- Availability of soda and other sugary drinks
- Coworkers’ healthy eating habits
- Ease of eating a healthy diet at work
They found that obesity rates rose as the workplace food environment got worse. For instance, 20.4 percent of employees in the least healthy work settings were obese compared with 16 percent of employees in the most healthy work settings.
Patient safety is a regular topic in this column. The safety of patient care is highly variable at hospitals, urgent care centers, ambulatory surgery centers, medical practices and more; my position is that employers have a responsibility to steer employees to the safest providers possible (bit.ly/1OAg872). One of the federal government’s big efforts to boost patient safety is called Partnership for Patients, which began in 2011. The program funded networks of hospitals and health systems called Hospital Engagement Networks. HENs were charged with coming up with strategies to meet the program’s twin goals: keeping patients from getting injured or even sicker while being treated and helping patients recover without avoidable medical complications like infections. The government doled out $218 million to 26 HENs over the first three-year phase of the program, which ended in 2014. Patient safety improved but still fell short of the improvement targets set by the program. So the feds just announced a second round of funding—some $110 million for one year—that will go to 17 HENs still participating in the program (go.cms.gov/1VlJmdj). One of the 17 is the Minnesota Hospital Association, which got a $2.5 million slice of the funding pie (bit.ly/1KOABhK). The MHA target safety areas include adverse drug events, patient falls and severe sepsis and septic shock. Let’s all hope it’s money well spent.
David Burda (twitter.com/@davidrburda, firstname.lastname@example.org) is editorial director, health care strategies, for MSP-C, where he serves as the chief health care content strategist and health care subject matter expert.