From the December-January 2010 issue of Treasury & Risk magazine

Reshaping Primary Care

One promising approach to containing soaring healthcare costs involves providing more primary care. In the medical home model, family doctors have long-term relationships with patients and coordinate their care with specialists. Aircraft manufacturer Boeing saw healthcare spending decline by 20% for a group of employees and dependents with chronic conditions whom it enrolled in a medical home pilot called the Intensive Outpatient Care Project in Puget Sound, Wash. After an initial exam, a medical team devised a care plan for each patient and used office visits, phone calls and e-mails to help patients manage their conditions.

The Boeing savings mostly reflected less spending on hospitalizations and emergency room visits, according to an article in Health Affairs. (Boeing declined to comment.) The project also improved patient outcomes, according to the article, including boosting their physical functioning scores and cutting their sick days by more than half.

A number of health systems and insurers have pilot projects under way, and both the House and Senate healthcare reform measures would provide funding for more pilots. To date, medical home pilots have generally shown savings in the range of 7% to 10%, says Edwina Rogers, executive director of the Patient Centered Primary Care Collaborative, a group of employers, insurers, health care providers and others working to develop the medical home approach.

In addition to cutting costs, pilots show the medical home model leads to higher quality care, better patient experiences and improved morale among doctors, Rogers says. While initial implementation often focuses on those with chronic diseases, the model is aimed at the entire population, she says.

"All the research shows us that areas either in this country or across the globe that have strong primary care infrastructures have better health outcomes, lower costs and more satisfied patients," says Veronica Goff, a senior consultant with the National Business Group on Health.

But Goff notes that the primary care system is weak in the U.S., where family doctors earn less than specialists. One part of the medical home approach involves paying doctors for outcomes and managing patients' care, rather than just for procedures, she says.

Steve Raetzman, a senior consultant at Watson Wyatt, notes many doctors and medical providers support the medical home approach.

"The good news is that the big health plans and HMOs are interested in this and are piloting it or implementing it," he says. "It's got real momentum."

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