Report: Medical home presents 'promising' model for complex patients
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Researchers from Mathematica, a research firm headquartered in Washington, D.C., who teamed with the Agency for Healthcare Research and Quality, published a summary of their research in the January/February edition of Annals of Family Medicine.
According to the summary, researchers identified 20 organizations nationwide through literature searches, conference presentations and expert recommendations and selected five for more advanced study based on four criteria: they served frail elderly or adults with disabilities, worked with a variety of small primary care practices, coordinated care across medical and social service systems and were in operation for at least two years.
Most of the organizations selected for advanced study worked in partnership with public payors, such as Medicaid, and the number of participating practices in each ranged from 12 to 1,400.
According to Mathematica researcher Eugene Rich, MD, and his coauthors, the five organizations selected for advanced study generally demonstrated the following qualities:
Care coordinators: Although each of the organizations studied varied in how they deployed care coordinators, each hired staff specifically for helping primary care practices coordinate patient care with specialists and social service agencies. “There is a wide variation in how care coordinators are shared with primary care practices across and within each program,” Rich wrote. “Average case manager caseloads range from 40 to more than 1,000 patients, depending on the complexity or severity of the patients in the practice.”
Health IT: Each of the organizations studied requires participating providers to use EHRs and some of the organizations require additional health IT capabilities.
IT support: “Most programs dedicate considerable resources to direct practice support by helping them reorganize workflow and systems and by providing tools to enhance practice capacity,” Rich wrote, adding that some organizations even offer 24-hour call lines for patients.
Quality improvement activities: To achieve quality improvement, each of the organizations studied emphasized the use of EHR and data capabilities to measure quality indicators, such as 30-day hospital readmission rates.
Learning opportunities: Each of the organizations studied provided peer-to-peer and in-person education opportunities, which often focused on technical information, to participating providers and their staff.
Payments: “To ensure consistent and active participation of primary care clinicians in care coordination and team-based care, most programs pay practices for the time spent on these activities,” Rich wrote.
Researchers concluded their summary by acknowledging that patients with complex healthcare needs present unique challenges to healthcare organizations, but suggested that this particular patient population may present opportunities for healthcare organizations to improve outcomes, lower costs, provide better patient experiences and provide high quality care.
They also suggested additional research to answer remaining questions.
“Given the diversity of communities and practices across the country, further studies need to clarify which models are most effective for practices of varying sizes and patient mixes, as well as those that operate in different settings,” Rich wrote.