Without hesitation, Dr. Allan Korn, the Blue Cross and Blue Shield Association's chief medical officer and senior vice president for clinical affairs, declared that the patient-centered medical home has the potential to transform the U.S. healthcare system.
"The things you want going up are going up, and the things you want going down are going down," said Korn in an interview following his appearance Monday on a panel assessing the state of the healthcare industry presented in San Antonio at the MGMA-ACMPE's annual conference. "There's no question that the medical home is working, and that's what's gratifying to me."
While speaking on the panel, Korn said he thinks steps could be taken to improve the patient-centeredness of the medical-home practice model. Still, he said later, medical homes—which use information technology to coordinate care and track the treatment of patients who have chronic diseases—have led to double-digit declines in patients' exposure to radiation from diagnostic tests, in "ambulatory-sensitive" hospital admissions, and in unnecessary and costly healthcare episodes.
They have also boosted physician satisfaction.
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Pathologists are integrated thoroughly into patient care at Cooper University Hospital, Camden, N.J., and this is by design—architectural design, that is.
The new $163.7 million Roberts Pavilion at Cooper was one of 105 entries in the 27th annual Modern Healthcare Design Awards contest. It was one of 11 winning designs, and EwingCole architects took home a Citation award for their work. What caught my attention, however, was that the architects said that special care was taken to locate the "clinical and anatomic pathology departments to enhance increased involvement of pathologists in the patient treatment stream, a fundamental shift in the role of pathology."
"We love it, it's gorgeous," said Dr. Roland Schwarting, Cooper's pathology department chairman and chief. "What I love about it is it's an integrated design.”
Schwarting explained how, typically, pathology departments and hospital laboratories are fragmented into various silos, hindering communication and collaboration. He said that on paper, it would amount to a very confusing "spaghetti diagram," with arrows pointing every which way to connect the various functions. One can still use a spaghetti diagram to illustrate the department's operation at Cooper, but "the noodles are not as long," Schwarting said.
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If the patient-centered medical home supported by per-member, per-month care-management fees becomes the standard primary-care practice model, then Oregon Health & Sciences University in Portland can claim to be its first training ground.
When the CMS announced the names of the 500 participants in its four-year Comprehensive Primary Care Initiative, the list included three OHSU primary-care clinics where residents are trained.
The CPCI begins with Medicare providing a $20 per-member, per-month care-management fee, with that sliding back to about $15 after the second year, when practices will be eligible to collect money from shared savings. Some private payers and state Medicaid programs are also participating in the CPCI, and—with Medicare, Medicaid and private payers combined—the program's goal is to have at least 60% of the participating practices' patient base covered by per-member, per-month fees. The intent is to have the practices use that money to invest in the staff and information technology necessary for care-coordination services that should help lower hospitalizations, eliminate duplicate testing and avoid other inefficiencies that drive up healthcare costs.
Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans of Grand Junction, Colo., says the program has the potential to "fundamentally change the economics of primary care."
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The 500 medical practices participating in the CMS Comprehensive Primary Care Initiative are going to be under a lot of pressure, as it is now up to them to prove that the patient-centered medical-home model works clinically and economically.
Let's face it: Government-sponsored pilot programs and demonstration projects come and go. Most produce some headlines at their launch, then they generate a few research papers a year or three after their completion, and then they're forgotten.
But hopes are higher for the CPCI, which was described as "very well-conceived, well-designed and, so far, a well-executed program" by Patrick Gordon, program director for the Colorado Beacon Consortium and director of government programs for consortium member Rocky Mountain Health Plans based in Grand Junction, Colo., an area contending for the country's coordinated-care crown.
The key to the four-year effort is that around 60% of the patient bases for participating practices will be covered by plans providing per member, per month management fees. In the case of Medicare, it will be $20, with the fees for Medicaid and other participating private payers yet to be determined.
According to Gordon, it could "fundamentally change the economics of primary care" if the care coordination results in fewer hospitalizations and lower global costs to the country's healthcare bill.
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