'Medical home' concept would bring new kind of health care

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A coalition of insurers, health care providers and employers are designing a pilot program to launch the "medical home" concept in doctors' offices around the state.

Conceived by the American Academy of Pediatrics, a patient-centered medical home is a new way to deliver health care, both in how patients are treated and how doctors are reimbursed.

Instead of being rewarded just for procedures, doctors are paid for taking time out of the examination room to coordinate continual care.

Patients, as a result, are treated in a more holistic manner, with an emphasis on healthy behaviors and prevention - not just acute care, said Michael Magill, chairman of the University of Utah School of Medicine's Department of Family and Preventive Medicine.

The concept, which has the potential to become a cornerstone of health-reform efforts in the U.S., has already taken root in Utah.

Intermountain Healthcare and others are striving to use the model, while the state's Medicaid program is pairing its emergency room "frequent fliers" with primary care providers.

A medical home is a good idea because "it has the promise of reducing costs and providing high quality care," said Mike Tanner, human resources manager at O.C. Tanner. "And because over the last 30 years, we've tried just about everything else."

The company's average per-person cost of insurance has spiked from $280 in 1977 to $9,000 in 2007, he said.

What the medical home concept is not, Magill stressed to the Legislature's Health System Reform Task Force Thursday, "is a return to managed care - it is not a return to the failed model of gatekeepers and it's not tied to any one insurance plan."

Using team care to promote self care could be accomplished by using electronic medical records to reach out to patients - before problems arise, said Robert Wheeler, medical director for Regence BlueCross BlueShield of Utah.

"If a person is advised to get a test and doesn't get it," he said, "you have a system in place that says, "We expected that test and didn't get it - now what?"

Planning for the pilot project, slated to begin in 2010, will last a year or more and cost about $250,000 - to be provided by groups invested in it.

Wheeler said eligible doctors' practices will be divided into two groups. One will be given money to report their health outcomes, while the other - also paid to report outcomes - will receive "enhanced interventions," including care managers and electronic registries.

In the end, the pilot will quantify the savings and help determine how much money could be diverted to creating such programs all around Utah.

However, Rep. David Clark, R-Santa Clara - the task force's House chairman - expressed concern that because the pilot program is largely a private sector effort, any information produced by the pilot will be proprietary. Groups that participate should agree up front to share their data, he said.

"That ought to be in the first page of any agreement you have with any of these folks, signed in blood," he said.