Healthcare Matters

With everyone focused on ways to improve care while reducing costs, the patient-centered medical home concept is on the rise. Better-coordinated care compels significant improvements in the frequency, timing and quality of communication between patients and doctors (or a doctor’s staff), so a great deal of attention is being focused on how to optimally make that happen.

Is something truly innovative going on out there? Not really. What is happening is the “wall’ is coming down and basic communications tools –like email and telephones—are finally being used appropriately. Being able to send an email to your doctor to request a prescription refill is hardly novel, but it is effective. Retraining practice staff to spend more time collecting diagnostic information versus payment data seems reasonable. And following up with patients by making a telephone call to see if they’re feeling better seems like it should have been standard practice all along –but it surely wasn’t.

Summa Health is having noteworthy success in fostering and operating patient-centered medical homes in Ohio. Several practices have become part of what Summa calls the NewHealth Collaborative. Its is an “accountable care organization” formed with 60 area doctors at the base, but includes hospitals and and other health-care providers as well. “For us, the patient-centered medical home is not a place. That’s one of the confusions people have,” said Dom Dera, medical director for NewHealth Collaborative. “It’s a redesign of how primary care is organized and delivered, making it more team-based and highly coordinated. It puts the needs of the patients first. That hasn’t always seemed the case, as primary-care doctors have been pushed to see more patients each day because their payments are tied to volume.”

According to the results of one national survey published in Health Affairs, only 27 percent of U.S. adults can easily contact their primary-care doctor by telephone, get care or advice after hours and schedule timely appointments. Primary-care offices that apply for the voluntary recognition program must prove they provide access, identify and help patients at high risk for chronic illnesses, follow industry recommendations for best practices and support people so they can better manage their own health, said Paige Robinson, NCQA’s recognition program external relations manager. “They also are responsible for assuring appropriate care coordination, referral tracking and solid communication between primary care and specialists,” she said.

Electronic health records are playing a critical role, as they are being scanned to identify patients who are overdue for examinations or various tests. For example, since adopting the new approach, Dom Dera said, his practice has been using its electronic medical records to reach out to any of his 523 diabetic patients who are overdue for blood testing or an eye exam. He also emails patients with lab results or to suggest they start exercising more to lower their slightly elevated cholesterol. “It’s an involved service that I’m not getting paid for,” he acknowledged. “At the end of the day,” he said, “it’s about better patient care, too. This is a better way to engage our patients.”

“We will have several arrangements in place in 2013 that will include care coordination payments and opportunities to share in savings related to quality and efficiency improvements,” said Michael McMillan, executive director of Market and Network Services for the Cleveland Clinic, in an email.

Let’s hope so.

—Tom Finn