‘Medical home’ program gains traction [The Post-Star, Glens Falls, N.Y.]

Oct. 07--An experimental program in regional collaboration between health care providers and insurance companies has been "pretty remarkably successful," said Dr. Dennis Weaver, a consultant on the project.

Health care costs for patients covered by commercial insurance companies decreased from $380 per-patient-per-month in 2009 to $316 in 2012, while costs for Medicaid patients dropped from $334 to $266, respectively, according to a recent "risk adjusted" analysis.

Health care executives and government officials said various statistics show the four-year-old Adirondack Medical Home program is meeting it goal of reducing health care costs, improving wellness and making the system easier for patients to access.

The program involves hospitals in Plattsburgh, Saranac Lake, Elizabethtown, Ticonderoga and Glens Falls, and health centers in the areas those hospitals serve.

Not all providers have been in the program the entire four years.

Costs were reduced by redirecting patients from hospital emergency rooms to health centers, and using care managers to encourage patients to get preventative care so patients are hospitalized less often and follow-up care so fewer patients are readmitted to a hospital after an illness or surgery.

Electronic medical record systems enabled health centers, specialists and hospitals to share medical information more efficiently.

Negotiations are beginning to use the experimental program, which ends in about one year, as the basis of a permanent program.

"We have the care management resources in place, the statistical systems in place, the electronic medical records in place, and are ready to go to the next step," said Dr. John Rugge, chief executive officer of Hudson Headwaters Health Network.

The concept of the "medical home" hearkens back to the days of having a family doctor who tended to virtually all of a family's medical needs.

Under the medical home, each patient is assigned a primary care physician, who works with a team to coordinate care to take place in the most appropriate setting.

"Usually that most appropriate setting is within that physician practice, and that's why it's called the 'home.'" said Paul Scimeca, vice president of physician practices and community health for Glens Falls Hospital.

What is different from the era of the 1950s and '60s is the use of computer technology.

The Adirondack Medical Home established a shared medical records data base, and an e-mail and telephone message system for patients to ask questions of their physician and for health centers to remind patients of appointments and necessary lab work or medical testing.

The program was conceived as a way to recruit physicians, who were reluctant to practice in the Adirondacks because it was not financially feasible, said Weaver, the consultant.

"What the general agreement was is that we will deliver care a little differently, but in exchange for that there would be an augmented payment stream, particularly in the beginning, for primary care providers to practice in a different way," he said. "We've gone from losing docs to gaining docs."

That "different way" has included the teams that work with physicians to coordinate care.

"At Hudson Headwaters, we have seven new job titles for people doing different components of the medical home," Rugge said.

The concept fits with aspects of the President Obama's health care reform plan, which calls for better coordination of care, said U.S. Rep. Bill Owens, D-Plattsburgh.

"There are probably 20 of these (medical home experiments) around the country, all of which have had similar outcomes ... not all at the same rate," he said.

The local medical home program has been subsidized by the state and federal government, providers and insurance companies.

The largest funding was a $7 million state grant that was matched by the other participants, Rugge said.

"This is one where everybody was asked to contribute," he said.

The results have given health care and insurance executives and government officials the confidence to continue making investment.

"Initially this had to be done on a hope and a prayer and a gamble in a plan. Now the idea is we can continue to afford to continue those programs because we're seeing savings elsewhere in the system," Rugge said.

One of the challenges going forward will be figuring out how to keep hospitals financially viable as fewer patients are hospitalized or seeking treatment in hospital emergency rooms.

Glens Falls Hospital has experienced an 11-percent reduction in emergency room visits last year, for example, and Champlain Valley Physicians Hospital in Plattsburgh had a 42-percent reduction in patients being readmitted after being hospitalized, Rugge said.

"So we're kind of in an interesting situation while the whole health care system is in transition," said Scimeca, the Glens Falls Hospital vice president.

State Health Commissioner Nirav Shah recently announced the state is establishing a planning group to discuss how to keep North Country hospitals and nursing viable, Rugge said.

"In the same way that the state helped us to together tackle the primary care crisis, now we need everybody pulling together to re-frame the entire system so it comes off stronger and better than it is," he said.

It is expected that eventually payment methods will evolve from paying by the service to a system where a collaborative, such as a medical home program, will be paid a basic fee per patient, which would be divided up between the participating providers, Scimeca said.

"It's the direction of where we're all moving in the future, and we're very excited to be a part of that," he said.

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