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Federal,
State Governments, Insurers test 'Medical
Home' model of Health Care to reduce costs
[Jul 21, 2008] Some health insurers and
other payers, including Medicare and
Medicaid, are
testing
the "medical home" model of care to see if
patient-centered care can reduce later
treatment costs, the New York Times reports.
According to the Times, insurers on average
pay $60 for a visit to a primary care
physician. Experts say that level of payment
allows physicians to spend only a few
minutes with each patient.
The medical home model -- in which "doctors,
staff and patients pull together as one big
health care family" -- pays physicians more
to allow them to spend more time with each
patient to increase accuracy of diagnoses,
focus on preventive care and help patients
improve management of their chronic
conditions, the Times reports.
This focused care would reduce costs for
payers and patients by limiting unnecessary
tests and visits to specialists and curbing
preventable hospital visits.
According to the Times, pilot projects that
involve about two million patients testing
the medical home model currently are being
run in at least six states.
North Carolina's Medicaid program reduced
its costs in 2006 by about $162 million, or
11%, through a medical home project,
according to Mercer.
Pennsylvania Gov. Ed Rendell's (D) Office of
Health Care Reform is collaborating with
Independence Blue Cross, Aetna and Cigna and
some Medicaid providers to create a medical
home pilot program in the Philadelphia area.
The insurers have agreed to invest $13
million over three years in the program,
which will expand to other parts of the
state later this year. In addition, Blue
Cross Blue Shield of Michigan this year will
launch its own medical home program.
BCBSM plans to spend $30 million on the
program, which will involve about 4,900
primary care physicians, according to BCBSM
Chief Medical Officer Thomas Simmer. In
addition, the Medicare law passed last week
authorizes $100 million over three years for
a medical home project.
Increasing PCPs
Advocates of the medical home model hope it
will bring more PCPs into the health care
system. According to the American Academy of
Family Physicians, only 7% of medical school
graduates last year chose family practice.
Family practice physicians have annual
incomes of $150,000 on average, according to
AAFP. American Medical Association officials
said that in 2006 there were more than
251,000 family physicians, general
practitioners and internists practicing,
compared with almost 472,000 specialists,
whose incomes are typically higher.
The Medical Group Management Association
said that gastroenterologists have incomes
of about $406,000 annually and cardiac
surgeons have incomes of about $433,000 per
year.
Opponents
Opponents of the medical home model are not
convinced the extra money paid to create and
maintain a medical home will yield savings,
the Times reports.
"There is very little concrete rigorous
evidence that the medical home will do all
those wonderful things they want it to do,"
Mark Pauly, a health policy economist at the
University of Pennsylvania's Wharton School,
said.
Don Liss, an Aetna medical director, said
that a "reasonable body of evidence suggests
that improving primary care as a foundation
for health care will improve quality and
access to care" but that there is no
guarantee that it will provide savings on a
"reasonable time horizon" (Freudenheim, New
York Times, 7/21).
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