Health Affairs: Seattle medical home model pays off

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Transforming primary care into a "patient-centered medical home" model paid off in a two-year evaluation at Seattle-based Group Health Cooperative, according to an article published in the May edition of Health Affairs.

The evaluation compared the medical home prototype to Group Health's other medical centers, showing:

  • The quality of care was higher, patients reported having better experiences and clinicians said they felt less "burned out;"
  • Patients had 29 percent fewer emergency visits and 6 percent fewer hospitalizations, resulting in a net savings of $10 per patient per month; and
  • For every dollar Group Health invested, mostly to boost staffing, it recouped $1.50.

This evaluation prompted Group Health to spread the medical home model to all 26 of its medical centers, which it completed in January 2010, according to the article.

"A medical home is like an old-fashioned family doctor who really knows you as a person," explained evaluation leader Robert J. Reid, MD, PhD, an associate investigator at Group Health Research Institute and Group Health's associate medical director for preventive care. "Patients feel rushed when their doctor visits are too short. Likewise, many primary-care doctors say one downside of the expansion of medical knowledge is that they feel stressed by having to do too much in too little time."

Group Health decreased the number of patients each salaried primary care doctor was responsible for from 2,300 to 1,800. This led to more time for planning, outreach, coordination, staying in closer touch with patients by e-mail and phone, and longer office visits--from 20 to 30 minutes.

Group Health invested $16 more per patient per year in staffing for its medical home prototype. This investment didn't include the necessary health information technology infrastructure, which Group Health already had in place, the article stated.

According to the article, the investment paid off quickly in a broad range of improved outcomes, including better-quality care, better experiences for patients, less burnout for clinicians and cost neutrality in the first-year results. By the second year, most of these outcomes were more pronounced, particularly for costs: the overall return on investment was 50 percent, mostly from curbing visits to emergency rooms and hospitals, according to the study's findings.

For others implementing medical homes, Reid suggests:

  • Invest in primary care by hiring enough clinicians so they can serve their patients well;
  • Involve patients in designing care that comprehensively meets their needs;
  • Have strong leaders who focus on what patients want, clearly articulate those wants and let care teams take charge of their change process;
  • Have good managers who break big changes into carefully staged parts, so teams aren't overwhelmed; and 
  • Invest in health IT, and thoughtfully integrate it into the daily practice of the medical home.