Dr. Neil Siegel, UniversityCare at Edmonson Village, talks… (Kim Hairston, Baltimore…)
Maryland will soon join a growing list of states in crafting a new way to deliver health care — one that pays doctors extra to both improve quality and cut costs.
The pilot program, which involves 200 doctors and 200,000 patients, will test whether "patient-centered medical homes" can bolster primary care, particularly among the chronically ill, and avoid expensive treatments and emergencies.
Participating doctors will focus on prevention by developing disease-management plans and more closely tracking prescriptions and trips to specialists. They will also provide extended hours, same-day appointments and electronic communications.
"By focusing on prevention and wellness we can take a big bite out of chronic disease," said Lt. Gov. Anthony G. Brown, who is overseeing health care reforms in Maryland. "And if people visit the emergency department less, costs will be reduced."
Brown, who will announce the participating medical practices in January, said the medical home idea has been floated for years by doctor groups but moved to the forefront during the national health care debate. Maryland's program was created by the General Assembly this year.
Many providers and insurers have begun pushing preventive care more aggressively and the federal government is encouraging such programs. More than two dozen states have launched even more coordinated efforts, like Maryland's.
No one is certain the state program will prove better or cheaper in the long run, but early reports have made Brown and other officials optimistic.
As in other programs, Maryland practices will receive from $4 to $6 per patient per month from the five major health insurers and Medicaid to make their medical teams more available and to develop plans for those with hard-to-manage health problems such as diabetes and heart disease. Doctors will also share in any savings if their patients use the emergency room less and spend fewer days in the hospital.
Even before the state pilot begins, some local practices and insurers have launched their own programs based on the medical home model, which gets its name because a practice serves as a base for a patient's care.
UniversityCare in Edmondson Village, a family practice in West Baltimore, said it was the first in Baltimore to gain recognition as a patient home from a national standards-setting organization in July. Its doctors aren't paid more now; the practice began its transition to the model about two years ago to improve care and hopes insurers will eventually provide more compensation.
Dr. Neil Siegel, medical director of the practice and two others affiliated with the University of Maryland Medical Center, said all of the office's 11,000 patients will benefit from added evening office hours and same-day appointments.
A new electronic records system tracks preventive measures such as mammograms and inoculations, medications, tests and visits with specialists. It also monitors trends among the chronically ill to better help treat individual patients.
"It will definitely take time to adjust," he said. "But a national transformation to this method could mean higher patient satisfaction and more consistent and coordinated care."
Already sold on the program is Joyce Hunter, a longtime UniversityCare patient who is being treated for diabetes. She's said the changes make her more confident in the care provided because the whole medical team can see her doctor's plans for keeping her healthy on the computer. And she appreciates the online services — she can get test results, ask questions, refill prescriptions and make appointments.
"It's all very convenient and everyone is on the same page," she said. "I'll still go to the emergency room if I need to, but I'm less likely to need the emergency room."
That's what attracted Maryland's largest insurer, CareFirst BlueCross BlueShield, to the medical home model. Chief executive Chester "Chet" Burrell looked at the statistics from its members: 5 percent, or about 3.5 million people, were making up to 40 percent of claims, mainly by going to the hospital. They had multiple chronic illnesses affected by their lifestyles. And about 70 percent of patients in general were not taking their medications as directed.
He said better management of high blood pressure, asthma, diabetes and other such maladies was needed to "bend the health care cost curve." He started his own demonstration program based on the medical home model two years ago and, in January, plans to open the program to all 5,500 doctors in the network in Maryland, Virginia and Washington. So far, 2,500 doctors have signed on.