SEATTLEAn evaluation of recent innovations in delivering primary care at a Group Health Cooperative medical center shows significant success and rapid return on investment. The data led to a decision to invest in these best practices in all of Group Health's 26 medical centers by 2010.
"Group Health has for many years focused on delivering quality, coordinated primary care, supported by fully integrated electronic medical records," said Group Health President and CEO Scott Armstrong. "This was an effort to bolster primary care furtherand really test what we believe: that excellent, proactive primary care will lead to better health outcomes at lower cost."
"At a time when resources are tight, we are so confident in our findings that we are hiring more primary care doctors, physician assistants, and nurses, because we believe this is the best way to achieve our goal of excellent affordable care," Armstrong said.
In one year, Group Health's Patient-Centered Medical Home pilot, compared to controls:
- Broke even on its primary care staffing investment through reduced downstream utilization costs. Emergency room/urgent care visits were 29 percent less and inpatient hospital stays for patients with conditions including diabetes, chronic obstructive pulmonary disease, congestive heart failure, and asthma were 11 percent less.
- Improved indicators of quality of care. Overall improvements were 1.6 times greater across 22 measures than in controls. In seven out of 22 measures, the proportion of people meeting their target went up by more than 5 percent over one year. One example is cholesterol management (LDL less than 100mg/dl) for people with heart disease.
- Enhanced patients' experience, including better bonding between patients and their physicians and care teams as well as better care coordination.
- Improved care teams' work satisfaction and reduced their emotional burnout.
"We saw these improvements in a system and a region that already compare well with the rest of the nation," Armstrong said. "Group Health and Washington state have relatively high-quality care and less overuse of hospitals. The pilot raised the bar even higher."
The Patient-Centered Medical Home pilot placed more emphasis on doctors and care teams proactively engaging patients in their health and investing more in care coordination. This resulted in more proactive phone visits, secure e-mailing, and more detailed face-to-face visits.
- Physician panel sizes (the number of patients for whom each doctor is responsible) were reduced from 2,300 patients to 1,800 patients.
- Appointment times were extended to 30 minutes, from 20 minutes.
- Group Health increased its primary care staff by 30 percent to reduce physician-panel size and expand multidisciplinary clinical teams: doctors (family doctors and general internists), physician assistants, nurses, medical assistants, and clinical pharmacists.
- Proactive staff-to-patient outreach increased, including clinical team analysis of each patient's needs, communication with the patient days before appointments, and detailed follow-up after it.
- Use of e-health technology was maximized, including electronic medical records and increased contact with patients through secure e-mail and phone.
- Decreased downstream utilization led to return on investment.
"These results lay the foundation for the initial return on investment to be extended in long-term cost savings well beyond the first year," said Michael Erikson, vice president for primary care administration. "We believe the reduction we saw in our care teams' burnout will result in less turnover and recruitment costs for physicians and other clinical staffperhaps up to $2 million dollars a year, across all recruiting areas for our primary care clinics," he added. "This addresses a fundamental area needed in health care reform to solve the shortage of primary care doctors: drawing physicians to get more opportunity to serve their patients' needs over many years."
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