Live from the Health Management Congress: Virtual Medical Home Goes Where the Patient Is

Thursday, July 24th, 2008
This post was written by Melanie Matthews

Ten years ago, disease management (DM) was being touted as the “silver bullet” of healthcare. But after 10 years of trying and experimenting, it’s not clear that DM is working, said Dr. Jeffrey Robertson during a keynote session during day 2 of the Health Management Congress in Orlando.

Citing data from a 2007 Rand study, Regence Blue Cross Blue Shield’s executive medical director said that while patients love DM programs, changing behavior is hard, required hospital and pharma data is not always timely and care providers are not always engaged.

But the news is not all bleak. Many health plans in attendance have found that addressing and managing a member’s behavioral health issues may be the key to improving compliance and outcomes. A case in point: A patient-centric model of delivery in place at Family Care Health Plan in Portland, Ore. provides a “virtual” medical home for its Medicaid/Medicare members, addressing the mental and physical health of it population.

Family Care’s COO Rebecca Chi described the the initiative as a “fluid, moving, mobile medical home that moves where the patient is.” Family Care’s service coordinators work within the network of IPAs and clinics the plan has created, reducing physicians’ workload by reviewing members’ care plans, conducting medication education and performing other tasks.

But for the 20 percent of Family Care’s population with behavioral health issues, “their medical home doesn’t start in primary care but in a mental health setting.” If a member’s care is primarily delivered by a mental health provider, Chi said, then that is where that member’s medical home is,”in a setting the member knows well so that they don’t have to re-tell their story.”

Family Care’s model eliminates redundancy and identifies barriers to optimal care delivery, such as transportation. “It’s more cost-effective to spend $20 on a taxi for a member than pay for an ER visit that could have been handled by the PCP.”

All data resides in one place and is easily accessible to all providers, which has cut down on the over-prescribing of mental health drugs.

Overall, Family Care has seen reductions in ER rates, hospitalizations and mental health in-patient days, as well as increases in immunization rates. “We (Oregon) no longer wanted to be the bottom of the barrel in immunization rates,” Chi said.

The success of the program has inspired Family Care in other areas. The health plan successfully boosted the number of members “established” with PCPs within 90 days by offering members a $10 gift card to visit their doctor. Members were greatly motivated by the incentive, Chi said.

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