Medical Home Key to Cost Control in Group Health Cooperative, Says CEO

Tuesday, February 15th, 2011
This post was written by Patricia Donovan

Interesting Kaiser Health News interview with Group Health Cooperative CEO Scott Armstrong on the state of health co-ops and how Group Health keeps costs down. I wasn’t surprised to hear Armstrong say that the patient-centered medical home model has been key to health cost control at Group Health:

Q. (Kaiser Health News): What has been the biggest thing that you’ve been able to change to keep costs from rising so quickly?

A. (Armstrong) The change in our primary care practice, often referred to as a medical home, is a great example. We have changed the schedule patterns for our primary care providers basically giving them much more time with every patient. We’ve changed how our nurses and pharmacists work collaboratively with our primary care doctors to manage the care for a panel of patients.

We are reaching out to patients who are overdue for visits, scheduling time for e-mail and phone visits and overall being a much more assertive coordinator of our patients’ care. The results have been amazing, … showing that investing in primary care in an integrated system like this will drive — by almost 20 percent — emergency room visits down, will drive hospital utilization down by more than 10 percent.

Armstrong echoes the sentiments expressed by Michael Erikson, Group Health’s VP of primary care services, two years ago when he walked through the results from Group Health’s medical home pilot during a 2009 Healthcare Intelligence Network webinar. Even then, many were calling the cooperative “a model for healthcare reform:”

At that time, Erikson said the critical elements of the medical home pilot included call management (using the most underutilized technology, the telephone); visit access, virtual medicine, chronic disease management, visit preparation, an outreach workcell, and smaller patient panels for providers.

Erikson also said that at the one-year point, ER and urgent care visits were down 29 percent and avoidable hospitalizations for chronic illnesses were down 11 percent. It looks like the model continues to perform today, since Armstrong reported similar reductions in this week’s interview.

Armstrong also shared some novels ways in which Group Health engages its patients in treatment decisions — including the use of DVDs— and has increased patient satisfaction in the process:

We have about a dozen specialty procedures where we are making the time to, through the use of DVDs and through interviews with our providers, involve our patient in an objective evaluation of two, three, four different alternative therapies or approaches to dealing with their issue whether it’s hysterectomies, knee replacements other joint replacements.

In some of these high-volume procedures, we’re seeing a 10-to-12-percent drop in the procedure rate itself. We’re finding that patients are thrilled to be involved and to know really what the implications of these choices are. We’re finding that the providers are very gratified by the fact that they are able to engage in this dialogue with their patients.

It will be interesting to see whether the number of health co-ops increases in the coming years. The health reform bill provides for federal loans to fund Consumer Operated and Oriented Plans (a.k.a. co-ops), but there are actually very few health co-ops in the country today.

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