Group Health Cooperative in Washington State is a staff model, integrated delivery system-based health plan. Like many health plans it has begun experimenting with the medical home concept and launched a pilot in one of its clinics. The pilot has been evaluated after a year and the evaluation reported in the American Journal of Managed Care. (AJMC Article) Group Health’s objectives were to enhance patient experience, reduce staff burnout, improve clinical quality and reduce emergency, specialty and avoidable hospitalization costs.
After a year, patients reported a better experience in the medical home model, particularly on access to care and the quality of their physician interactions. Staff had less burnout and clinical quality improved more than in the traditional clinics. There was no increase in overall cost, including the cost of running the program. Primary care visits were down slightly and specialty visits were up, emergency room use was down significantly and hospitalizations were roughly the same. Patients in the medical home demonstration used email and phone consultations much more frequently, which likely accounts for the decrease in primary care visits and emergency room use. The increase in specialty use also may be consistent with referral to the provider most likely to fix the problem correctly the first time.
While overall “quality” appears improved, it may be surprising that there are no cost savings. This was, however, just the first year of the program and more savings may appear over time. At this point, however, there is little evidence from this pilot that a medical home model will create significant savings. It should be noted, however, that this pilot was undertaken in a system which is already likely very cost-efficient. The same pilot in a pure fee-for-service system might result in higher savings, but also would likely be harder and more expensive to implement.