There are several major efforts underway to address perceived shortcomings in the US system of health care, with the hope of both improving quality and reducing costs. One of these is the medical home concept. Most versions of this concept focus on highlighting the role of the primary care physician in overall coordination of and responsibility for a patient’s care. A number of pilots and conversions are underway. The American Journal of Managed Care carried research on early results from the Geisinger Health System’s medical home conversion. (AJMC Study)
Geisinger is an integrated payer/provider group. It has implemented an advanced EMR and other IT systems for several years. Geisinger took several of its primary care sites and converted them to what it calls a ProvenHealth Navigator model, applied to Medicare patients. The study looked at the impact of the model on hospital admissions, readmissions and total medical spending (not including drugs). The comparison was both to patients treated at the same Geisinger sites, but not under ProvenHealth Navigator, and to non-Geisinger practices. Key components of the model were intensive use of nurse case managers and heavy reliance on good data analytics to identify care needs and gaps in care.
The ProvenHealth Navigator model reduced admissions by about 18% and readmissions by 36%. Total medical spending was down about 7% but this result was not statistically significant. Several cautions, most of which were noted by researchers, are in order. Often in these models drug spending goes up when other spending is down. Not including it may be misleading on total spending, although the researchers performed a separate analysis which indicated that drug spending did not increase. The costs of the model conversion and implementation do not appear to be included. Those could be substantial and might make a full economic analysis show no savings. Geisinger is an unusually advanced system, both in terms of IT capability and in orientation toward quality and care process improvement. It would likely be much costly and more difficult for most primary care practices to adopt a model like ProvenHealth Navigator. Nothwithstanding these caveats, the improvement in the quality of the care, both in process and outcomes, would seem to be obvious and that should always be the primary goal of changes in any health system.