Health care leaders discuss 'medical home' model
Innovative approach to primary care strengthens relationships, enhances health while saving money
By Maileen Hamto, CareOregon Communications Writer

Doug Eby, physician executive for the Southcentral Foundation

“We think the work is about getting the correct tests, the right pills and the right procedures, but that’s just the start,” said Doug Eby, executive for the Southcentral Foundation, a Native Alaskan health care company championing the medical home model that is changing the way primary care is delivered.

The organization has successfully improved health indicators among their population, while also lowering costs. “The work really is about impacting behavioral choices and decisions that people make when they’re not in the presence of their physician.”

Eby addressed Oregon’s health care leaders, legislators and medical professionals at the “Oregon Health Plan and the Safety Net: Reform, Rally and Kickoff” event held in December.

The event builds upon discussions held in 2005, when almost 250 policymakers, health care professionals, managed care organizations, community health centers, and advocates met to strategize on ways to address the growing health care crisis and the dramatic increase in uninsured and underinsured Oregonians.

According to Eby, SCF has seen a 50 percent reduction per capita use of emergency room services, a 35 percent reduction in hospital days, and a 65 percent reduction in utilization of specialty services. “We’re providing much better care at much less per person cost. The satisfaction ratings for customers and employees are markedly improved,” he said.

What’s the secret to their success? A solid understanding that health care is a service-driven industry, and a dedication to effectively managing “messy human relationships.”
 
“Whether people get chronic conditions and whether they manage their chronic conditions well almost entirely depends upon what they do when they’re not in our presence,” said Eby. “Dealing with people who seek health care answers, we applied tangible, circular, multi-directional thinking. Our goal was to modify behaviors.”

Building continuous, personal and accountable partnerships with patients is central to SCF’s mission. Half of each physician's schedule each day is reserved for same-day appointments, so patients have access to their provider when they need it.

Doctors work alongside case management nurses to provide team-based care for patients. Families are encouraged to sign up for the same care team, so they can get to know their providers better. The compensation structure also is different, because providers don’t get paid per patient visit.  

“When patients have more power, when we respect them as people in charge of their own health issues, when we work with them as partners as they make their own health choices – they choose less medication, less procedures and lower costs,” said Eby.

“We’ve been willing to walk in a long-term, respectful, personal, trusting, and accountable relationship over time with the patient in the context of their culture, their family, and their community -- mindful of their preferences, biases and goals over time.”

CareOregon’s Care Support and System Innovation (CSSI) program will pilot the medical home model in a small number of network clinics, said Dr. David Labby, Medical Director. With the go-ahead from the CareOregon board and support from the state to explore new methods of reimbursement to make the model sustainable, the CSSI “Primary Care Renewal” initiative was launched at the annual CSSI meeting in October. 

Proposals from clinics are currently being reviewed.  CareOregon will provide funding support, project management staff, technical support, and training as clinics work out the details of applying the medical home model in each of their own settings.

“It is called ‘renewal’ because this is the way those who went into health care thought they would be practicing when they started training.  It is called ‘renewal’ because it is based on reestablishing the personal relationships most of us want from the health care system,” said Labby. “It is called ‘renewal’ because it might be one small Oregon step in moving the most expensive heath care system in the world toward the most satisfying and effective system the world can offer.”