Medical homes

Primary care redesign rolls out statewide

What is a medical home? A conceptual model or a philosophy? A specific delivery system? A designation through formal recognition?

It’s always a trial to transition from philosophy to practicality. But clinics from the four corners of Oregon have accepted the challenge of launching the medical home as an established, functioning system of care.

Representatives from 15 clinics met at CareOregon’s Learning Commons in July to launch a medical home collaborative to benefit patients most in need: those whose care is provided in safety net clinics.

The National Medical Home Initiative for Safety-Net Clinics is funded by a grant from The Commonwealth Fund, a private foundation supporting independent research on a high performance health system. It’s coordinated in Oregon by the Oregon Primary Care Association and CareOregon with support from Qualis Health, a Seattle-based quality improvement organization.

Jonathan Sugarman, MD, MPH, president and CEO of Qualis Health, explained that the medical home concept is based on four cornerstones:

• Primary-care based
• Patient-centered care (active participation oriented to patients’ needs)
• New model of practice (with decision support and information technology)
• Payment reform of the current payment system, which hinders the innovations upon which primary care homes depend

Medical homes hold the potential for reducing or eliminating disparities in access to and quality of health care, Dr. Sugarman said. But safety net clinics, which serve a population more likely to experience these disparities, are less likely than private physician offices to be medical homes.

That’s why the Commonwealth Fund is especially interested in supporting community health centers and other public clinics in their efforts to build medical homes, he said.

Dr. Jonathan Sugarman
President and CEO, Qualis Health

There are more than 100 pilot projects exploring the medical home concept, but the pilot project in Oregon is a little different because it focuses on safety net and community clinics. These clinics serve a population that is facing life and socioeconomic challenges and difficulty accessing specialty care.

The participating Oregon clinics (including the five clinics involved with CareOregon’s Primary Care Renewal project) represent nearly 110,000 patient visits a year, Dr. Sugarman said. About 41 percent of the clinics’ patients have Medicaid; another 32 percent are uninsured. About 40 percent of the clinics do not have access to full electronic health records.

Qualis Health will provide support and CareOregon and OPCA will work together as a Regional Coordinating Center for the PCMH model. The Center will receive $125,000 per year for four years to build upon existing health policy and technical assistance and training programs at the participating clinics.

No “cookie cutter”

“Not all medical homes look alike,” said David Labby, MD, PhD, CareOregon Medical Director.

“Adopting a medical home model is not a project,” he said. “It’s a transformational journey.

“What we’re really doing is changing clinics into continuous change organizations. The idea we’re going to figure out a package that changes the health of our community is a many years’ journey.”

The purpose of the collaborative is to equip the pilot clinics—which range in size and geography from Multnomah County Health Department to Winding Waters Clinic in Wallowa—with the skills to successfully embark on that journey and find the solutions to problems that are unique to their own communities, clinics and patients.

Why take the challenge? Because it’s worth it.

Becoming a medical home requires epic, whole-practice reimagining and redesign, says Dr. Jonathan Sugarman, CEO of Qualis Health. “It is not ‘plug and play.’ It is easy to get change fatigue.”

So why do it?

It’s worth the effort.

The Southcentral Foundation is often cited as proof of the effectiveness of the medical home concept. This organization, based in Anchorage, Alaska, provides health care to Native Alaskans and is a model for CareOregon’s medical home pilot: Primary Care Renewal.

Ten years after adopting the medical home model, the Southcentral Foundation reported these improvements:

• Urgent care and emergency department use, down 40 percent
• Hospital days, down 30 percent
• Asthma patients receiving “perfect” care, up from 35 percent to 85 percent
• Childhood immunization, up from 85 percent to 94 percent
• Numbers on waiting list for behavioral health care, down from 1,300 to zero
• Customer satisfaction, 91 percent
• Employee team satisfaction, 85 percent

For more information about medical homes, see the article in a recent issue of Parade magazine.

The grant

The National Medical Home Initiative grant was announced in May by the Commonwealth Fund and eight co-funders: Colorado Health Foundation (www.coloradohealth.org); Jewish Healthcare Foundation (Pittsburgh); Northwest Health Foundation (Portland, Oregon); Partners HealthCare (Boston); The Boston Foundation; Blue Cross Blue Shield of Massachusetts Foundation; Blue Cross of Idaho Foundation for Health; and Beth Israel Deaconess Medical Center (Boston).

For more information about the project in Oregon, including a list of participating clinics, see the press release announcing the grant.