Title: Patient-Centered Medical Home Pilot
Organization: Adventist HealthCare
Innovation Type: Medical Home
What They’re Doing: Medical Home for High-Risk Patients
Clinical Innovation: Using cost data, Adventist identifies their high cost employees and connects each of them with a participating primary care physician (PCP) who must be available to help coordinate and manage their patients’ care for one hour every month. The participating PCP’s are given access to a claims-driven electronic medical record that enables visibility into all of the participant’s diagnoses, visits, hospitalizations and prescriptions. Each participant is assigned a personal health nurse who supports the PCP, develops a care plan for the participant in consultation with the PCP and helps him/her comply with the care plan by following up after each appointment to answer questions and ensure compliance with the care plan.
Supportive Financing Mechanism: Instead of paying an insurance company to cover health care claims for their employees, Adventist is a self-funded insurer. This means that Adventist takes on the health care risk of its employees and directly pays all medical bills out of its own funds. Adventist has hired personal health nurses to work with their employees and pays physicians a care management fee for providing care coordination services. Adventist believes that the cost-savings from keeping their high-risk members healthier will cover the additional money they spend on care coordination activities.
Evaluation Plan: Adventist conducted a retrospective analysis examining the health risk and cost of program participants before implementation of the program and after one year of participation in the program.
Evaluation type: Quasi- experimental .
Patient Health and Cost Outcomes:
Improved Health. The number of high -risk patients seen by PCP’s participating in the program by more than 48%. Most of these high-risk patients were reclassified as moderate and low risk over the course of the year.
Cut Costs . Participants’ per member per month costs dropped 35% from $1,981 in 2009 to $1,290 in 2010 while members not enrolled in the program increased .9% from 296 in 2009 to $299 in 2010. The annual per member per month cost reduction was $381,630.
Good return on investment. Based on a total cost of $31,204, the directly recorded savings of $87,365 represents a return on investment of 2.79.
Other Outcomes of Interest:
Publications: no peer-reviewed articles.
Lee, J.G., Dayal, G.,Fontaine, D. "Starting a Medical Home: Better Health at Lower Cost." Healthcare Finance Management. June 2011. Article can be found here: http://www.hfma.org/Publications/Leadership-Publication/Archives/E-Bulletins/2011/June/Medical-Home-Leads-to-Healthier-Patients%E2%80%94and-Savings%E2%80%94for-AHC/
Target Population: Employees of Adventist who were classified as high-risk patients and saw at least 15 different providers and 9 different prescribing physicians in 2009.
Date of Implementation: Launched pilot in late 2009.
Contact: Gaurov Dayal, M.D, Senior Vice President and Chief Medical Officer, 301-315-3883, GDayal@adventisthealthcare.com
Where to learn more: Please contact Gaurov Dayal, M.D.