A new model of primary care that emphasizes disease prevention and doctor-patient collaboration appears to be lowering Minnesota’s medical costs while raising the quality of care patients receive.
Patients seen at “health care homes,” created as part of far-reaching state health reforms enacted in 2008, had medical costs that were 9 percent less between 2010 and 2012 than those for patients who sought primary care at traditional clinics, according to a set of reports released Thursday by the University of Minnesota and the state Health and Human Services departments.
Those patients also received more effective care for asthma, vascular disease and other chronic conditions, the researchers found.
The reports offered some of the strongest evidence yet on the effectiveness of Minnesota’s 2008 reforms, which included funding for the creation of health care homes as well as statewide grants to promote healthier foods and more recreation in schools and communities. The findings also provide a tacit boost to the federal Affordable Care Act, which mimicked some of the reforms underway in Minnesota when it was signed into law by President Obama in 2010.
“This is the way to go to improve quality, improve patient satisfaction and lower cost,” said Dr. Ed Ehlinger, state health commissioner.
Melissa Winger, whose 18-year-old son suffers from a variety of conditions due to abnormal development of his internal organs, described how the new strategy has improved his care. She takes him to a pediatric health care home, which is more efficient because his doctor collaborates with specialists on appointments and tests to avoid redundancies. Her son used to require 60 medical appointments a year, she said, and missed 30 days of school in the process.
Under the coordinated approach, she said, he misses no more than five school days annually and avoids clinics and hospitals, where the proximity to other sick people could expose him to infections.
“He is healthier because his problems are managed better,” Winger said.
Four in 10
The U analysis compared costs of medical services from 2010 through 2012 for a group of patients on the state’s Medical Assistance program who used health care homes against those who used traditional primary care clinics. The average cost for patients in health care homes was $2,588, while the average cost for patients in traditional clinics was $2,850.
Spread across the entire Minnesota health care system, efficiencies like that could produce hundreds of millions of dollars in savings for patients, taxpayers and businesses.
Already more than four in 10 primary care doctors serve in state-certified health care homes, and collectively they serve 3.3 million patients.
Ehlinger said the long-term success of health care homes will likely require a greater number of insurers and large self-insured employers agreeing to pay doctors for the care coordination services they provide under this approach.
Switching to a health care home model requires clinics to make upfront investments: Some hire coordinators who provide follow-up care, such as calling depressed patients to ensure they are taking prescribed medications.
The state Medical Assistance program and some private-sector insurers currently support health care homes with monthly payments ranging from $10 to $60 per patient for care coordination. The amount varies by the patients’ needs and illness levels.
Those costs weren’t factored into the U analysis, so the total cost of caring for patients in health care homes is slightly higher than indicated, said Douglas Wholey, a U researcher who led the study. He expects more evidence of savings, though, as he continues to track health care homes over the next two years.
The concept of health care homes has been obscure to some patients and confusing to others, who figured doctors were already coordinating their medical care. But doctors under the traditional pay-per-service model of U.S. health care often had little time for such oversight as they hopped from exam room to exam room and patient to patient.
“This has completely changed the way I have been able to practice in the office,” said Dr. Kris Kopski, medical director of innovations for the Park Nicollet Health Services.
Thursday’s reports, which were required as part of the legislation that approved health care home funding, also showed patients in better health.
Among asthmatic adults, 42 percent using health care homes in 2011 had optimal control of their diseases, compared with only 23 percent using traditional clinics. Patients with vascular diseases such as clogged arteries were also much more likely to have ideal levels of cholesterol and blood pressure if they were using health care homes.
Winger serves on a family council that supports the state health care home project. One of the benefits, she said, is that doctors in health care homes must consult patients about their care goals up front.
“Not everybody that has the exact same chronic condition has the exact same life,” she said. “They have different goals. They have different interests.”