Group Health Cooperative’s Patient-Centered Medical Home Group Health Cooperative is a nonprofit, consumer-governed health-care system that provides healthcare and health insurance coverage to residents of Idaho and Washington. Originally a staff model HMO that employed physicians, Group Health became a network HMO , meaning that it contracted with a large multispecialty medical group and with independent physicians. Group Health had traditionally stressed primary care. But as it tran-sitioned away from being a staff model HMO, its primary care practices began showing signs of strain. Primary care patient panels kept getting larger, referrals to specialists increased, hospitalization costs rose, emergency department use mounted, evidence of workforce burnout increased, and recruiting primary care physicians kept getting harder. In response, Group Health began turning one of its locations into a patient-centered medical home. Doing so entailed using its electronic health record system to recognize patient care needs, expanding use of phone and e-mail communication to reduce patient visits, and increasing the time physicians spent per patient visit. This process involved adding a medical assistant for each physician. It also involved adding a nurse practitioner to handle same-day visits, adding one clinical pharmacist per 10,000 panel members, and adding two licensed practical nurses per 10,000 panel members. The practice that became a patient-centered medical home improved in patient satisfaction and clinical quality more than comparable Group Health practices (Reid et al. 2010). Cost per member per month also rose more slowly than in other practices, primarily because hospitalization rates did not rise in the patient-centered medical home. At 21 months, admission rates were 6 percent lower in the patient-centered medical home practice, and use of emergency and urgent care was 29 percent lower.
Discussion questions:
1. Why would it make sense to become a network model HMO?
2. Would you like to get your primary care at a patient-centered medical home?
3. Did it make sense for Group Health to support the patient-centered medical home transition?
4. Could an independent practice afford to become a patient-centered medical home?
5. Why is Medicare sponsoring patient-centered medical home demonstrations?
6. How would a 6 percent reduction in hospitalization rates affect hospitals?
Its case study on chapter 3 in economics for nealthcare managers text book third edition.