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Doctors running these medical homes generally receive an extra or bigger payment from insurers to manage a patient's health. The amount varies depending on the plan.
When it started a medical-home program in 2009, Blue Cross Blue Shield of Michigan increased office visit reimbursements. The extra pay amounted to about $7,500 more per doctor annually.
All told, the insurer spends about $35 million a year to support patient-centered medical homes that now care for around 2 million people. In return, it estimates that it saved between $65 million and $70 million last year alone.
Growth in hospital admissions and emergency room visits slowed for patients treated in these medical homes. Electronic prescribing helped doctors use generic drugs more because they could see lists of covered medicines and co-payments charged to the patient.
The insurer's annual medical costs are about $9 billion, so the medical homes offer a relatively small slice of savings. Still, Dr. Thomas Simmer, the chief medical officer, is encouraged.
"All of us who are vexed by high health care costs are impatient to find something that's really going to be the answer to it," he says. "You can't be impatient. You have to realize you're talking about human beings and patients' health."
It takes a heavy dose of patience to transform a practice into a medical home. The process can take a couple of years and has to be done while the practice is still functioning.
"The metaphor we frequently talk about is redesigning the plane while you're flying," said Dr. Bob Graham, a former CEO of the American Academy of Family Physicians who has helped set up medical homes.
Patients must also be willing to work more with their doctor or be comfortable seeing other members of a care team instead of just the physician. Primary-care doctors also need to foster cooperation from specialists who may not receive extra reimbursement to do so.
Money is an issue, too. Lynch's practice, which has 58 family doctors, spent about $500,000 in 2003 to switch to electronic medical records, a must for quick and efficient file-sharing with other providers. The practice has since spent more on upgrades and training, but Lynch says it recouped the investment in part by becoming more efficient and eliminating the clerical work those paper files required.
Despite the challenges, Simmer and others who work with patient-centered medical homes expect the concept to grow.
"I absolutely expect it to be the norm in primary care because it's just plain better primary care," Simmer says.
Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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