“You save one
hospitalization, you save a lot of resources,” said Dr. Ed Ehlinger,
commissioner of the Minnesota Department of Health.
Clinics that take more
responsibility for patients’ health and health habits outperformed other
primary care clinics and saved Minnesota more than $1 billion over five years,
a University of Minnesota analysis concluded.
The study, released Tuesday,
validated Minnesota’s decision in 2008 to offer additional funding to clinics
that become certified “health care homes,” meaning they manage patients’
overall care and provide extra support to chronically ill patients.
A patient receiving primary
care from a health care home was less likely to need a lengthy hospital stay
between 2010 and 2014, and rang up only $7,216 in medical expenses per year — 9
percent less than a patient receiving traditional primary care.
“You save one
hospitalization, you save a lot of resources,” said Dr. Ed Ehlinger,
commissioner of the Minnesota Department of Health.
Minnesota went “all in” on
the concept of health care homes before it became a staple piece of the federal
Affordable Care Act, said Douglas Wholey, the health policy professor who led
the analysis.
Minnesota now has 361
certified health care homes, or 54 percent of all primary care clinics in the
state.
Compared to the traditional
office-visit model, health care homes help patients get access to medical
specialists and then review the results of tests, prescriptions or
recommendations by specialists to make sure they are consistent with a
patient’s overall care plan. The clinics also provide or connect patients to
exercise, dietary or other wellness programs in their communities.
Asthmatic children receiving
care at health care homes were more likely to have asthma action plans, which
spell out how to manage the disease and respond in the event of an attack and
shortness of breath. As a result, 39 percent of asthmatic children in health
care homes were meeting medical goals, compared with 19 percent at traditional
clinics, the researchers found.
Patients with diabetes,
depression and vascular disease also showed more progress, according to the U
analysis, which was required as part of the legislation funding health care
homes.
‘It gets their attention’
Lisa Hoffman Wojcik of
Mankato is grateful for the health care home that manages the care of her
13-year-old son, Konnor, who has suffered health problems since birth.
Talking immediately with a
care coordinator, rather than leaving a message on a nurse voice mail and
waiting for a call back, saves time for the busy family, she said. Sometimes
the clinic steps in when she is struggling to get help from a specialist.
“I can call, as a parent,
3-4-5 times,” she said. “When you have your provider calling, saying ‘I’m
really concerned,’ that really gets the attention of other providers.”
Savings from health care
homes weren’t as substantial for patients 65 and older covered by the federal
Medicare program, the analysis showed.
Most of the savings came
from Medicaid, which provides health care for roughly 1 million low-income
Minnesotans and people with disabilities, and serves a disproportionate share
of the state’s minorities.
A surprise in the analysis
was that emergency room costs were higher among health care home patients;
conventional wisdom was that extra oversight would reduce the need for ER care.
However, the decline in hospital admissions, outpatient visits and
prescriptions far outweighed any rise in ER costs.
Ehlinger said the results
should motivate more clinics to achieve certification, especially in rural
parts of the state that lack them.
One problem is that private
insurers don’t provide care-coordinator payments for health care homes in the
same way as public programs such as Medicaid, said Janet Silversmith, a policy
director for the Minnesota Medical Association. Private payers have tried to
encourage holistic patient care through other value-based payments to clinics,
but their lack of direct funding for health care homes makes it harder for
small clinics to maintain them, she said.
The $1 billion in savings
was largely due to the benefits of health care homes, the analysis found, but
patient selection also was a factor. Healthier or more motivated patients
simply might be drawn to clinics that are health care homes, boosting their
results.
Health care homes did show
improved performance and patient health scores the longer they stuck with the
approach, Ehlinger noted.
Team approach
At South Lake Pediatrics,
doctors varied their readiness for the new model, which requires record-sharing
with specialists at other clinics and more of a team approach in working with
in-house care coordinators.
But now, children at its
several West Metro clinics receive faster care and families have access to
support services through a registry of patients with complex conditions such as
ADHD, said Maria McGannon, a South Lake nurse practitioner.
“We could not go back to the
way we were before,” McGannon said.
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