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Report: 'Medical Homes' May Be Answer to Overburdened Health Care System

Coordinated care keeps costs down for low-income patients (May 1)

One of the persistent questions about the Patient Protection and Affordable Care Act (PPACA) is how so many people, new to insurance, are going to obtain quality health care when the system seems so strapped already. According to a new report from the Kaiser Family Foundation, the law has an answer to that: the “medical home.” But the concept is not widely understood.

In medical homes, health care services are coordinated to manage each patient's care. That means patients come to or call the practice first when they have a problem, and it means a team of physicians, nurses, and other health professionals take care of patients and keep tabs on their conditions over time. The team makes sure that patients are taking medicines properly and are receiving timely preventive care, and that no unnecessary tests are done.

Medical homes use computerized record-keeping to track patients and to watch for trends that might signal the need for new treatments. All of this sounds expensive, and at first it may be, but two large-scale programs suggest that medical homes may save a lot of money over time, the report says.

The first of these demonstration projects — the Virginia Coordinated Care for the Uninsured program — began 7 years ago at the Virginia Commonwealth University (VCU) medical center in Richmond. More than 26,000 people have been enrolled.

“Our patients had lower utilization of the emergency room, fewer in-patient admissions, and the overall cost of care went down,” said VCU Health System Vice President Sheryl Garland.

At first, it cost about $8,000 a year, on average, to care for a patient, but for those who stayed in the program at least 3 years, costs dropped by 50%.

In California, statisticians saw a similar trend in the Healthy San Francisco (HSF) program, which started 6 years ago with funding from the city, county, local employers, and donors. Thirty-seven clinics and medical practices have provided care at little or no cost to approximately 49,000 people.

According to HSF Program Director Tangerine Brigham, costs dropped an average of $540 per patient per year. Many of the patients had chronic conditions — diabetes, hypertension, congestive heart failure, or asthma. Brigham says that seeing a medical professional on a regular basis keeps them out of the hospital and the emergency room — expensive places for care.

A 2009 survey by the Kaiser Family Foundation found that 94% of HSF patients were satisfied with their treatment.

Sources: Kaiser Family Foundation; May 1, 2013; VCU Health; and Healthy San Francisco.

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