Pilot Project Test-Drives ‘Medical Home’

Patient compliance, more consistent care and greater management efficiencies leading to a more profitable, less stressful medical practice — many in the health care industry are hoping that what sounds like an Rx to relieve physician headaches is simply the natural outcome of turning a practice into a medical home.

To explore the concept, Humana is launching a one-year pilot project in Atlanta with two practices that are members of the WellStar Physicians Group.

Throughout the pilot, Humana will work to support the WellStar practices as “medical homes.” A medical home is a partnership between a patient and a physician who provides a team approach to managing all of the patient’s medical care.

What is a medical home?
In brief, the medical home system does the following:

• Places the primary care physician in the role of “quarterback” of a health care team.
• Promotes a stronger bond between the member and primary care practice.
• Helps reduce fragmentation and inappropriate use of ER or specialists.
• Promotes a centralized, comprehensive record of medical services.
• Allows patients to choose their primary care physician who will coordinate care.

The National Committee for Quality Assurance (NCQA) provides nine certification standards for practices to become a medical home. As part of the pilot project, Humana is working with the two participating practices to help them gain this certification.

The WellStar project
During the WellStar pilot, Humana’s Physician Strategies group will work to establish the medical home mode of care for 500 patients at the participating practices by:

• Taking a team-based approach to care
• Facilitating compliance with evidence-based medical guidelines
• Supporting physicians and patients in deciding when to involve a specialist and providing assistance in choosing that specialist
• Defining access standards that provide members with timely appointments with their physician, and avoiding visits to a different primary care physician, retail medicine clinic or ER solely because the member could not get in to see his or her doctor

The pilot project will include a control group at one or more of WellStar’s 13 nonparticipating practices.

“WellStar is the first of several pilots in which we hope to demonstrate that supporting primary care physicians and compensating them for these additional care coordination activities can help support their goal of delivering coordinated care to their patients,” said Michael Sherman, M.D., Humana’s corporate medical director, physician strategies. “Providing services in accordance with the NCQA certification requirements should result in not only better care, but also more appropriate use of resources.”

Humana has extended its commitment to developing the medical home concept with a position on the executive committee of the Patient Centered Primary Care Collaborative. The PCPCC comprises key health companies, large employers, consumer groups and other stakeholders working to develop the medical home concept to achieve better health for Americans. For more information, visit http://www.pcpcc.net/.

Back to top