Specialist medical homes: Keeping patients out of the hospital
Tuesday, August 16, 2016
Specialty medical homes provide a tremendous opportunity to control costs with better management of complications and the prevention of hospitalizations. Lawrence Kosinski, M.D., a gastroenterologist, has been successful at doing just this for his Crohn's disease patients, and his accomplishments were highlighted in a recent H&HN article.
According to Kosinski, his practice has reduced spending for Crohn's disease patients by almost 10 percent over 10 months. His model, which relies upon technology-assisted patient engagement, has reduced hospital costs for patients by 57 percent and emergency department costs by 53 percent. Kosinski has noted that fewer than 30 percent of patients who required hospitalization had seen a gastroenterologist in the 30 days before the admission.
Kosinski has expanded his medical home population to also engage patients on reducing the risk of hospitalization from infections, bleeding, bowel obstructions and fistulas. Once treatment plans are established for patients, these patients are also electronically surveyed monthly to detect changes in their condition that warrant an intervention to prevent serious complications.
Sometimes a specialist may be the best clinician to serve as the patient's primary care provider for an extended period of time. Multiple sclerosis clinics are an example of specialty medical homes, and the model may also make sense for physicians treating patients with rheumatoid arthritis, cardiac arrhythmia or late-stage kidney failure.
Specialty medical homes could also help hospitals and specialists involved in managing pools of higher-risk patients and being financially accountable for their health status even after they leave the hospital. This includes the joint-replacement population or the three new episodes of care under mandatory experiments with bundled payments — acute myocardial infarction (heart attack), coronary artery bypass grafts, and treatment for hip or femoral fractures.
Those interested in starting a specialty medical home will find some useful insight from this Center for Neurological and Neurodevelopmental Health video on the changing landscape of healthcare delivery and the role of specialty care medical homes; especially for those with chronic conditions and special needs.
Other resources include:
High Value Care Coordination (HVCC) Toolkit: A collaboration between the American College of Physicians (ACP), Council of Subspecialty Societies (CSS) and patient advocacy groups led to the creation of a toolkit of resources for helping primary care and subspecialists develop more effective and patient-centered communication.
ACP Practice Advisor: A web-based tool to assist practices transforming towards the delivery of more patient centered, high-quality and efficient care delivery. Four modules were added in 2014 directly linked to the standards of the NCQA Specialty Practice Recognition Program.
Patient-Centered Specialty Practices are recognized by the National Committee for Quality Assurance (NCQA) for their committed to access, communication and care coordination. Standards emphasize the value of:
- clinicians offering enhanced access to care by providing multiple access points for service without primary care consults. This can include self-scheduling appointments, expanded hours and multichannel communications between patients, physicians and office staff.
- Use of an electronic system(s):
- to collect and record patient information in searchable fields
- to track, monitor and report data on the populations managed
- for embedded clinical decision support interventions and point of care reminders that follow evidence-based guidelines for conditions appropriate to the services provided
Electronic communication and engagement tools that can accommodate language needs and variances in health literacy while surveying patients' health status or delivering instructions and educational content. Platforms, such as the one offered by Patientriciti, can accommodate evidence-based guidelines and/or risk assessments and engage patients in a way that helps patients understand and take the necessary actions. These electronic patient engagement tools can also facilitate reports back to the care team for ongoing care coordination and management.
Just as the transforming healthcare delivery system has led to an expansion of primary care medical homes; it is driving growth in patient-centered specialty medical homes.
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