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Health Center to assess new model for primary care practice

by Kristina Goodnough - February 4, 2008

The Health Center’s Ethel Donahue Center for Translating Research into Practice and Policy (TRIPP Center) has received a grant from the Commonwealth Fund to evaluate one of the first major demonstrations of the medical home, a new primary care practice model designed to improve care for adult patients.

The term medical home refers to a type of primary care physician practice that promotes a team approach to patient care led by a personal, primary care physician.

The team provides direct services to patients and coordinates services from other physicians and health care providers using advanced health information technology.

Patients have access to enhanced appointment systems and to telephone and e-mail communication.

Besides better care and outcomes for patients, the model is designed to provide greater efficiency for providers, compared to traditional physician practices.

It has been recommended by both the American College of Physicians and the American Academy of Family Physicians.

A demonstration of the new model has been launched by Group Health Inc. (GHI), a New York State health insurer, and Health Plan (HP) of New York, a large health maintenance organization.

Under the demonstration or pilot project, GHI and HP-affiliated practices interested in adopting the medical home model will be randomly assigned to either a supported group or a comparison group, each with 25 adult primary care physician practices.

The supported group is expected to include a total of approximately 100 physicians and 20,000 patients.

The supported group will be paid with a revised payment system; will be offered care coordination services; and will receive technical support to redesign their offices and management systems.

Staff of the TRIPP Center advised on the design of the project and received funding to independently evaluate it from the Commonwealth Fund, a foundation that seeks to promote a high-performing health care system.

The center will base its evaluation on submission of claims and performance measures of quality for procedures such as mammograms, diabetes testing, and cervical cancer screenings; outcomes for diabetes and hypertension patients; efficiency measures; and patient experience measures.

TRIPP Center staff will document the experiences and challenges faced by the medical practices as they are transformed into medical homes, and the impact of that transformation on the quality of care.

The center will compile and publish the results at the end of the two-year study period.

“Our task is to provide unbiased findings to inform the health care community about the true value of medical home transformations,” says Judith Fifield, director of the TRIPP Center.

“This evaluation is the first to rigorously assess implementation of the medical home model in adult primary care practices,” she adds.

“The medical home has the potential to transform health care practice to improve the delivery and quality of patient care and health outcomes.

“Our findings will help policymakers, clinicians, and payers understand the true value of this model,” she adds, “and will serve as a baseline for future research and implementation.”

The medical home model was originally designed as a way to improve care for children.

In recent years, it has been endorsed by primary care specialty societies as an appropriate model for adult primary care practices as well.

“Primary care physicians are being challenged to adopt these new models,” says Fifield.

“At the same time, policymakers and payers must understand how best to facilitate the transition, and whether the model results in real benefit to payers and practitioners.”

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