Robert Reid thinks he has seen the future, and it comes from Washington.
Not D.C. -- the state of Washington.
That's where Reid of Seattle's Group Health Research Institute has seen the patient-centered medical home in action, and that's what he was preaching to medical leaders in Sacramento yesterday.
"At Group Health, we found it was possible to improve outcomes, lessen physician burnout and reduce costs," Reid said. "That’s a triple whammy! You never see that."
Reid gives credit for the Washington state practice's fundamental improvement to adoption of the patient-centered medical home model.
"This really is an exciting time for primary care and there's a marked opportunity here," Reid said. "The United States has finally woken up to the promise of primary care -- and we're moving into a new era with the patient-centered medical home."
Reid boils the concept to five major points:
- Establishing and maintaining a strong relationship between the doctor and the patient;
- Making sure a physician leads a patient's care;
- Making health care proactive and comprehensive;
- Increasing access centered on patients' needs, with maximum use of technology; and
- Making sure clinical and business systems are aligned with all of these goals.
To do all of that, Group Health hired more physicians so they could have more time to talk to patients (roughly 30 minutes per visit instead of 20). They made sure medical personnel, including physicians, had desktop time -- that is, time to make phone calls and send emails to deal with patients electronically.
Group Health also instituted many small innovations, such as setting up a pre-visit chart review by a medical assistant. "They checked in to see why the patient was coming in, if tests had been completed, that kind of thing," Reid said. "It's not rocket science. But no one had ever done that before."
According to Reid, 47 states have medical home pilots underway. "There's a lot of activity and it's continuing to grow."
When Group Health instituted the patient-centered medical home, Reid said, the number of office visits went down, in part because of greater use of email and phone contact, and in part because physicians were given more time to see patients, so all things can be taken care of at once, rather than making patients return.
"And we found that emergency room use went down," Reid said. "We had 30% fewer ER visits, and 11% fewer preventable hospitalizations."
Those changes made a world of difference, he said. "In terms of cost, the entire amount we spent on implementing the medical home was recouped in just the first year with the savings in the emergency room alone," Reid said. "For hospital systems on a tight margin, these are vitally important changes."