Wednesday, February 16, 2011

Are You Medically Homeless?

I attended a very interesting evening talk a few weeks ago from the George Snively Visiting Professorship in Family Medicine lecture series, where we heard from Robert Reid of the Group Health Research Institute in Seattle, Washington. The Group Health Cooperative is a consumer-governed nonprofit health care system that coordinates both health insurance coverage and provision of care itself in the Seattle area, serving over 600,000 individuals.

The Group Health system is a model of care that has been exemplified by many as the necessary future of health care in the United States. Similar structures can be seen with Kaiser, Intermountain Healthcare, and the Geisinger Health System. The model provides an integrated delivery system of health care, where insurance, providers, financing, and care coordination are organized around what has become known as the patient-centered medical home. The idea goes that once a patient is in such a system, incentives are more properly aligned to keep the patient healthy and maximize health care efficiencies in order to provide the most value for the costs of services. This not only provides better care for the patient, but also results in better long-term outcomes at a lower cost.

What was most interesting at Group Health was the attempt in the early 2000s to lower short term costs through strategies like cutting down on doctor appointment duration times and increasing patient:provider ratios throughout the system. Since Group Health is uniquely positioned to collect large volumes of data throughout such experiments, they quickly realized that short-term techniques like this actually decrease quality of care, while increasing the longer-term cost per patient. When Group Health decided to return more patient-centered strategy, they saw a return of better-value care.

Care integration will be key as the nation moves into the meat of health reform implementation, through consumer-governed cooperatives like Group Health and in the similarly structured state Health Insurance Exchange systems. Such models allow for streamlined care coordination across every spectrum of health care, while providing gigabytes of reliable data on how to more effectively improve outcomes and patient satisfaction at a lower cost per patient. In short, the insurer is incentivized to actually make the patient well, the physician is salaried and thus incentivized to not just provide more care but better care (and is fully protected from malpractice worries), and the patient is incentivized to stay well. The medical home model will be central to these efforts, and to learn more about what they actually are I recommend this informative short video.

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