Med­i­cal home mis­sion­ary sees en­cour­ag­ing cost and qual­ity trends

Modern Healthcare - - Q & A -

“Hospi­tal sys­tems and ac­count­able care or­ga­ni­za­tions must have ro­bust pri­mary care as their foun­da­tion.”

Dr. Bruce Ba­gley is pres­i­dent and CEO of Trans­forMED, a wholly owned sub­sidiary of the Amer­i­can Academy of Fam­ily Physi­cians, which pro­vides guid­ance and sup­port to physi­cians im­ple­ment­ing pa­tient-cen­tered med­i­cal homes. Ba­gley, a fam­ily physi­cian who spent nearly three decades prac­tic­ing in Al­bany, N.Y., also served as AAFP’s pres­i­dent and board chair, and most re­cently as its med­i­cal di­rec­tor for qual­ity im­prove­ment. Mau­reen McKin­ney, Mod­ern Health­care’s ed­i­to­rial pro­grams man­ager, spoke with Ba­gley in April at the an­nual meet­ing of the Amer­i­can Col­lege of Physi­cian Ex­ec­u­tives. They dis­cussed the growth of the med­i­cal-home model, emerg­ing out­comes data and how pri­mary-care physi­cians are do­ing when it comes to im­ple­ment­ing health in­for­ma­tion tech­nol­ogy. This is an edited tran­script.

Mod­ern Health­care: What kinds of ser­vices does Trans­forMED pro­vide?

Dr. Bruce Ba­gley: Trans­forMED helps pri­mary-care prac­tices be­come more ca­pa­ble. We’re re­ally about es­tab­lish­ing med­i­cal homes in many com­mu­ni­ties. The med­i­cal home is noth­ing less than an ex­treme makeover for how we do pri­mary care. It’s more ser­vice-ori­ented for pa­tients, more ef­fec­tive for out­comes, more ef­fi­cient for the bot­tom line, bet­ter for the health sys­tem, and makes go­ing to work more fun for doc­tors and their staff. We also are help­ing de­velop med­i­cal neigh­bor­hoods, so pri­mary care doesn’t op­er­ate as an is­land. Hospi­tal sys­tems and ac­count­able care or­ga­ni­za­tions must have ro­bust pri­mary care as their foun­da­tion.

MH: You re­ceived a federal grant to eval­u­ate med­i­cal-home out­comes. What are you see­ing so far?

Ba­gley: Two years ago, we got a $21 mil­lion, three-year grant from the CMS In­no­va­tion Cen­ter. With this grant, we’re build­ing med­i­cal neigh­bor­hoods in 15 com­mu­ni­ties around the coun­try. One part­ner is VHA, which is the con­vener. Cobalt Talon is help­ing us an­a­lyze the Medi­care data to de­ter­mine costs. Phy­tel helps take qual­ity data out of the elec­tronic health records for our qual­ity reporting, registry func­tions and out­reach to man­age chronic ill­ness. We’re just be­gin­ning to get some data back. We now can tell an in­di­vid­ual prac­tice what its qual­ity data look like and what its to­tal cost of care is, down to the in­di­vid­ual physi­cian.

Even though that might not be sta­tis­ti­cally sig­nif­i­cant in some cases, it doesn’t mat­ter. We’re about qual­ity im­prove­ment. So if we find that there’s a par­tic­u­larly high ER-visit rate or high bed-day rate per thou­sand, we help the prac­tices un­der­stand what’s caus­ing that and what to do about it.

We are see­ing trends that are in the right di­rec­tion. The med­i­cal homes we’re study­ing are about 5% bet­ter than the trends would pre­dict. This is very pre­lim­i­nary data, but it’s also very con­sis­tent with what we’ve seen in many other pi­lots.

MH: Are more large hos­pi­tals and health sys­tems look­ing at the med­i­cal home model?

Ba­gley: I think en­light­ened lead­ers rec­og­nize they have to have ro­bust pri­mary care to do any­thing else. If you’re try­ing to build an ACO, ro­bust pri­mary care is a crit­i­cal com­po­nent. Each com­po­nent has to demon­strate its ef­fec­tive­ness and ef­fi­ciency.

MH: How are pri­mary-care physi­cians do­ing when it comes to im­ple­ment­ing health IT sys­tems?

Ba­gley: Pri­mary-care prac­tices should be ITen­abled. That con­trasts with the think­ing that, “If I open the box and I in­stall it, ev­ery­thing will be won­der­ful.” It re­ally is a plat­form for re­design for ev­ery­thing—knowl­edge man­age­ment, reg­istries for chronic ill­ness, com­mu­ni­ca­tion, ed­u­ca­tion, con­nect­ed­ness and de­ci­sion sup­port, se­cure mes­sag­ing with pa­tients and pa­tient ed­u­ca­tion. More than 80% of our ac­tive mem­bers at the Amer­i­can Academy of Fam­ily Physi­cians have EHRs of some kind. At least they’re en­gaged at that level, so we’re very proud of that. We’re prob­a­bly the largest sin­gle physi­cian group with that high of a par­tic­i­pa­tion level.

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