The Group Health Medical Home At Year Two

As the patient-centered medical home model emerges as a key vehicle to improve the quality of health care and to control costs, the experience of Seattle-based Group Health Cooperative with its medical home pilot takes on added importance. This paper examines the effects of the medical home prototype on patients’ experiences, quality, burnout of clinicians, and total costs at twenty-one to twenty-four months after implementation. The results show improvements in patients’ experiences, quality, and clinician burnout through two years. Compared to other Group Health clinics, patients in the medical home experienced 29 percent fewer emergency visits and 6 percent fewer hospitalizations. We estimate total savings of $10.3 per patient per month twenty-one months into the pilot. We offer an operational blueprint and policy recommendations for adoption in other health care settings.

The patient-centered medical home has emerged rapidly as the main policy vehicle to reinvigorate U.S. primary care. The widely endorsed 2007 joint principles of the patient-centered medical home, developed by a coalition of professional organizations, emphasize the attributes of primary care. These include access to care, long-term relationships with health care providers, and comprehensiveness and coordination of care. The principles also embrace a health professional team orientation grounded in evidence-based medicine and quality improvement. They support the use of advanced electronic health records to enable, and a payment system to reward, these activities.1 Many demonstrations of the patient-centered medical home are under way, and preliminary evidence is starting to emerge.2⇓⇓–5

Despite agreement on the organizing principles for patient-centered medical homes, no consensus exists on an operational definition of the components of the model or investments required.6,7 These components include enhanced staffing, key electronic health record features, and optimal methods for transformation to this new practice model.

Several questions about medical homes remain unanswered. These include how quickly the anticipated improvements emerge and how operational definitions apply to practices with different settings, patient mixes, and cultures.

Since 2006, Group Health Cooperative, a nonprofit, consumer-governed, integrated health insurance and care delivery system based in Seattle, Washington, has pioneered a medical home redesign that relies on its existing electronic health record technology. The one-year evaluation of a prototype clinic redesign revealed early and broad improvements compared to control groups in patients’ experiences with care, provider burnout levels, and clinical quality.2 The up-front investments in redesign were recouped in the first year, largely because of fewer emergency department and urgent care visits compared to controls.

In this paper we present longer-term results—at twenty-one to twenty-four months—to track progress in meeting multiple objectives of improving quality, creating a sustainable work environment, and reducing costs. This analysis highlights considerations for organizations contemplating medical home transformations and for policy makers interested in facilitating the successful adoption of medical homes.