Some local primary-care doctors want to make their office your home.
The “patient-centered medical home” concept is growing, especially as government programs and private insurers alike increasingly focus on ways to boost quality while reducing cost.
For patients like Joe Ohls, the evolving approach means improved communication with his doctor and better coordinated care from the practice’s entire staff.
Ohls, a 58-year-old deputy sheriff from Copley Township, said he appreciates being able to send emails to his doctor to request prescription refills.
During the past year or so, he’s also noticed the medical assistant and other staff spending more time with him getting information before his doctor, Dr. James Dom Dera, sees him. And several times, he’s received follow-up calls at home to check whether he’s feeling better.
“By streamlining their system, we are able to spend more time with the doctor,” Ohls said. “I understand the constraints and how difficult it is and how his schedule is. But the time I spend with him, I certainly want it to be quality time. If everybody else can do all that stuff beforehand so he has a handle on it before he even walks into the room, that’s wonderful.”
Dom Dera’s office, Ohio Family Practice in Fairlawn, is one of three primary-care practices that recently became among the first in the Akron area to be designated as patient-centered medical homes by the National Committee for Quality Assurance (NCQA).
The others are Pioneer Physicians Network/Louisville Medical Center and Family Practice Center of Wadsworth.
Not a place
The practices are part of NewHealth Collaborative, an “accountable care organization” formed by Summa Health System and a group of more than 60 area doctors to better coordinate care among physicians, hospitals and other health-care providers.
“For us, the patient-centered medical home is not a place. That’s one of the confusions people have,” said Dom Dera, medical director of the patient-centered medical homes for NewHealth Collaborative. “It’s a redesign of how primary care is organized and delivered, making it more team-based and highly coordinated. It puts the needs of the patients first.
“The patient is the center of our universe.”
That hasn’t always seemed the case, as primary-care doctors have been pushed to see more patients each day because their payments are tied to volume.
According to the results of one national survey published in Health Affairs, only 27 percent of U.S. adults can easily contact their primary-care doctor by telephone, get care or advice after hours and schedule timely appointments.
Primary-care offices that apply for the voluntary recognition program must prove they provide access, identify and help patients at high risk for chronic illnesses, follow industry recommendations for best practices and support people so they can better manage their own health, said Paige Robinson, NCQA’s recognition program external relations manager.
“They also are responsible for assuring appropriate care coordination, referral tracking and solid communication between primary care and specialists,” she said
Practices pay $80 per provider for a toolkit and then an application fee that ranges from $250 to $500 per clinician, depending on the size of the practice, Robinson said.
Since adopting the new approach, Dom Dera said, his practice has been using its electronic medical records to reach out to any of his 523 diabetic patients who are overdue for blood testing or an eye exam.
He also emails patients with lab results or to suggest they start exercising more to lower their slightly elevated cholesterol.
“It’s an involved service that I’m not getting paid for,” he acknowledged. “At the same time, that patient would still probably call.
“At the end of the day,” he said, “it’s about better patient care, too. This is a better way to engage our patients.”
Payments might soon be coming.
“We will have several arrangements in place in 2013 that will include care coordination payments and opportunities to share in savings related to quality and efficiency improvements,” said Michael McMillan, executive director of Market and Network Services for the Cleveland Clinic, in an email.
Several of the Cleveland Clinic’s primary-care practices have been designated as patient-centered medical homes. Others throughout the region, including in Twinsburg, are pursuing the recognition.
The practices use electronic medical records to identify patients who need preventive care, as well as to avoid potential drug interactions and to keep patients informed, said Dr. Robert Jones, a Cleveland Clinic general internist in Independence and quality officer for the Cleveland Clinic Medical Institute.
They also provide patient education through group appointments or meetings with diabetes educators — initiatives that can lower health-care costs by keeping people healthier, he said.
In addition, primary-care offices on the main campus and in Independence and Strongsville recently started using registered nurses as care coordinators, who closely follow patients at high risk for hospitalization.
“In the old days, it was more reactive medicine,” Jones said. “Now we try to anticipate these concerns ahead of time.”
Cheryl Powell can be reached at 330-996-3902 or email@example.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.