JPS hopes new program will cut unnecessary emergency room trips

The JPS Health Network will soon roll out a new healthcare model in clinics that is intended to improve access to primary care and reduce unnecessary emergency-room visits.

The model, known as primary and family-centered medical homes, has gained momentum nationally and is a facet of healthcare reform.

Under the strategy, a primary care physician coordinates team-based, comprehensive patient care. Instead of focusing on individual episodes of sickness, a health team stresses management of chronic conditions and overall wellness.

Advocates see the model as a possible antidote to the current tendency of patients to see many different providers, few of whom are familiar with the patients' medical histories.

"It relies heavily on the physician-patient relationship," said Chris Dougherty, JPS senior vice president of community health. "It's interesting because it is actually a return to the old values of a family doctor who is responsible for patients' health."

Pilot programs testing the model are under way nationwide, including one in North Texas, where almost 10 primary care practices have teamed with insurers to test the concept, according to the Texas Medical Home Initiative.

The model has shown promise in reducing hospital admissions and emergency room admissions, said Dr. Terry McGeeney, president of TransforMED, an affiliate of the American Academy of Family Physicians.

"Medicaid programs in 48 states and most the major payers are looking to leverage the medical home," he said. "It's about getting the right patient to the right care at the right time."

Pilot program

JPS officials will select four community clinics at which to pilot the model, which could be introduced this year, Dougherty said.

If successful, the program would expand to include all 80 primary care physicians in the network. JPS has 35 community- and school-based clinics.

Under the model, primary care physicians oversee teams of clinicians, including nurse practitioners, registered nurses, caseworkers and nutritionists, who coordinate patient care, Dougherty said. Patients would have access to a 24-hour-a-day phone line to reach a clinician, who could offer advice on when to seek emergency care.

"Instead of just automatically going to the emergency room, the patient could get advice on whether they should just come into the clinic the next day or maybe just need to talk the problem through," Dougherty said.

The model includes efficiencies to free up time for physicians, who are in short supply nationwide. Patients with certain conditions, like diabetes or asthma, attend group meetings to learn to manage their conditions instead of sitting one on one with a physician.

"In the current healthcare model, [physicians] spend a lot of time doing something that someone else could be doing," McGeeney said.

Dougherty said the creation of a medical home can be largely established through reorganization of existing resources. Savings through efficiencies and reduced emergency department use should make the transformation cost-neutral, he said.

The model does rely on creation of an electronic medical record system, which JPS is spending $94 million to install over five years.

A new way of thinking

Financial incentives to keep patients healthy are crucial if the model is to work, some experts say. The current fee-for-service model generally rewards doctors for seeing more patients, not for better outcomes.

"The way it works now is that care is episodic," said Dr. Sue Bornstein, director of the Texas Medical Home Initiative. "Something happens, you go to the doctor, you get it treated, then you are gone and they forget about you."

Healthcare reform proposes new incentives for physicians to manage overall health, McGeeney said. Some insurers have invested in pilot projects that pay a care-management fee to providers.

Tightened Medicare regulations discouraging repeated hospital admissions have helped lead to a new way of thinking. One in 5 Medicare patients discharged from the hospital is readmitted within 30 days, and half of nonsurgical patients are readmitted without seeing an outpatient doctor for a follow-up exam, according to a 2009 study.

Another crucial success factor is patients engaging in their own care, McGeeney said.

"If the diabetic is not engaged to lose weight, if the asthmatic is not engaged to quit smoking, it becomes more difficult," he said. "We need to patients doing things with us, not waiting for us to do things to them."

Alex Branch, 817-390-7689