A Work-Site Approach to Medical Homes

A work-site approach to medical homes Not all companies need to change the health care system to create medical homes for their employees. In fact, the term “medical home” broadly refers to improvements in primary care and the coordination of specialty medical care through a team approach that engages patients to take control of their health. Work-site wellness clinics can embrace features of medical homes in hopes of improving the care of patients and reducing overall medical costs.

Most on-site clinics resemble a primary care office, with a doctor or nurse practitioner and other nurses or health care aides. With a small staff, an employer can begin to identify the sickest patients in a population through health risk assessments and screenings that objectively measure a person’s health.

“That’s cardinal rule No. 1,” says Arnold Milstein, chief physician for Mercer Health and Benefits. Once the sickest patients are identified, the hard part begins. This is when a patient’s “care team” works to get the patient to adhere to a health regimen that includes taking medicine and changing unhealthy behaviors. The team also coordinates care among specialists.

Milstein says that medical homes can exist in various settings, but, as he wrote in an article published in the journal Health Affairs last fall, successful medical homes share three important characteristics.

First, Milstein writes, they must offer “an exceptional form of individualized” care that is designed to prevent emergency room visits and unplanned hospitalizations for chronic illnesses.

Second, the care should be designed efficiently. This means that in most cases, a patient’s chronic care plan is designed by a doctor-led team. After that, the difficult task of getting patients to manage their care is left to lower-paid health care professionals such as nurses or licensed vocational nurses.

Third, a patient’s “care team” should carefully select specialists based on the cost and quality of their care and funnel most patients to those specialists.

Arguably, the first criterion is the most important—and hardest to achieve. In his research visiting primary care practices, Milstein concluded that the most successful practices boosted patient motivation to improve their own health by demonstrating that the practices were “so committed to their patients that they would go to extraordinary means to protect them from preventable health crises.”

Commitment in this case means spending enough time with patients to educate them about their illness and how to manage it; following up with patients between visits to give them help in managing their health; responding promptly when a patient seeks urgent help; and linking patients with a “carefully selected group of specialists.”

Work-site clinics may be better designed to achieve these goals if the clinicians are paid a management fee, rather than being paid for each service they perform, says Brian Klepper, a consultant to work-site clinics.

Building trust is key. Milstein says doctors have to convey with “passion and obvious belief” to patients the importance of managing their health. Milstein noticed that some of the most successful clinics had nurses who had backgrounds similar to those of their patients. By virtue of their income, education and culture, they were “much closer to the patient’s world,” he says.

Pranav Kothari, co-founder of medical consulting firm Renaissance Health Inc., says that medical practices—whether they exist at a work site or in a shopping mall—need to be designed to cater to the needs of the person, not just the person’s illness.

“At the beginning and end of the day, it’s all about relationships,” Kothari says. “The patient has to trust you. And that comes from this whole culture of transformation that has to happen in medical practices.”

Workforce Management, July 2010, p. 17-18 — Subscribe Now!