This article first appeared in the St. Louis Beacon, Jan. 28, 2011 - Like many other baby boomers, Kim Niccum of Kirkwood has experienced the stress of helping an aging parent cope with chronic illnesses while taking care of her own home and work responsibilities.
"It's been quite a struggle trying to care for her," Niccum says of her mother, who has been in and out of hospitals during the past 18 months.
When her father's health also began to fail, Niccum was "pleasantly surprised" to find that handling his needs would be a lot less stressful. That's because the primary-care practice where both parents are treated, Des Peres Internal Medicine in west county, has since shifted to a new care model -- a patient-centered medical home.
A new form of medical practice
It's not a place were people live but a program where patients are expected to get better access to doctors and treatment by a team, often including a nurse practitioner and a social worker. The patient's treatment is documented in an electronic medical records system designed to improve health care quality and efficiency. The computer system applies clinical algorithms to the patient record, reminding practitioners of best-treatment protocols.
The medical home model is relatively new to St. Louis. It's a big change in the way most local doctors practice medicine. At the Des Peres office, for example, patients may make an appointment to see a doctor, a nurse practitioner or a case worker. Or they have the option of simply walking in between the hours or 8 a.m. and 7 p.m., and seeing a doctor or a nurse practitioner without making an appointment. Through an electronic portal, called MyMercy, patients can make appointments, email a doctor with a question that doesn't necessarily require an office visit, view lab test results, track health history and get prescriptions refilled online.
Niccum remembers what made her realize the medical home model was different. A call came from a newly hired case worker for the Des Peres office after her father's heath deteriorated. The case worker called to tell the Niccum family that "we weren't alone, and that she was there to help us. She has taken the pressure off me. If I'm sitting at work and discover 'oh my god, I have to make three phone calls on behalf of my parents,' I can ask her to do that for me. It's nice to have an advocate."
Dr. Jason Hand, one member of the Des Peres medical practice, says a primary goal of medical homes is to increase patient access to care. The Des Peres office includes a case manager to focus on the best care possible for the sickest patients, a care coordinator to handle issues involving patients with only a few ailments, and a commitment to measure the quality of care. The hope is that these additional practitioners will help to reduce health cost, one of the overall goals of medical homes.
"We have to find a way to control cost without lowering quality," he says, adding that some medical expenses are needless and can be influenced by more dialogue with patients.
"I saw a lady the other day (who) had seven different doctors she was going to that were not her primary care physicians. She was so overwhelmed with those appointments that she could barely think straight."
"If I send you to a cardiologist four times a year, you're going to get four EKGs and a stress test every year. That alone will cost $5,000, $6,000 or $7,000. It's not necessary to see a cardiologist that often if you don't have a major heart problem. We want patients to feel like they can go to their regular doctor and ask questions and get answers, and they don't necessarily have to go to a specialist."
Lowering Health Costs
Medical home certifications have three levels, all requiring physicians to comply with up to 10 requirements. These range from using data-driven diagnoses of medical problems to evidence-based guidelines for treating certain chronic diseases. Practices that comply with all 10 requirements are certified as level 3 programs, the certification that Des Peres is now seeking.
Unlike St. Louis, Kansas City already has several medical providers with level 3 certification. Many are part of a pilot program run by Blue Cross and Blue Shield of Kansas City, covering about 45,000 patients, says Dr. Blake Williamson, vice president and senior medical director for the system.
The goal of the pilot, he says, is to develop a "sustainable patient-centered medical home model for improved access for patients, and improved quality and efficiency of care."
He says the insurer was attracted to the medical home model based on evidence in the 1990s showing that the model could not only improve care but reduce medical cost. One example he and others cite involved programs in place in North Carolina and elsewhere since the 1990s. Williamson says the system in Kansas City began about 14 months ago, and that it will take three to five years to determine the efficiency and effectiveness of the concept.
"But there's enough evidence out there that this is something worth exploring, worth developing. There's definitely evidence that it does make a difference in giving patients a higher quality of life and it makes a difference in the cost of health care. The cost is lower because patients won't be in emergency rooms as much."
Nor will they spend as much time in hospitals, says Hand at the Des Peres practice. When patients are better cared for in the doctor's office by a team that includes case managers and care coordinators, they are less likely to end up in hospitals, he says.
"It empowers people to be in charge of their health care," Hand says. "By opening up their medical records online, people have alerted me to errors in their records from previous doctors. It's really interesting. It's changing the dynamics. It's one of those things that can change primary care."
He says his patients are already taking more responsibility for their health. For example, he says, the number of patients getting colon-rectal screening is now up to 80 percent from 60 percent.
"That means there are people who literally have had colon cancer prevented because of the policies that we've put in place. We think this will be the future of primary care. We can't keep doing what we're doing. We have to make it better."
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
