MetroHealth quietly enrolls first four patients in medical homes program

Updated Thursday, Feb. 26, 2009.

MetroHealth System in Cleveland enrolled the first four patients in its emerging medical home program on Wednesday, the system’s interim chief executive, Mark Moran, told trustees during their monthly meeting.

“Enrolled” may be the wrong word, Moran said after the late afternoon meeting. “We’re trying to get up and running by early March. The team is in place at Lee-Harvard. I think they’ve probably got four people who were actively Harvard patients to say, ‘I want to be part of the program.’ ”

A pilot of the program is set for an official launch on March 2 at MetroHealth’s facility at Lee and Harvard Roads in Cleveland. The system is in the midst of finalizing marketing materials to educate potential patients about the pluses of having a medical home.

The excitement about the medical home campaign — more than a year in the making as part of the system’s strategic planning effort to increase revenue sources and cost efficiencies — was palpable among trustees Wednesday. “Oh, it’s a big deal. It’s a really big deal,” Moran said after the trustee meeting.

“We’ve got all the ingredients — the full continuum of care, the disease management programs, great primary care resources that we manage in a little bit different way that’s going to  have much better outcomes for the patients,” he said.

The medical home project — which will go by a different but yet undisclosed name — also could help MetroHealth deal with the rising amount of uncompensated care it provides as the Cuyahoga County-owned hospital. “I think it will make the challenges that we have a lot more manageable,” Moran said.

The system cut more than 100 jobs last year to limit losses that ballooned early in 2008. Also last year, MetroHealth began using fees to move some people who had routine care needs out of emergency rooms and into clinics where cost of care is lower.

This month, the system stepped up this effort by charging poor patients small fees for using emergency rooms for non-emergency care and discounting clinic care for a greater number of patients.

The “patient-centered medical home” model has emerged in the last several years to answer the needs for rising health care costs and falling quality of care. The model puts care coordination solidly in the hands of medical professionals, not health insurance case managers, according to the American College of Physicians, which is trying to pioneer the homes among its members.

The model pays doctors for coordinating care, say, through a monthly care coordination payment. It also gives doctors financial incentives to use technology such as electronic health records and innovative practices like telephone consultations rather than office visits to lower health care costs and improve quality of care.

In addition to paying doctors for office visits — an element of the existing “pay-for-service” model — the medical home model also pays doctors for meeting quality and efficiency goals.

Much of medical home care would be paid for by federal Medicare and Medicaid insurance programs.

Under the model, a team of medical professionals coordinated by one doctor provide each patient preventive and disease management care. This proactive care is designed to head off expensive trips to the emergency room and to manage chronic conditions like high blood pressure so patients don’t get sick.

Patients also will have to make commitments to caring for themselves, at least under the MetroHealth program. They will be asked to sign a commitment on  the back of their membership cards, said Eileen Korey, the system’s vice president of communications.

“The payback on this initiative is that it has produced an incredible model of care that any one of us would love to have,” longtime MetroHealth trustee Donna Rego told other board members during her strategic planning report Wednesday.

That model of care includes “a medical management team that is yours — so your physician, your nurse practitioner, your social worker,  your nutritionist, whatever professional you need is a member of that team,” Rego said. “I think this is going to have enormous significance as we go on.:

“And it’s going to be a very effective way of getting people to connect into a system, which not only is good for their health, but obviously at the end of the day, is also good for the community pocketbook because it helps to reduce the cost of managing illnesses that often go left untended and then suddenly they’re catastrophic and very, very costly.”