looks like the new model they are testing seems to work.. hope it will show similar resul on the roll out phase...
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Metropolitan Health Networks' Patient-Centered Medical Home Pilot Delivers Outstanding Results
Collaborative Program with Humana Proves Valuable Healthcare Model in Caring for Medicare Advantage Customers
WEST PALM BEACH, Fla.--(BUSINESS WIRE)--Metropolitan Health Networks, Inc. (NYSE AMEX:MDF), (“Metropolitan” or “Metcare”), a leading provider of healthcare services in Florida, today released the utilization, financial, and quality results from the first year of its Patient-Centered Medical Home (PCMH) pilot program that was sponsored by Humana. The 12-month analysis of outcomes revealed compelling results in all three categories.
The Pilot Program Overview
In August of 2008, Metcare and Humana agreed to collaborate on a pilot program to formally study the impact of the PCMH model in a Medicare Advantage (MA) capitated group, establishing specific utilization, financial, and quality metrics. The pilot began November 1, 2008 and concluded on October 31, 2009. Baseline measures were determined from medical claims for the period November 1, 2007 to October 31, 2008, and a matched control group was identified and tracked for similar measures. This group represented Medicare Advantage HMO customers seen by primary care physicians within the same markets under a capitated risk arrangement but in a traditional medical practice model.
The 12 month Results
Utilization:
Hospital days per 1000 customers dropped by 4.6 percent compared to an increase of 36 percent in the control group.
Hospital admissions per 1000 customers dropped by three percent, with readmissions running six percent below Medicare benchmarks.
Financial:
Emergency room expense rose by only 4.5% for the Metcare group compared to an increase of 17.4% for the control group.
Diagnostic imaging expense dropped 9.8 percent compared to an increase of 10.7 percent for the control group.
Pharmacy expense increases were limited to 6.5 percent versus a 14.5 percent increase for the control group.
Overall medical expense for the Metcare group rose by only 5.2 percent compared to 26.3 percent increase for the control group.
Quality:
Preventative breast and colorectal cancer screening was 13.3 percent and 6.3 percent higher respectively, compared to the control group.
Seasonal influenza vaccination rates increased nine percent to 64 percent, compared to the national average of 43 percent.
Average LDL cholesterol levels dropped by 1.8 percent, and customers with levels below 100 (a target level) rose by 4.0 percent.
Ninety-four percent of diabetic patients had an A1C level of less than nine percent.
Customer satisfaction results improved or stayed the same in 45 of 61 categories.
Commenting on the results, Michael Earley, Chief Executive Officer of Metropolitan Health Networks, Inc., stated, “In 2008, a strategic initiative was set into motion by Metropolitan to transform a number of our medical practices from a traditional medical practice model to a PCMH model. With the release of today’s exemplary study results, we could not be more pleased. This is just the beginning. Under the PCMH model, we are experiencing levels of quality never before achieved in our system while reducing expenses across our spectrum. PCMH empowers the primary care physician, a shrinking resource, with the right tools to take the leading role in their patients’ overall healthcare plan, allowing them to deliver better care and better outcomes. Under PCMH, we are delivering unprecedented and measurable healthcare reform and savings without cutting benefits. Working within our means and without government intervention, we think this is an idea whose time has come. It is the logical and practical future of healthcare delivery.”
The Process of Change
“The transformation began by performing a comprehensive practice evaluation, focusing on process, workflow, forms, and policies and procedures,” stated Jose Guethon, M.D., M.B.A., President and Chief Operating Officer of Metropolitan Health Networks, Inc. “Considerable time was devoted to staff education and training on customer service and engagement. This was necessary to emphasize and hardwire the principle of what we call patient-centeredness. Because the PCMH model is a team-approach to care, the culture and attitudes among the staff at the medical practice had to change. This also had financial implications for us. While Metropolitan’s revenues are a mix between fee-for-service and capitation, the primary reimbursement method is capitation, making us financially responsible for all medical services covered by any particular plan for the customers we serve. In order for us to improve both the quality of care and our financial outcomes, it was imperative that we learn to better manage chronic conditions in a cost-effective manner and strive to operate our practices as efficiently as possible.”
“With gradual and measured steps we implemented the change process throughout selected practices,” Dr. Guethon continued. “Ranging from continuous education and staff training, to adoption of health information technology such as practice management systems that include telephonic messaging, electronic prescribing, a disease registry, speech recognition software, and a document management system, we immersed our people in the process of change and gave them the path and tools to succeed and the results speak for themselves.”
The Future
Guethon commented further, “With the power of today’s modern healthcare technology, it gets even better. We are now in a position to implement a fully integrated electronic medical record solution that will have a very positive impact. By leveraging this technology to track and ensure compliance and empowering and engaging patients through such tools as EmmiSolutionsTM , an interactive video health education tool, and ClientIQTM, an on-demand customer satisfaction software solution, we expect that results from the pilot’s second year will be even more impressive. What is exciting is that we think we can take this further. Later this year, we intend to recruit additional PCMHs from among our affiliate network. Metropolitan will develop teams to help facilitate continuous transformation through education, training, and implementation. We intend to be industry leaders in sharing best-practices with respect to building a PCMH.”
About Metropolitan’s PCMH Program
Metropolitan’s primary care practices employ licensed healthcare providers such as family practice and internal medicine physicians, nurse practitioners, RNs, and LPNs. These community-based practices deliver care to over 9,000 of Metcare’s 35,500 total MA patients with a mean age of 72.4 years. The transformation continues into its third year. As a commitment to its program, Metropolitan applied for NCQA’s certification program and expects to be one of the first medical practices in the State of Florida to receive such certification.
The PCMH, as defined by the Patient Centered Primary Care Collaborative (www.pcpcc.net), is an approach to providing comprehensive primary care to adults, youth and children. The key components of a true PCMH include:
Access to care based on an ongoing relationship with a personal physician who is able to provide first contact, continuous and comprehensive care;
Care provided by a physician led team of individuals within the practice who collectively take responsibility for the ongoing needs of patients;
Care based on a whole person orientation in which the practice team takes responsibility for either providing care that encompasses all patient needs or arranges for the care to be done by other qualified professionals;
Care coordinated and/or integrated across all elements of the complex health care system and the patient’s community;
Care facilitated by the use of office practice systems such as registries, information technology, health information exchange and other systems to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
For more information on Metropolitan’s PCMH efforts, visit www.metcare.com/patient-centered-medical-home.html.
About Metropolitan Health Networks, Inc.
Metropolitan Health Networks, Inc., with its group of Metcare of Florida primary care practices, is a growing healthcare organization that provides comprehensive healthcare services for Medicare Advantage members and other patients in Florida. To learn more about Metropolitan, please visit www.metcare.com.
