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    Unlocking Primary Care: CareOregon's Medical Home Model

    Primary care needs renewal


    Your family doctor is exhausted. Patient care has broken down into hurried, isolated visits. There are more patients, more paperwork, less time and less pay. Blame the payers, blame the legislators, blame the specialists or...radically restructure the system all the way down to its foundation. Rectify the purpose of primary care through deep system changes.

    CareOregon, a non-profit managed Medicaid plan in Portland, Ore., with 100,000 members, has methodically begun to do just that. This small plan is driving its infrastructure toward a patient-centered medical home model—a concept that is just now beginning to take root in the industry.

    Called the Primary Care Renewal project, the overhaul comes at a time when family doctors and Medicaid budgets are stretched to the limit.

    "Part of the reason physicians aren't going into primary care is because it's very laborious work," says Dave Ford, CareOregon's CEO. "Without a primary-care home, infrastructure support and team-based care, it's exhausting. The Primary Care Renewal brings an enthusiasm back to practice, and that's going to be attractive. It also brings money in so that the practices will see average income increases."

    4 Circumstances Driving the Need For Patient-Centered Medical Homes
    According to 2008 data from the American Academy of Family Physicians, family doctors are extremely busy. They conduct an average of 84.9 office visits and 8.1 hospital visits per week. Primary care chalks up 208 million office visits each year—almost 83 million more than the next largest medical specialty.

    As for compensation, the American Medical Group Assn.'s 2008 survey indicates family medicine is one of the lowest paid medical trades, averaging $190,182 in annual compensation, compared with, for example, cardiology at $379,975, or urology at $383,029. Primary care physicians earn approximately 55% of the average earnings of any other physician category, according to the American College of Physicians.

    My Medical Home

    At a glance
    The American Academy of Pediatrics originally introduced the idea of a medical home in 1967, and it has built up to take on a new life in today's healthcare environment.

    Today's vision of the medical home is to shift primary care from the craft of a single physician to the coordinated delivery of a comprehensive set of health services by a patient's dedicated, accessible, multidisciplinary team. Team dynamics can more efficiently address chronic conditions and comorbidities, and the hope is that more costly treatments in more costly settings will be avoided.

    It's a tall order, considering the exhausted state of primary care right now. It's also a very conceptual model of process improvement, and the industry is just beginning to bring the abstract idea down to a level of concrete action.

    CareOregon initiated its Primary Care Renewal project out of the necessity to address a tightening budget while serving a population that includes dual-eligibles and the disabled, as well as homeless, migrant and low-income families. Many struggle with language barriers as well.


    Julie Miller
    Julie Miller was the former Managed Healthcare Executive Editor in Chief until May of 2014.


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