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Study: ‘Medical homes’ yield limited quality improvement, no cost containment

BY Antoinette Alexander

NEW YORK — A three-year pilot of a “medical home” model of primary care yielded few improvements in quality and cost of health care, according to a new Rand study.

Evaluating one of the nation’s earliest and largest multi-payer medical home pilots, researchers found that most participating primary care practices achieved recognition as medical homes, but the quality of care improved significantly for only 1-of-11 widely used quality measures.

The findings are published in the Feb. 26 edition of the Journal of the American Medical Association.

“The medical home has gained popularity as a new model of primary care, with the expectation that the approach will produce better and lower-cost health care,” stated Mark Friedberg, the study’s lead author and a natural scientist at Rand, a nonprofit research organization. “Our findings suggest that achieving all of these goals is a challenge.”

Medical homes, also known as “patient-centered medical homes,” are primary care practices that are designed to provide comprehensive, personalized, team-based care using patient registries, electronic health records and other advanced capabilities. Recent medical home initiatives have encouraged primary care practices to invest in these new capabilities, participate in learning collaboratives and achieve medical home recognition. Health plans offer to pay more to the practices that achieve recognition.

Comprehensive primary care can improve outcomes for chronic conditions like diabetes and asthma, while lowering costs by reducing patients’ needs for care from hospitals and emergency departments.

Researchers evaluated the Southeastern Pennsylvania Chronic Care Initiative, which was the first of several regional multi-payer medical home pilots in the state. In this region, 32 primary care practices and six health plans participated in the pilot between 2008 and 2011.

Using data on approximately 120,000 patients, researchers compared quality, utilization and costs of care between the pilot practices and 29 other practices that were not in the pilot.

The study found that pilot practices successfully adopted the medical home capabilities, such as creating lists of patients overdue for needed services, and achieved recognition as a medical home from the National Committee on Quality Assurance. Rates of monitoring for kidney disease among patients with diabetes improved, and there were signs that quality improved for some other aspects of diabetes care.

However, the evaluation of the medical home pilot did not detect improvements on the quality measures that assessed asthma care, cancer screening and control of diabetes, according to researchers.

In addition, the medical home pilot did not show a reduction in patients’ use of hospitals or emergency departments, or the total costs of medical care.

“It is possible that the pilot we evaluated had some, but not all of the ingredients necessary to produce broad improvements in quality and efficiency,” Friedberg stated. “Findings from this evaluation and others should help refine the medical home model.”

Researchers indicate that there are several possible reasons that the pilot medical home pilot did not show broader improvements on measures of cost and quality.

The pilot emphasized quality of care for diabetes and asthma, and practices did not have financial incentives to contain costs. While most participating practices adopted new capabilities that targeted quality of care, fewer increased night and weekend hours, which could have created short-term savings by reducing unnecessary visits to hospital emergency departments.

Because the pilot practices volunteered to become part of the medical home experiment, they may have been more quality-conscious than other practices even before the pilot began. This would have created a “ceiling effect” where there was less room to improve quality, according to researchers.

Rand researchers also are conducting evaluations of several additional medical home primary care pilot projects, including other regions of the Pennsylvania Chronic Care Initiative.

The Commonwealth Fund and Aetna supported the study.

 

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Hy-Vee, MU Health Care to open Mizzou Quick Care Clinics

BY Antoinette Alexander

COLUMBIA, Mo. — The University of Missouri Health Care and grocer Hy-Vee have announced plans to open walk-in medical clinics at all three Hy-Vee stores in Columbia, Mo. Construction of the Mizzou Quick Care clinics will begin in mid-March.

The clinics at 25 Conley Road and 405 E. Nifong Blvd. are slated to open by Aug. 1, and the clinic at 3100 W. Broadway is slated for completion by Oct.1.

"Mizzou Quick Care will provide convenient, affordable, walk-in medical care to anyone in the community age 1 year or older with a common illness, such as an ear infection, strep throat or the flu," stated Mitch Wasden, CEO and COO of MU Health Care.

"Convenient, affordable, quality primary care is in keeping with our mission to advance the health of our community," he added. "The Mizzou Quick Care clinics will be linked to all MU Health Care providers through the health system’s advanced electronic health record, and the providers at Mizzou Quick Care will be able to facilitate access to higher-level care for those in need."

Susan Pereira will serve as medical director of the Mizzou Quick Care clinics. Pereira is a family medicine physician at MU Health Care, as well as an associate professor in the Department of Family and Community Medicine at the MU School of Medicine.

"We have an opportunity and responsibility to our customers to help them meet all their health-and-wellness goals," stated Andy McCann, chief health officer for Hy-Vee. "Partnering with University of Missouri Health Care to offer quick and convenient clinical services in our Columbia stores for minor ailments is just one more way we accomplish that goal."

Mizzou Quick Care clinics will serve patients with upper respiratory symptoms like sore throat or cough, urinary symptoms, skin rashes and minor injuries. The clinics also will offer employment-screening physicals and daycare physicals, pregnancy tests, sports physicals, flu shots and limited adult immunizations.

 

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Study: Long checkout lines negatively impact shoppers likelihood to return

BY Antoinette Alexander

DULUTH, Ga. — Many Americans would likely not return to a store if they experienced long checkout lines, according to new research from global retail technology company Omnico Group.

According to Omnico Group’s latest national primary research campaign, more than 77% of Americans would be less likely to return to a store if they experienced long checkout lines, supporting the perception that consumers who "want it here" expect to get it fast.

The Omnico study looked at how U.S. retailers are currently offering consumer-facing technology to aid retail decision-making and improve the customer experience. It found that after eight minutes, Americans are likely to abandon the checkout line and leave the store with no purchase. Although more patient than their British counterparts, who leave after six minutes, Americans are more likely to never return to that store as a result of the negative experience than their British counterparts.

"Although we have known for some time that retailers who actively focus on preventing abandoned baskets and checkout attrition see compelling benefits to their bottom line, the impact of long lines on longer-term customer loyalty is alarming," stated Bill Henry, Omnico Group’s CEO. "The retail landscape is changing as more retailers move to an omnichannel’s approach of embracing mobile POS technology. These are powerful tools to improve the customer experience and retailer performance."

With 74% of shoppers in the study owning a smartphone, the study also looked at smartphone adoption and how mobile technology is changing shopping behavior. It found that retailers need to bridge the gap between what consumers expect and what can actually be delivered. Similarly, the report picks up on the current big themes of the modern retail debate, such as whether to introduce line-busting mobile technology; how to deliver voucher and loyalty programs using the customers’ smartphone; and whether to embrace showrooming.

The findings also highlight the high cost to retailers in terms of sales lost, thanks to long checkout lines resulting from too few registers, and underscored the need for retailers to introduce digital solutions that nurture loyalty.

"Customers want technology solutions that join up the channels and transform the customer experience," Henry said. "Omnichannel solutions enable brick-and-mortar retailers to accelerate their growth in challenging conditions and provide new opportunities to win back customers from pure-play online shops. Retailers that embrace omnichannel technology and offer seamless customer journeys to the shopper have a very bright future."

Additional highlights include:

  • The top three technologies that will improve the average customer’s in-store experience are self-checkout, free Wi-Fi and "click-and-collect" (i.e., order online, pick up in-store) technology;
  • Controlling for price and reward programs are the best to encourage Americans to be loyal customers. Coupons also are well-received; and
  • Millennials, between the ages of 25 years and 34 years, lead the way in mobile use, particularly when comparing prices and shopping on competitive retailers’ websites while in the store.

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