United Hospital Fund Examines Promising Collaboration of Providers and Payers to Create Medical Homes and Improve Primary Care
Adirondack Demonstration Tests New Care Model to Improve Access and Quality While Reducing Costs
A new report from the United Hospital Fund examines a promising initiative to redesign medical practice in an area spanning four counties in the Adirondacks. The initiative—the Adirondack Medical Home Demonstration—involves a partnership of hospitals, primary care physicians, private insurance carriers, and New York State.
Recognizing a critical shortage of primary care physicians as an opportunity to effect real change, health care providers and other community members identified the patient-centered medical home model as their best chance of improving primary care for physicians and patients alike. Over four years, physicians, payers, state officials, and community leaders worked to achieve broad consensus on the structure and funding of this demonstration, aimed at boosting the region’s ability to attract and retain primary care physicians, increasing quality and continuity of care, reducing avoidable utilization and costs, and improving the health of the community.
The report examines the development of the initiative, from reaching consensus on the problem, to designing and funding the project, through implementation.
“One of the least discussed but most important aspects of the Affordable Care Act is its focus on innovative projects that demonstrate how to improve health care delivery,” said James R. Tallon, Jr., president of the United Hospital Fund. “The Adirondack Medical Home Demonstration is an excellent example of this type of project, addressing a local concern, but also testing an innovative way to organize and pay for health care. Of particular note, it moves away from paying per unit of care—a model that provides incentives for greater health care spending, regardless of impact— to paying for effective management of care. The theory behind it is strong. We and the rest of the country will watch to see whether the theory plays out in practice.”
The report The Adirondack Medical Home Demonstration: A Case Study also identifies factors that contributed to the successful development of the initiative, while explaining why replication elsewhere may present a different range of challenges. As the report says, “If a defined and recognized community has a pressing need, and if the providers who serve that community can work together, and the payers agree to participate, it is possible to put together an initiative with the potential to transform the delivery of health care at the front end, in primary care physicians’ offices. But defining a recognizable and actionable ‘community’ is not always easy, particularly in dense urban and suburban regions, where there may be neither a sense of shared identity and connectedness, nor a history of collaboration.”
The report concludes that its final lesson is the need to reconsider the case for regional health planning—“in short, having local health systems operate more like integrated delivery systems, in the interest of the public and the communities they serve.”
The Adirondack Medical Home Demonstration: A Case Study, written by Gregory Burke, a consultant, and Sean Cavanaugh, former director of Health Care Finance for the Fund, is available from the Fund’s website, www.uhfnyc.org.
This report complements an earlier Fund publication, A Multipayer Approach to Health Care Reform, which assesses the opportunities and challenges for multipayer collaborations based on this same Adirondack initiative. It is available from the Fund’s website.
About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose mission is to shape positive change in health care for the people of New York.