Health care focusing on teamwork

By John Laidler
Globe Correspondent / December 16, 2010

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Eight primary-care medical practices in the region are helping Massachusetts chart a new path toward delivering and paying for health care.

The eight practices are among 46 recently selected by the state to participate in a three-year demonstration program aimed at promoting patient-focused, team-oriented medical care.

Founded on a growing concept across the country, the Patient-Centered Medical Home Initiative involves having a primary-care doctor head a team of providers that coordinates all of a patient’s health needs, including management of chronic conditions, visits to specialists, hospital admissions, and reminding the patient to schedule checkups and tests.

The intent is to improve the quality of care and in so doing reduce long-term costs.

“The hope is that this would allow us to provide care the way physicians want to provide care and the way patients want to receive it,’’ said Dr. Scott Early, a family physician and the chief medical officer of Lynn Community Health Center, which is one of the local practices selected for the program.

Because of funding and time constraints, Early said most primary-care practices today are not able to work with patients in the comprehensive way they would like.

He said the medical home approach, which includes creating electronic records for each patient, is designed to change that.

“It’s where things are headed to help figure out how can we deliver care better, how can we cut down on people falling through the cracks. . . . how can we connect better with the community,’’ said Dr. Laura Sullivan, medical director of the Malden Family Medicine Center, another participant in the program.

In addition to the Lynn and Malden centers, other practices taking part in the initiative are Broadway Health Center and Union Square Family Health Center, both in Somerville; Drum Hill Primary, LLC, in Chelmsford; Greater Lawrence Family Health Center’s Haverhill Street facility in Lawrence; Harvard Vanguard Medical Associates, in Medford; and Revere Family Health Center.

The Malden and Revere centers and the two centers in Somerville, are all run by the Cambridge Health Alliance.

The 46 practices will receive technical assistance to transform their practices to patient-centered medical homes. Included will be individual on-site coaching, assistance in establishing patient registries, and training through a learning collaborative.

Thirty two of the sites were also tapped to take part in a pilot program in which participating insurers will pay them to help cover the costs of coordinating the patient’s care and other medical home activities.

Included are all of the participating sites in this region except for the Malden and Broadway Health centers.

The Revere and Union Square centers and Greater Lawrence were also among 14 Massachusetts community health centers selected in 2009 to participate in a privately funded national pilot program to support transformation of health centers to patient-centered medical homes.

Dr. JudyAnn Bigby, the state’s secretary of health and human services, said in a prepared statement that the latest initiative is “one of the key building blocks’’ in the state’s effort to have all the primary care practices in Massachusetts transformed into advanced patient-centered medical homes by 2015.

“The real key to reforming the health care payment and delivery system is putting the primary-care physician at the center of it,’’ said David Martin, director of health policy and strategies for the Executive Office of Health and Human Services. “Part of what we are trying to accomplish with the patient-centered medical home . . . is almost like turning the clock back 100 years to where everyone had a county doctor who knew them and coordinated all their care.’’

Andrea Gaulzetti, director of clinical services for the Lynn Community Health Center, said her group is happy to be part of the new initiative.

“The goal of all health-care providers is to be able to connect with their patients in ways that are . . . really centered on the patients rather than centered on office visits and schedules,’’ she said.

Gaulzetti said that through the state initiative, her center will focus on using the medical home approach for its chronic disease patients, particularly those with diabetes.

Robert Ingala, chief executive officer of Greater Lawrence Family Health Center, said his group has already made considerable progress moving toward a patient-centered medical home model. But he said the group looks forward to the state’s help.

“It’s a great step forward in terms of assisting primary-care organizations to ultimately become a medical home,’’ he said, noting that the payments the center will receive from insurers “certainly will help us in building the infrastructure for care coordination and care management.’’