Editorial by Thomas Ebert, M.D., Vice President and Chief Medical Officer, Health New England


Just like the Cheers bar, suppose there was a medical practice where everybody knew your name.  In Western Massachusetts, Health New England (HNE) is trying to get medical practice right.  Over the past two years HNE has embarked on transitioning its HMO members to Patient Centered Medical Home (PCMH) services.  Currently more than 7,500 GIC members receive care in PCMHs in the Springfield, Northampton and Amherst areas. 

 So, what is different?  We have paid attention to access to care, patient satisfaction and the overall cost of care.  Primary care physicians are engaged and want to know what services their patients are using, such as emergency services.  Our PCPs are demanding better communication from specialists, and more importantly, from our hospitals.  And the biggest change we have seen is that our PCPs want to know how much the services they order cost.  In the past most PCPs never asked about the cost.  They were always surprised when told, for example, an ER visit costs $1,000, or a CT scan, $500.

 What is next?  We know HNE has to change.  We need to supply more relevant and actionable data on a regular basis to the medical home practices.  We have to push the hospitals towards cost transparency.  You may have heard that there is a companion to the medical home and that is the Medical Neighborhood (the specialists and hospitals with whom primary care physicians work).  Our specialists are in that neighborhood, but only if they cooperate with the PCPs.  Some specialists in our network are beginning to have office hours at the PCP practices.  They are providing timely and relevant consultations without taking over the care.  This has led to better coordination of services and better reconciliation of what is ordered, particularly medications. 

 What about patients?  We’re not ready to claim that every patient’s experience is better because of the medical home model, but our members are beginning to see some positive differences.  They are beginning to work with care managers who are working in the medical practices.  The practices are reaching out to patients regularly around preventive services and care follow-up. And when patients call they get in to see their physicians sooner and at more convenient times.  We have measured access and patient satisfaction in medical homes compared to other practices.  Access for routine care is better and patient satisfaction is higher. 

 The transformation in the medical practice is a journey and it will take time to get it right.  We at HNE believe that this is the most important innovation in care delivery in our company’s 25 year history.

 Dr. Thomas Ebert is the Chief Medical Officer for Health New England and has been in this position for the past 12 years.  Previously, he worked for Pilgrim and Harvard Pilgrim Health Care. Prior to this, he practiced nephrology for twenty years at Worcester Memorial Hospital.

This information provided by the Group Insurance Commission.