There's a scene in the 1996 movie Independence Day where Harvey Fierstein (right), trapped in traffic trying to escape the shadow of an ominous alien ship, calls his doctor's office. Informed that Dr. Katz is not available, Fierstein screams "For $300 an hour, you can put me through to his house in the Hamptons!"

Had Fierstein been a patient with access to Group Health Cooperative's medical homes, his doctor could have called him, reminded him to take his blood pressure medication and scheduled a date for a follow-up visit.

On Wednesday, we began a series of blog posts that will highlight the innovative work being done by members of Health CEOs for Health Reform -- a New America Foundation coalition of industry CEOs and physicians committed to improving our health system.

Today, we'll examine the innovations in primary care made by the Group Health Cooperative -- a consumer-governed, integrated health care system covering over 600,000 individuals and delivering care in one of the largest integrated group practices in the Pacific Northwest. In the video below, Group Health president and CEO, Scott Armstrong, MBA, explains why his organization decided to adopt a medical home model for primary care, how they restructured their system, and the impressive results that followed.

With Congress considering private sector health insurance cooperatives as a possible alternative to a public health insurance option, Group Health has drawn national attention. As Armstrong told The New York Time's Kevin Sack recently:

There's a kind of accountability to the patients in our system ... And when you bring the principles of a cooperative to bear, patients feel responsibility for holding the system together and for their own health. 

Features of Group Health make it quite unusual, even within the finite world of insurance cooperatives. Yet the lessons from Group Health's experience in revamping its primary care model can be applied to our health care system as a whole.

Group Health started its transformation after seeing within its own network of providers the kind of variations in cost and quality of health care documented across the U.S. by the Dartmouth Atlas and Atul Gawande. In January 2007, it started a medical home pilot at its Factoria Medical Center. Now Group Health plans to introduce the medical home model in all its medical centers by 2010. What follows are some key points to take away from Group Health's experiences:

Strengthening the patient-doctor relationship:

One of the hallmarks of a medical home model -- however you define it -- is that it strives to give doctors more time. Medical homes give doctors more time to spend with patients and more time to do the kinds of things that can keep people healthy but are generally not reimbursed (or reimbursed poorly) under current payment models. Group Health expanded its primary care staff by 30 percent, allowing it to: reduce physician panel sizes (the number of patients under each doctor's care); increase multidisciplinary teams of doctors, physician assistants, nurses, medical assistants, and clinical pharmacists; and extend appointment times from 20 minutes to 30.

More Coordination and Better Communication

In his presentation during a recent HC4HR briefing on Capitol Hill, Armstrong described his own experience, as a patient, with Group Health's medical home model. He received an email one morning saying his lab reports had come. Using Group Health's electronic medical record, he was able to securely access the results online. To his disappointment, he saw that his cholesterol was too high. A few hours later, Armstrong got a call from his doctor, telling him, yes, the cholestoral was still too high. Not only had the doctor already adjusted the medication, the prescription had been sent to the pharmacy (e-prescribing) and the new meds would be mailed to Armstrong in the next couple of days. Efficient, fast, and convenient.

Rapid Change and Real Results

Group Health's efforts have paid off. Relative to baseline estimates, ER visits for patients in Group Health's medical home dropped by almost 30 percent. Avoidable hospital admissions declined by 11 percent. Those savings alone, Armstrong argued, can more than pay for the investments needed in primary care. Overall quality measures increased, as did employee satisfaction. Group Health's vice president for primary care, Michael Erikson, believes the reductions in turnover and recruitment costs for physicians and other clinical staff may save the organization up to $2 million a year. Based purely on the testimonies posted by real doctors to Group Health's medical home blog, Erikson maybe on to something. Patricia Boiko, a family practice physician, writes:

Two years ago, I was at wits end. When I entered a room with a patient my first words were always, "Sorry, I am running late". I was frustrated at the lack of time to look up issues or call consults while the patient was in the room. I was always back logged with results and getting answers to patients.

That all has changed. Gradually over the last two years, I have arrived! I walked into each room today within 15 minutes of the appointment time, completely prepared for the visit. I prepped the MA [medical assistant] with all the things that would aide the efficient and complete care of each [patient] before they were seen. I called a consultant today who was too busy to discuss a case with me and preferred me to refer the [patient]. I called another consultant who was able to give me advice over the phone as to how to work up the patient. The patient was happy not to have to see another doctor and is on her way to appropriate diagnosis and treatment. I am not backlogged with calls, labs, or consultations. The work gets done today and the rework is at a minimum. I am truly happy in the practice and able to tell patients how great the GH Medical Home system is. 

Check back next week, as we examine more examples of what works in health care and check out this Health CEOs for Health Reform white paper for practical policies that can transform health care in America.