QUALITY: UnitedHealth, IBM Launch Medical Home Pilot

Not waiting for action from the federal government, some private companies are searching for ways to drive down health care costs while preserving, or even improving, quality. In today's New York Times, Reed Abelson reports on a pilot medical home program started in Arizona by I.B.M., one of the state's biggest employers, and UnitedHealth Group, its insurer. The pilot will give 26 doctors at seven medical groups more direct responsibility for coordinating the care of 7,000 patients. UnitedHealth will also begin to pay doctors for overall quality of care, not just for the services provided.

Medical homes are a promising way to improve patient care and control health care costs. The medical home model gives patients a "home base," a physician who coordinates the patient's path through surgeries, specialists, and other care. It is seen as a particularly promising tool for managing chronic disease. In North Carolina's Medicaid program, assigning patients to a physician at a community clinic (their "medical home") has saved the state millions since FY2004. Both Senate Finance Committee Chair Max Baucus and the Medicare Payment Advisory Commission are interested in expanding medical homes in Medicare.

Like so many American companies, I.B.M. is struggling with the soaring costs of insuring its workers. "What we buy is garbage," Dr. Paul Grundy, I.B.M.'s director of health care transformation, told the Times in a frank description of the high costs and poor outcomes of their current system of insurance. The Arizona experiment should contribute to the growing body of evidence on medical homes and help inform federal policymakers crafting comprehensive health care reform.