Primary-care practices across Maine take a new approach to help patients and reduce costs

As an internist, Dr. Carl DeMars specializes in solving puzzling diagnostic problems. For the last three years, as the medical director of Mid Coast Health Services' Accountable Care Organization, he's been practicing that skill in the arena of health care policy as an advocate for a new approach to primary care known as the "patient-centered medical home."

"I see the patient-centered model as the very foundation of our health-care system," he says. "Too often we've relied on waiting for sick patients to show up at the door and sending them out with their prescriptions. The patient-centered medical home is all about treating patients proactively. It's about making decisions together with our patients, talking with them about the positives and negatives and the costs of the different treatment options."

It's time to fix the system from the ground up, he says, pointing to the $11 million investment Mid Coast Health is making to create primary-care clinics in Topsham and Bath that were designed from top-to-bottom to facilitate a team approach to primary care. Together with a clinic in downtown Brunswick, the three medical homes will be supported by coordinated teams of physicians, nurse care managers and behavioral health specialists — all having the mission of helping people to stay healthy, rather than simply treating them when they're sick.

DeMars and his Mid Coast colleagues are not alone in their embrace of the new PCMH direction.

Of the roughly 500 primary care practices in the state, upwards of 175 have begun implementing the new PCMH approach, according to figures provided by Maine Quality Counts, an independent collaborative aiming to improve health care. They extend into every corner of Maine: 75 are enrolled in the pilot program launched in 2010 by Maine Quality Counts, the Dirigo Health Agency's Maine Quality Forum and the Maine Health Management Coalition; another 100 or more were added in the Health Homes initiative overseen by MaineCare and the Maine Department of Health and Human Services.

Because almost 40% of emergency room visits and between 10% and 17% of inpatient hospitalization costs are estimated to be preventable, according to an April 10 commentary in the Journal of the American Medical Association, primary care has emerged at the forefront of local, state and national health care initiatives to reduce costs.