early two years after employees at Boeing Co. fought the company’s plan to create a network of what it called “high-performance doctors,” management is in the midst of another experiment to change the way employees receive health care.

    The Chicago-based aircraft maker has pilot projects at three Seattle-area outpatient clinics that, if successful, would improve care for people with more severe chronic illnesses.

    Boeing’s model, known generally as the "medical home," is being adopted by several large employers throughout the country—including IBM Corp., Armonk, N.Y., and Hannaford Brothers Co., Portland, Maine—as a more effective way to provide and pay for primary care.

    "We don't reward a system in which comprehensive coordinated care and robust prevention … [are] valued," said Paul Grundy, director of health-care technology and strategic initiatives for IBM.

    The medical home could change that. Though no exact definition exists for it, the medical-home concept generally involves paying primary-care doctors extra to spend more time managing a patient’s health.

    These efforts include:

• coordinating care among a patient’s team of specialists;

• providing patients with immediate phone, e-mail and in-person access to health-care professionals;

• using electronic health-care records to avoid errors and duplication of services;

• following commonly accepted guidelines of care; and

• using a team of primary-care doctors to evaluate and improve patient care.

    The hope is that paying doctors more to provide better health care for sicker people will improve patient health and reduce overall health-care costs.

    Boeing's effort in Seattle applies lessons learned in a hospital intensive care unit. The company is developing three pilot programs at outpatient clinics in the Seattle area—Virginia Mason Medical Center, Valley Medical Center and the Everett Clinic.

    The clinics will first work with 700 Boeing employees and their dependents before the company determines whether to expand the pilot programs. Boeing declined to comment, saying it wanted to wait until the results of the pilot programs were calculated. All three clinics also declined to comment.

    The clinics are following a model known as the ambulatory intensive care unit, or AICU, which focuses on patients with more serious chronic illnesses. These patients tend to account for a disproportionately large share of a company’s health-care costs.

    "If one has a young and well population, the opportunity to save money and improve health through a primary-care medical home is going to be a lot less than for a severely chronically ill population,” said Arnold Milstein, medical director of the Pacific Business Group on Health, a San Francisco health-care coalition.

    Mr. Milstein, who also holds the title of U.S. health-care thought leader at Mercer Health & Benefits LLC, helped develop the AICU. The idea of the unit is to replicate the 'high touch' care given to patients at a traditional intensive care unit. It consists of a core team of doctors and other medical professionals who give more care to fewer but sicker patients.

    Pranav Kothari, co-founder of Renaissance Health Inc., a medical consulting firm in Cambridge, Mass., helped develop the AICU model and is working with Boeing on the pilot project. Though unable to comment specifically on Boeing, Mr. Kothari said the half-dozen AICU pilot projects he works with throughout the country—all sponsored by employers or unions—are designed to identify patients who have or are at risk of developing chronic illnesses or have complex medical needs, and thereby would incur significant health-care costs.

    "We had the insight that [chronically] sick people need a different type of care" than a person who sees a doctor because they are momentarily sick, Mr. Kothari said.

    The AICU is based on three levels of care, he said.

    The first is designed for intensive care management—providing high-tech, high-touch proactive care and support for people identified with health risks. Care is designed to identify and coordinate medical needs early, potentially reducing more intensive and costly medical treatment later.

    A big component of this care level is supporting change in patients' behavior. What’s most effective is shifting the focus to personal goals rather than disease-oriented goals, in part to help motivate people who might not be willing to accept the label that comes with being "sick," Mr. Kothari said.

—Crain's Benefits Outlook Online,  November 2008