According to presenters at a
June 6 policy summit(fora.tv) on health care
innovation here, the lower health care costs the United States is experiencing
may be due, in part, to the growing use of innovative payment and delivery
models of health care. This is backed up by results from at least one pilot
program testing the patient-centered medical home (PCMH) model of care that has
seen a large decrease in costs.
Bruce Bagley, M.D., right, TransforMED interim president and
CEO, talks about the patient-centered medical home with Chet Burrell, president
and CEO of CareFirst BlueCross BlueShield, and Marci Nielsen, M.P.H., Ph.D.,
CEO of the Patient-Centered Primary Care Collaborative after participating in a
policy summit on health care innovation.
During the summit, CareFirst Blue Cross Blue Shield, a
sponsor of the summit, which was held by theNational Journal Live,
announced that its medical home program in Maryland, Northern Virginia and
Washington, D.C., had achieved dramatic cost savings and improvements in the
quality of care for the second straight year. In 2012, the PCMH project, the
largest of its kind in the nation, saved $98 million, according to CareFirst.
In addition, two reports issued by the Congressional Budget
Office earlier this year projected billions in federal budgetary deficit
savings as a result of lower health care costs. "CBO has issued two
reports in which the data points around health care costs are dramatically
changing," said Neera Tanden, J.D., president of the Center for American
Progress and a former senior adviser for health reform at HHS, who delivered
the summit's keynote address.
Tanden attributed at least part of the slowdown in health
care costs to the growing use of PCMHs, accountable care organizations and
bundled payments. "These innovations are driving the changes," she
said.
STORY HIGHLIGHTS
- The
move to team-based, coordinated care has created a greater need for the
patient-centered medical home and other innovative payment models that
rely on a foundation of primary care, according to a recent policy summit
held in Washington.
- The
forum highlighted the accomplishments of the CareFirst medical home
program, which achieved cost savings and improvements in the quality of
care for the second straight year.
- Bruce
Bagley, M.D., interim president and CEO for TransforMED, said the
prevailing fee-for-service payment system discourages innovation and
change in the health care arena.
The Health Care Environment
Tanden's keynote address was followed by an expert panel
that included Bruce Bagley, M.D., TransforMED interim president and CEO; Chet
Burrell, president and CEO of CareFirst; Marci Nielsen, M.P.H., Ph.D., CEO of
the Patient-Centered Primary Care Collaborative; and Kavita Patel, M.D., fellow
and managing director of delivery system reform and clinical transformation at
the Center for Health Care Reform at The Brookings Institution.
Bagley told the audience of about 200 policymakers and other
stakeholders that the health care environment has changed, becoming much more
oriented toward primary care. "I have never seen this much attention to
primary care in the policy arena and the political arena," he said.
There is a general acknowledgement that health care spending
and costs are not sustainable, creating a need for innovative payment and
delivery models to slow health care costs and improve quality. The prevailing
fee-for-service payment system has discouraged innovation and change in the
health care arena because the model is based almost entirely on office visits
as the central commodity, Bagley said. "Until we get unshackled from that,
it is very hard to do things that are not visit-based."
When Bagley asked how many people in the audience could
e-mail their physicians for a consultation, only two hands went up. "That
is sparse," Bagley said. "That is sad."
He called for a blended payment model to compensate
physicians for care coordination and other services that fall outside
face-to-face visits. One of the goals of the AAFP and TransforMED, said Bagley,
is to create an environment where physicians can deliver continuing, comprehensive
and personal care in more consistent and reliable ways using tools, such as
registries, for patients with chronic diseases.
In recent years, said Bagley, it has become increasingly
clear that practices need an infrastructure to implement and sustain the PCMH
model. "It is not only about paying doctors more," he said. "It
is about creating an environment in which the work of primary care can be done
in an effective and efficient way."
The CareFirst Pilot
That environment is demonstrated in the CareFirst PCMH pilot
project, which relies on a network of primary care practices, known as medical
care panels, to deliver and manage care through a team-based approach. The
program comprises 420 physician panels, and each panel is responsible for
taking care of about 3,000 CareFirst members. The panels are accountable for
aggregate patient costs and quality across all settings.
"Every single thing that is done for those patients in
any setting, by any provider, is the responsibility of that panel," said
Burrell. "We debit every single item and service against that panel."
The message to the physician practices is unmistakable:
"Don't let your patients break down, don't let your patients get excess
services, and don't ignore things that need to be tended to," Burrell
said. "The job is to take care of the (patients) better, and for that we
need a team, not just the physician."
CareFirst provides each panel with an overall budget for the
coming year and then challenges the panel to beat that budget, allowing it to
share in the savings if it comes in below the target. The panels are able to
beat the budgets by reducing hospital readmission rates, emergency room visits
and complications from drug interactions, effectively taking better care of
their patients, said Burrell.
CareFirst has 2.5 million members in Maryland, Virginia and
Washington, D.C. More than 1 million are included in the pilot. The inpatient
medical costs for members within the PCMH pilot were 15 percent lower in 2012
than for those who were not in the pilot. PCMH patients also had drug costs
that were 4 percent lower, and their cost per admission was 8.3 percent lower
than the non-PCMH patients.
Burrell said elements of the CareFirst model can be
replicated in other parts of the country. He pointed out, however, that health
care intrinsically is local. "There are meaningful differences in the way
it is provided in difficult localities," said Burrell. "You should
build on that and not try to ignore that and make everything one common model.
There is no one right way."
According to Bagley, the ultimate goal is to achieve the
triple aim of health care: better care for the individual, better population
health and lower costs on a per capita basis. "That should be common
everywhere," Bagley said. "That is the goal of our system."
An Illinois congressman is taking another stab at reducing Medicare fraud. U.S. Rep. Peter Roskam (R-Wheaton) has introduced a bill to require the government to sniff out fraud in Medicare and Medicaid the same way credit card companies are alerted to suspicious activity. “It’s literally deploying technology that’s already used. This is not blue sky technology. This is not some brand-new, untried thing, but it is technology that is tried and true, and what we’re saying is it is time for the federal government to adopt this same technology,” he said at a news conference at Northwestern Memorial Hospital in Chicago.
