Preventive care stepped up

Preventive care stepped up

Misty Williams; Staff  Atlanta Journal Constitution  May 7, 2012

'Medical home' model may expand, aiming to boost care, cut costs.

Imagine this: Doctors getting paid more if they help improve your overall health rather than simply treat ailments as they arise. It could become a reality for some Georgia doctors and patients if plans in the works by two insurance giants pan out. Aetna and WellPoint say they expect within the next year to start reimbursing selected doctors for coordinating all of a patient's health needs both inside and outside the office. Both companies' initiatives focus on the "medical home" model in which primary care doctors become a hub for a patients' care, whether creating plans to manage chronic diseases, connecting them with specialists or extending office hours to accommodate work schedules. The goal is to improve care and cut costs by preventing unnecessary hospital visits and catching illnesses early. "The health care system that we have in this country is incredibly fragmented," said Jill Hummel, WellPoint's vice president of payment innovations. "We can't just sit around twiddling our thumbs, waiting for the ... industry to transform." Introduced by pediatricians in the 1960s, the medical home concept has built momentum in recent years as a possible solution to escalating health care costs, in part because advanced technology allows doctors to keep tabs on more patients, communicate with each other and better measure outcomes. Medical homes have historically treated small groups of chronically ill people, said William Custer, a health care expert at Georgia State University. Expanding the idea to the general population, which has a wider range of conditions and treatments, requires a broader network of providers, he said. "Connecting them all in a meaningful way was impossible even 20 years ago," he said. Still, the medical home movement will likely take years to spread, reaching just a fraction of patients at first. Medical home experiments across the country have returned mixed results on quality and cost savings, Custer said. WellPoint has reported an 18 percent decrease in hospital admissions in a Colorado pilot program. "The results have been encouraging enough and the intuition strong enough that the whole industry is moving that direction," Custer said. Becoming part of a medical home has brought Renate Howard a peace of mind the North Georgia resident struggles to express. Her physician, Dr. Marti Gibbs, is part of the Longstreet Clinic near Gainesville. It recently became one of only 28 practices in Georgia to receive medical home certification by the National Committee for Quality Assurance, a nonprofit focused on improving care. Gibbs coordinates care among three specialists for Howard's 89-year-old mother. She also helps the 63-year-old manage her borderline osteoporosis. It's good that the way doctors are paid is changing, Howard said. "[Gibbs] can be blessed more for the services that she gives." Giving doctors a financial incentive is critical to the medical home concept working, experts say. Electronic health record systems can cost tens of thousands of dollars. It costs more to hire health coaches, case managers and others to help manage care. But they don't necessarily get paid for making follow-up calls, holding health education classes, creating exercise plans or other nontraditional services aimed at keeping people healthy. "Why should a physician's practice invest the time, money and culture change if they're not going to be compensated?" said Wayne Hoffman, a former Atlanta family physician turned health care consultant. Starting in early 2013, Blue Cross and Blue Shield of Georgia, a WellPoint subsidiary, will begin paying some physicians for services not typically reimbursed, such as creating care plans for patients with multiple illnesses. The company has roughly 2.4 million members and nearly 18,000 doctors in its network in Georgia. It's unclear how many will become part of the program, since practices will have to meet certain standards. Physicians could also see a cut of any savings generated by reducing costs and earn as much as 30 to 50 percent more than they currently do. Connecticut-based Aetna is also rolling out a program later this year that will pay doctors an extra $2 or $3 per member each month upfront with the potential for an end-of-the-year shared savings bonus. That extra cash can help physician practices afford electronic medical records or hire extra staff, said Elizabeth Curran, head of Aetna's national network strategy and program development. More pay could someday be a boost for doctors who have already invested heavily in the transformation. Dr. Gibbs would prefer that day come sooner rather than later. Her practice has spent the past year and a half becoming a medical home. Nurses spend more time with patients, analyzing charts before visits to identify needed screenings and making follow-up calls to ensure drugs are taken properly. Gibbs is still paid, however, based on each traditional medical service and continues to see 25 to 30 patients daily to pay overhead costs and salaries. "That's not providing the best care for those patients, and it's certainly not what I went into medicine for," she said. "Every patient is an individual, and I don't want to lose sight of that in the numbers." It will take years for payment models to transition from volume to value, said Dr. Jim Sams, medical director of primary care for Piedmont Medical Care Corp. Current medical home efforts are a bridge --- still paying fee-for-service while adding shared savings opportunities for lowering costs, Sams said. Physicians will eventually assume more risk with insurers potentially withholding payments if they don't meet quality and cost goals, he said. "[Health care] is capable of bankrupting our country over the next 10 years," he said. "Something has to change." The 'medical home' concept Designed to improve overall health, a medical home serves as a central point for coordinating a patient's medical care. That often includes services doctors' offices haven't traditionally provided. As part of a medical home, patients may: *Work with nurses and doctors to create management plans for chronic illnesses, such as diabetes. *Receive follow-up calls after visits from nurses who can answer questions. *Have expanded access to care through evening hours, weekend hours and email. *Receive reminders about upcoming preventive screenings. *Be connected with nutritionists, social workers and other professionals who can help them achieve wellness goals.