ConnectiCare Partners with Doctors Statewide; Sees Members’ Primary Care Visits Rise

Community Medical Group, Inc. (formerly known as New Haven Community Medical Group, Inc.) the Latest to Begin Collaboration Arrangement

FARMINGTON, CT (December 11, 2014) – ConnectiCare, Inc. and Affiliates, Connecticut’s local health plan, has made significant progress in getting its members to their doctors regularly through active collaboration arrangements with doctors statewide.  As a result, primary care visits are up and hospital admissions, readmissions and emergency room visits are down.

ConnectiCare has practice collaboration arrangements with eight Connecticut-based medical groups throughout the State including:  Integrated Care Partners (Hartford HealthCare), St. Francis HealthCare Partners, ProHealth Physicians, Connecticut State Medical Society IPA, Grove Hill Medical Group, Charlotte Hungerford Multi-Specialty Group and Connecticut Multi-Specialty Group.  Most recently, Community Medical Group, a physician-led independent practice association, based in New Haven has entered into a collaboration arrangement with ConnectiCare. Continue reading

Medical Home Common Theme in ACA State Grant Programs

We have been tracking some of the health plan innovations that are being funding as part of the Affordable Care Act. (ACA). Stateline, the daily news service of the Pew Charitable Trusts, has published an article that looks into the progress states are making in their efforts to grapple with the relatively high cost and low quality of U.S. health care.

Stateline notes that out of the $1.8 trillion the ACA is projected to cost over the next decade, $10 billion is dedicated to innovation programs. Susan Dentzer of the Robert Wood Johnson Foundation, a nonprofit group that promotes improvements in the U.S. health care system told Stateline, “The idea is to take governors up on their claim that states are the laboratories of democracy where meaningful innovations can occur.”

So far, Stateline reports, Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont have applied for funds under the under an ACA program called the State Innovation Models Initiative, and this year, they began testing new health care financing models. Another 19 states are in various stages of developing similar experiments. Continue reading

Connecticut Health Care Redesign Plan Focuses on Primary Care, Doctor Payments and Reducing Waste

The ct Mirror is reporting that a team of state officials and health care industry representatives are trying to redesign the way health care is paid for and delivered to the vast majority of Connecticut residents.

According to a draft of their plan, their vision includes bolstering primary care practices to take on a larger role in patient care and offer treatment during expanded hours. It calls for better linking of medical practices with social services and other supports that could help people in high-risk communities. And it includes changing the way health care providers are paid by giving them an incentive to rein in what their patients’ care costs — a model that’s been embraced by Medicare and insurance companies but has drawn fire from patient advocates. Continue reading

Cigna Acquires Alegis Care with Plans to Expand Medical Home and Chronic Care Services

BLOOMFIELD, Conn., September 03, 2013 – Cigna (NYSE: CI) announced today it has completed its acquisition of Alegis Care, a portfolio company of Triton Pacific Capital Partners. Alegis Care is a multi-specialty, medical health services organization dedicated to creating a comfortable medical home experience for homebound Medicare and Medicaid patients. Alegis Care specializes in serving the chronically ill and elderly with physician services, comprehensive care coordination and a high level of patient care in the safety and comfort of a patient’s own home or place of residence.

Read the full story at Newsroom.Cigna.com

Patient-Centered Medical Homes Improve Access and Quality of Care

VIRGINIA BEACH, VA–(Marketwire – Sep 2, 2011) – Amerigroup Corporation (NYSE: AGP) is working with hundreds of physicians in six states on a patient-centered medical home(PCMH) pilot program that is helping doctors improve access and quality of care for their patients.

According to the latest Patient Centered Primary Care Collaborative (PCPCC) report, Amerigroup currently ranks 8th nationally for the number of providers participating in the PCMH pilot program, and is the only plan in the top ten that is solely dedicated to serving public beneficiaries. Amerigroup’s PCMH strategy requires focused, on-the-ground training and collaboration with its providers, and is creating an innovative delivery system for its members in an effort to produce better outcomes, higher quality care and lower costs.

Amerigroup Chief Operating Officer Richard Zoretic remarked, “Amerigroup’s Patient Centered Medical Home initiative is a natural extension of our larger Provider Collaboration strategy designed to deepen our relationships with those physicians offering the best combination ofclinical quality and affordable care. We look forward to introducing the PCMH model to additional providers as part of our ongoing effort to improve the quality and efficiency of care delivered to our members.”

“Our partnership with Amerigroup has increased our efficiency and patient compliance, making us more effective in the communities we serve,” said Dr. Melvin Lightford of the Metro Center Health Group in Nashville, Tennessee. “Thanks to the patient-centered medical home, our patients are able to get the access they need, we are able to better deliver the appropriate primary care preventative treatments and keep our patients out of the emergency room. We have enjoyed working with Amerigroup on this pilot program over the past year and look forward to our continued partnership.”

In Nashville alone, approximately 40,000 Amerigroup members are participating in a PCMH. With a strong focus on provider collaboration and continuity of care, this initiative is improving quality and access for thousands of members, while reducing non-emergent E.R. visits and hospital readmissions. For example, the Metro Center Health Group in Nashville has decreased its patients’ ER visits by 7% for the first six months of 2011 versus the same period in 2010.

Dr. William G. Runyon, Chief Medical Officer for Amerigroup Tennessee said, “With many patients seeking most of their medical care in emergency rooms, we have had a real challenge controlling costs and improving quality care.” Dr. Runyon added, “By using the PCMH model to facilitate a stronger relationship between primary care providers and their patients, we have seen significant improvements in our providers’ abilities to reduce ER visits and hospital admissions, ultimately resulting in better outcomes for our members.”

Pediatrician Jeffeory H. White, M.D., is one of Amerigroup’s newest partners in the Georgia PCMH pilot program. Dr. White remarked, “Part of our mission statement at White’s Pediatrics is to promote ‘the optimum physical, mental, emotional, and spiritual well-being’ of every pediatric patient. I am proud to be able to work with Amerigroup to take White’s Pediatrics in this new and exciting direction.”

Amerigroup is on track to have 42 practice sites and close to 500 providers participating in medical home models in six states by the end of 2011; Georgia, Florida, Maryland, Tennessee, Texas and Nevada, with plans to expand to additional health plans in 2012.

Medical Home Fact Sheet

About Amerigroup Corporation
Amerigroup, a Fortune 500 Company, coordinates services for individuals in publicly fundedhealth care programs. Serving approximately 2 million members in 11 states nationwide, Amerigroup accepts all eligible people regardless of age, sex, race or disability. Amerigroup is dedicated to offering real solutions that improve health care access and quality for its members, while proactively working to reduce the overall cost of care to taxpayers. Click here for more information about Amerigroup Corporation.

 

Blue Cross Blue Shield of Michigan Designates 2,500 Physicians in Nation’s Largest Medical Home Program

DETROIT — Blue Cross Blue Shield of Michigan has designated approximately 2,500 physicians in roughly 770 practices across the state as patient-centered medical homes (PCMH), a 28 percent increase over the 1,800 designatedPCMH physicians in 2010. This is the nation’s largest PCMH effort for the third consecutive year.

In the patient-centered medical home model, primary care physicians (pediatricians, internists and family practice doctors) lead care teams that bring intensive focus to their patients’ individual health goals and needs. The care teams work with patients to keep them healthy, monitoring their care on an ongoing basis. PCMH teams coordinate patients’ health care using registries to track patients’ conditions and ensure that they receive the care they need.

PCMH practices offer patients various capabilities and services that patients may not find at non-designated practices.  They offer 24-hour access to the care team, coordinate specialist and complementary care – such as nutrition counseling – and teach patients how to manage conditions such as asthma and diabetes. All PCMH-designated primary care physicians offer their patients 24-hour phone access to clinical decision-makers, comprehensive information on after-hours care options, medication review and management, and a well-established process for informing patients about abnormal results.

“Partnering with Blue Cross, many dedicated health care professionals are greatly improving access for patients, achieving better outcomes of care and more effectively managing costs, ” said Thomas L. Simmer, M.D., senior vice president and chief medical officer for BCBSM.  “This program gives Michigan residents closer relationships with their doctors, not only when they are sick, but when they need advice and guidance to keep them healthy.”

In comparing utilization trends of PCMH-designated and non-designated physicians, BCBSM has observed that PCMH-designated doctors are succeeding in managing their patients’ care to keep them healthy and prevent complications that require treatment with expensive medical services. For example in 2010, PCMH practices had an 11.1 percent lower rate of adult ambulatory care sensitive inpatient admissions than non-designated practices.

PCMH practices also had a 6.3 percent lower rate of adult high-tech radiology usage; a 6.6 percent lower rate of adult ER visits; a 3.3 percent higher rate of dispensing generic drugs; and a 7.0 percent lower rate of adult ambulatory care sensitive ER visits over non-PCMH doctors.

“Many doctors tell me that this is what they envisioned for primary care. This patient-centered medical home model gives doctors the structure, process and tools they need to manage their patients’ care continually, rather than just fix their ailments from episode to episode,” Simmer said. “Physicians are working hard to transform their practices into patient-centered medical homes. In fact, we’ve now doubled the designated doctors from 1,200 in 2009 to 2,500 in 2011.”

More than 5,000 primary care doctors in Michigan are working toward designation as PCMH practices by transforming how their practices deliver health care services to patients. Simmer notes that while 2,500 of the 5,000 doctors attempting designation actually achieved it for 2011, they commend the efforts of those other 2,500 physicians for their work in supporting the PCMHmodel of care.

“All of these physicians are partnering with Blue Cross through this initiative to improve the primary care environment throughout the state,” Simmer said.

The benefits of PCMH reach all of a practice’s patients, regardless of whether the patient is insured by Blue Cross. The Blue Cross Patient-Centered Medical Home initiative affects millions of Michigan residents through designated physician offices today.The Blue Cross Blue Shield of Michigan Patient-Centered Medical Home program uses a model that considers both process of care and performance to designate physicians.  Half of the designation score is based on the amount of PCMH capabilities that the physician practices have in place – such as 24-hour telephone access, use of disease registries, and active care management. The other half of the designation score is based on quality and utilization measurements, such as emergency room visits, radiology and evidence-based care measures among their patients.

Blue Cross has posted a list of PCMH designated physicians on its website atbcbsm.com. People interested in locating a PCMH physician in their community can go to bcbsm.com and click on “Find Doctor” at the top of the page.

The PCMH initiative is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and the Michigan Blues, all aimed at improving quality in medical care. To learn more about this comprehensive effort, go to valuepartnerships.com.

 

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. For more company information, visit bcbsm.com.

 

 

Health Plan of Michigan Announces New Health Care Incentive: Improving Quality, Supporting Physicians

DETROIT, May 16, 2011 /PRNewswire/ — Health Plan of Michigan announced its new Patient Centered Medical Home (PCMH) Incentive Program. This program encourages providers to become PCMH by providing financial assistance during the practice certification phase. It also rewards providers who have already received PCMH designation.

The concept of a Patient Centered Medical Home is an approach to providing comprehensive primary care which improves access to health care, increases patient satisfaction and improves health outcomes.

The new program is available to all contracted HPM primary care physicians who are open to and accepting new HPM members, and have a current HPM membership of 100 or greater. The incentives are based on HEDIS® quality scores; reimbursements will increase as quality increases. Reimbursements include payments above the current Medicaid fee schedule and the HPM HEDIS Bonus Program. An additional per member-per month payment is also available for participating providers.

“We are very excited about this new Patient Centered Medical Home program,” said Sean Kendall, Director of Network Development for Health Plan of Michigan. “This is a great opportunity for us to support providers who want to become PCMH certified, and an equally good way for us to provide continued incentives to our providers who have already made the move to PCMH.”

Health Plan of Michigan is the state’s largest managed Medicaid program, with over 285,000 members. The HPM network consists of more than 3,300 PCPs, 8,200 Specialists and 98 hospitals in 64 Michigan counties.

Medical Home Pilot Nets Quality Gains, Cost Savings

ALBANY, N.Y. — CDPHP today announced that its nationally-recognized patient-centered medical home pilot resulted in dramatic declines in medical cost growth at three local physician practices. The pilot, designed to help physician practices transform their processes, improve care, and increase reimbursement for primary care physicians, showed that important opportunities exist to improve primary care in the area.
 
The three physician practices involved in the CDPHP® medical home pilot experienced a 9% reduction in the rate of overall medical cost increases—a savings of $32 per member, per month—as compared to other area physician practices, according to a Verisk Analytics™ independent analysis released by the Albany-based health plan.
The practices—Community Care/Latham Medical Group, Community Care/Schodack, and CapitalCare Family Practice Clifton Park—also demonstrated improvements in quality measures, most notably, the proper use of antibiotics and diabetic eye exams.
 
Data from the first year of the pilot also revealed significant reductions in advanced imaging utilization and emergency room visits. Total hospital admissions were 24 percent lower than otherwise expected among the population served by the practices participating in the pilot.
 
The independent analysis indicates that the novel payment model, in conjunction with the practice transformation support, made a difference in the way care was compensated and provided.
 
“We are very pleased by this news. It is an important first step in improving quality and transforming the way we pay for primary health care,” said Bruce Nash, MD, MBA, chief medical officer, CDPHP, who has overseen the pilot since its launch in May 2008. “While CDPHP and the physician practices currently working towards transforming their practices recognize that there are still significant opportunities for improvement, we know we’re headed in the right direction.”
 
The Future of CDPHP Enhanced Primary Care
In September 2010, 21 additional practices began the transformation scheduled to conclude at the end of 2011. Between the first and second phases, the program encompasses 24 physician practices, approximately 150 local physicians, and more than 50K CDPHP members. Given the third-party results and the medical community’s continued interest in the program, CDPHP will begin recruiting for Phase III of this initiative, now called the CDPHP Enhanced Primary Care program.
 
New elements have been added to the subsequent phases, including the embedding of CDPHP nurse case managers within the participating practices. These nurses work collaboratively with the practice staff to better facilitate medical, behavioral, and pharmaceutical services for patients. This interaction will play an integral role in realizing additional future savings from reduced hospital, emergency room, and imaging services.
 
Phase III will consist of primary care practices (family practice, internal medicine, and pediatrics) chosen by CDPHP by the end of May 2011. Selected practices will display strong leadership and a stable practice culture, and serve a significant number of CDPHP patients. The practice will need to demonstrate commitment in achieving NCQA Level III Medical home and enhancing access, as well as an overall willingness by practice leadership to participate and openly collaborate with CDPHP. In addition, due to the significance of technology in the medical home model, practices utilizing EMR and ePrescribing are preferred.
 
“The program’s initial results have thus far exceeded anyone’s projections,” said Nash. “If the results from the second year of the pilot even partially support these initial data, the CDPHP model will not only hold tremendous value for this region, but for national reform efforts as well.”
 
About CDPHP®
Established in 1984 as a physician-founded and guided health plan, CDPHP and its affiliates currently serve members in 24 counties throughout New York with a full family of products.

BlueCross Medical Home Initiative Improves Quality with Innovative Clinical Technology

CHATTANOOGA, Tenn. — As part of its Patient-Centered Medical Home strategy, BlueCross BlueShield of Tennessee is partnering with local health care provider groups and hospitals to roll out technology designed to positively impact the quality of patient care once that person leaves the hospital. Holston Medical Group in Kingsport, TN, is the first to incorporate Smart Transitions from Performance Clinical Systems in its hospital discharge workflows.

Numerous benefits in patient safety have been achieved since the technology was introduced, including alerting primary care physicians in 18 percent of the cases that a new “high-risk” medication had been prescribed and in 24 percent of the cases that post-hospitalization tests were ordered requiring primary care physician follow up.

“With recent studies showing readmission rates as high as 20 percent within 30 days of leaving the hospital, and with our associated costs for these readmissions being as much as $60 million a year, we believe creating a link between inpatient and outpatient care teams is critical for improving outcomes and satisfaction for our members, as well as for those who pay the bill,” said Dr. Robert Mandel, senior vice president of health care services for BlueCross. “We aim to empower all participants in the transition of care workflow with an easily embraced solution that not only supports evidence-based medicine, but makes care related information accessible in a much more timely manner than traditional processes.”

Performance Clinical’s Smart Transitions is a “cloud-based” interactive clinical checklist system, accessible anywhere through a secure Internet connection, which provides active guidance for clinicians to consider as they make their patient discharge plans. The system makes those plans instantly available via a computer to primary care physicians for proactive follow up with their patients. All steps are captured electronically in a database for ongoing analysis to support quality and performance improvement goals.

“Creating a strong chain of care communication is vital for delivering the quality of care expected of our physicians,” said Dr. Scott Fowler, president of Holston Medical Group. “Typically, the enabling technology for facilitating this communication is met with resistance because of its complexities and disruption to clinical workflows. With Smart Transitions, we found the opposite to be true. Our hospitalists appreciate how easy it is to incorporate into their routine and our primary care physicians are already benefiting from the real-time access to comprehensive transition of care plans.”

“We’re delighted that BlueCross BlueShield of Tennessee turned to us to help them drive this important component of their Medical Home Initiative,” said Performance Clinical’s co-founder and chairman, Jeremy Nobel, M.D., M.P.H. “Our interactive clinical checklist system provides partnering medical groups, hospitals and primary care teams with the infrastructure for decision support, shared access to patient-specific plans, and performance analytics to drive improvement. This milestone with Holston Medical Group and BlueCross is a great example of a high-impact, yet practical solution that delivers on the promise of better patient care through health information technology.”

About Holston Medical Group

As one of the largest multi-specialty providers within the Southeast, Holston Medical Group’s “Family of Care” consists of more than 800 employees, including 150 physicians and mid-level providers in its provision of 24-hour medical/surgical coverage. Regarded as a national leader in clinical research as well as electronic health record integration and utilization, Holston Medical Group provides convenient locations throughout Northeast Tennessee and Southwest Virginia, offering two Urgent Care Clinics (Bristol & Kingsport) and state-of-the-art diagnostic capabilities. On-site ancillary services available include digital x-ray and mammography, CT, MRI, ultrasound and cardiac services. Additionally, HMG provides the patient convenience of on-site laboratory services. For more information, visit the group’s Web site at: www.holstonmedicalgroup.com

About Performance Clinical Systems

Performance Clinical Systems is a healthcare technology company based in San Francisco, California and Boston, Massachusetts. Christopher Johnson, MD, MPH and Jeremy Nobel, MD, MPH founded the privately held company in 2004. Its core applications, SmartOrders and SmartTransitions, inject precision and consistency to evidence-based medicine, provide interactive clinical checklists directly at the point of care, and gather essential data for advanced analytics and quality improvement. The company’s solutions are attractive to hospitals and medical groups because they are quickly embraced by clinicians, deployed rapidly (within 90 days) work alongside or as a layer on traditional enterprise HIT systems, and contribute significantly to a provider’s ability to handle shifts in reimbursement and quality measures that put the burden of efficiency on them. For more information, visit the company’s Web site at www.performanceclinical.com

About BlueCross

BlueCross BlueShield of Tennessee is the state’s oldest and largest not-for-profit health plan, serving nearly 3 million Tennesseans. Founded in 1945, the Chattanooga-based company is focused on financing affordable health care coverage and providing peace of mind for all Tennesseans. BlueCross serves its members by delivering quality health care products, services and information. BlueCross BlueShield of Tennessee Inc. is an independent licensee of BlueCross BlueShield Association. For more information, visit the company’s Web site at www.bcbst.com.

BCBSNC, UNC Health Care Announce Partnership To Launch Novel Patient-Centered Practice

CHAPEL HILL – The state’s leading health insurer and the state’s health care system will collaborate to develop a completely new type of medical practice in which patients – not just their symptoms – are the focus of care. This advanced medical practice will extend beyond what is currently called the ‘medical home’ and will enable teams of health care providers to work collaboratively with patients and families in delivering high quality, coordinated care. BCBSNC and UNC Health Care expect the new practice, which will likely be located in Orange or Durham county, to open in the fourth quarter of 2011.

This venture would be the first product of what BCBSNC and UNC Health Care expect will be an ongoing collaboration in which they work together to enhance health care quality, improve efficiency and effectiveness, and reduce healthcare costs.

“The team approach to care emphasizes patient involvement and allows more time for clinical interaction and patient education and support,” said BCBSNC President and CEO Brad Wilson. “We believe this approach will result in improved health and fewer complications – both of which will help control rising health care costs.”

“We’re in an era of change in health care, so let’s work together to make positive change,” said Dr. William L. Roper, CEO of UNC Health Care.  “This innovative approach with education, patient support and self-management is one important step toward making health care less mysterious and more effective.”

The practice will care for 5,000 BCBSNC members focusing on patients with chronic conditions, including coronary artery disease, hypertension, diabetes, obstructive lung disease, major depression, and asthma. 

The new practice will provide continuity by coordinating care across a variety of settings and provider types. The practice is designed to enable more effective patient-provider interactions, which should result in better patient satisfaction and improved health. Additionally, this practice will provide an expanded set of services and greatly enhanced access to these services including:

  • Non-traditional visit formats (e-visits, televisits, home monitoring)
  • On-site mental health
  • On-site nutritionist
  • On-site pharmacy and medication management
  • On-site laboratory
  • Case management and coordination of care for patients requiring hospitalization
  • Group and educational visits
  • Extended weekday and weekend hours
  • State-of-the-art information technology

About BCBSNC: 
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 77 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at http://www.bcbsnc.com.

About UNC Health Care:
The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care. UNC Health Care is comprised of UNC Hospitals, ranked consistently among the best medical centers in the country; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; and Rex Healthcare and its provider network in Wake County. Although this new practice will only provide care for BCBSNC members, UNC Health Care’s other physician offices, hospitals and facilities will continue to provide care for patients with all types of insurance and those without insurance.