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

Hub and Spoke ACOs May be Hard Sell In U.S.

A post today on AISHealth.com describes a new alliance in western Pennsylvania between Highmark Health Services and six Allegheny Health Network (AHN) hospitals as being “like an ACO without walls.”

The article, which was reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, reported that this alliance is part of Highmark’s effort to accelerate the shift from volume-based, fee-for-service (FFS) payment to a system that pays for value.

Highmark describes the alliance, in this article, as a way to foster more integrated care, moving beyond primary care physicians (PCPs) in its Patient-Centered Medical Home (PCMH) program to add specialists and hospitals to the mix. Continue reading

Cigna and Partners In Care Launch First Accountable Care Program in New Jersey Involving an Independent Physicians Organization and a Health Plan

BLOOMFIELD, Conn. & NEW BRUNSWICK, N.J., December 20, 2011 – Cigna (NYSE:CI) and Partners In Care (“PIC”), an independent physicians organization based in Central New Jersey, have launched a collaborative accountable care initiative to expand patient access to health care, improve care coordination, and achieve the “triple aim” of improved health outcomes (quality), lower total medical costs and increased patient satisfaction. Collaborative accountable care is Cigna’s approach to accountable care organizations, or ACOs.

An ACO is a variation on the patient-centered medical home model of health care that rewards primary care doctors for improved outcomes and lower medical costs. Cigna’s program with PIC is the first patient-centered accountable care program in Central and Northern New Jersey involving an independent physicians organization and a health plan.

The program is focused on approximately 14,000 individuals covered by a Cigna health plan who receive care from among 360 doctors at more than 160 participating physician practices. Individuals who are enrolled in a Cigna health plan and later choose to seek care from one of the participating practices will also have access to the benefits of the program.

“Patients with chronic conditions, such as diabetes or hypertension, see many different specialists and health care professionals with little to no coordination among them. It is unnecessary, disorganized and dangerous,” said Steven Goldberg, M.D., chairman, PIC. “Monitoring these patients and ensuring their care givers are talking to one another – with one patient-selected personal physician in the leadership role – will undoubtedly lead to safer, more consistent, and more effective medical care.”

“Cigna and Partners In Care have shared values, and the commitment to patient-centered care is evident in every aspect of this program,” said Kevin O’Brien, president & CEO, PIC. “As we work together to help patients remain healthy, the overall costs are less – it’s a win for everyone.”

The participating physician practices will monitor and coordinate all aspects of an individual’s medical care. Patients will continue to go to their current physician and will not need to do anything to receive the benefits of the program. There also are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes or heart disease.

Critical to the program’s benefits are clinicians and registered nurses, employed by Partners In Care, who serve as clinical care coordinators and help patients with chronic conditions or other health challenges navigate the health care system. The care coordinators will enhance care by using patient-specific data that Cigna provides to identify patients being discharged from the hospital who might be at-risk for readmission, as well as patients who may be overdue for important health screenings or who may have skipped a prescription refill. The care coordinators will work with the patient’s physician to help patients get the follow-up care or screenings they need, identify any issues related to medications and help prevent chronic conditions from worsening.

The care coordinators will also help an individual’s medical home provide health education and refer individuals to Cigna’s clinical programs, such as disease management programs for diabetes, heart disease and other conditions; and lifestyle management programs, such as programs for tobacco cessation, weight management and stress management.

“The current health care system is focused on treating illness and rewards physicians for volume rather than value; it’s not designed to drive long-term health improvement and lower costs,” said Dr. Ron Menzin, Cigna’s medical director for New Jersey. “If our goal is a healthier population and lower medical costs, we need to create a patient-centered health care system that emphasizes prevention and primary care and that rewards physicians for quality of care and improved health outcomes.”

Cigna will pay physicians as usual for the medical services they provide. Partners In Care will also pay the physicians for the care coordination services they provide on the patient’s behalf. Additionally, physicians may be rewarded through a “pay for performance” structure if they meet targets for improving quality and lowering medical costs.

“Employers bear a large portion of the nation’s health care costs, so it’s important to them to find a model of health care that can lower these costs through improved employee health,” said Laurel Pickering, president & CEO of the Northeast Business Group on Health (NEBGH). “This patient-centered collaboration between Cigna and Partners In Care is an excellent example of how health plans and physicians can work together to achieve a healthy, productive work force and create a health care system that works for everyone.”

The principles of the patient-centered medical home are the foundation of Cigna’s collaborative accountable care initiatives. Cigna then builds on that foundation with a strong focus on collaboration and communication with the physician practice. With the addition of Partners In Care, Cigna is now engaged in 17 patient-centered initiatives in 15 states, encompassing more than 170,000 Cigna customers and more than 1,800 primary care physicians, including multi-payer pilots and Cigna-only collaborative accountable care initiatives. The company plans to continue increasing the number of initiatives significantly in 2012. Cigna has been a member of the Patient-Centered Primary Care Collaborative since October 2007.

About Cigna

Cigna (NYSE: CI) is a global health service and financial company dedicated to helping people improve their health, well-being and sense of security. Cigna Corporation’s operating subsidiaries in the United States provide an integrated suite of health services, such as medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance.

About Partners In Care

Partners In Care, Corp. (PIC) is a privately held, physician owned, for-profit provider of healthcare and management services. With a broad network of independent community physicians throughout New Jersey.

Highmark’s Pay-For-Performance Program Saved Lives and Health Care Dollars in 2010-2011

Nov. 3, 2011 | Pittsburgh, Pa. — Highmark’s latest data on its Quality BLUE pay-for-performance programs demonstrates that participating hospitals and physicians consistently take better care of Highmark members than health care providers that are not part of the program.

“Whether you look at infection rates, screening for various diseases or electronic prescribing rates, Highmark members are getting better care from providers that are part of the Quality BLUE program,” said Linda Weiland, vice president of provider network innovations and partnerships. “We see very clear patterns of improved patient safety and clinical care for our members.”

Highmark today released its annual Quality BLUE report which provides data from fiscal year 2011 on both the hospital and physicians pay-for-performance programs. Some of the major findings include the following:

  • Well-child visits in the first 15 months of life exceeded the national average by 15 percent and well-child visits for children, ages 3 -6, exceeded the national average by 13 percent.
  • Seventy-six percent of female members age 42 to 69 received mammography screening for breast cancer from Highmark providers in the past two years. This is a full nine percent higher than the national average.
  • Seventy-two percent of office-based physicians in Quality BLUE use electronic prescribing compared to only 36 percent nationally. Electronic prescribing improves patient safety and reduces errors. It also improves efficiency and cost savings.
  • An estimated 351 cases of MRSA with a care cost savings estimated between $9.5 million – $12.2 million were eliminated during the past four years. MRSA is an antibiotic-resistant organism, which can cause potentially life-threatening bloodstream and surgical site infections in hospitals and community settings. Through the Quality BLUE hospital program, hospitals provide MRSA education to patients and family members.
  • An estimated 1,535 central line associated bloodstream infections (CLAB) with care costs savings of $11.2 million to $44.8 million were eliminated in all nursing units, not just intensive care units, during the last five years, saving potentially 184-384 lives. A central line is a catheter inserted into a large vein close to the heart to monitor blood circulation, provide nourishment and administer fluids and medication. While these catheters are life sustaining, they put patients at risk for infection.

 

The Highmark Quality BLUE hospital pay-for-performance program began in fiscal year 2002 with six hospitals. By fiscal year 2011, program participation grew to 63 hospitals and today includes 81 hospitals.

Highmark’s Quality BLUE physician program is offered in 49 counties in Western and Central Pennsylvania, with approximately 6,300 PCPs in more than 1,600 practices, providing services to more than 1.7 million Highmark members. Sixty-six percent of all primary care practices participate in the Quality BLUE program.

“During the past decade we know this program has greatly improved patient safety and saved millions of dollars,” said Weiland. “At Highmark we continue to push for paying for quality in health care and not just paying for services.”

About Highmark
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.8 million members in Pennsylvania and West Virginia through the company’s health care benefits business and is one of the largest Blue plans in the nation. Highmark has 19,500 employees across the country. For more than 70 years, Highmark’s commitment to the community has consistently been among the company’s highest priorities as it strives to positively impact the places where members call home. For more information, visit www.highmark.com.

Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit www.highmark.com.