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 and Holston Medical Group (HMG) Launch “Patient-Centered Medical Home” Pilot Program for the Tri-Cities and Southwest Virginia Region

BLOOMFIELD, Conn. & KINGSPORT, Tenn., October 26, 2010 – CIGNA (NYSE:CI) and Holston Medical Group (HMG) have launched a pilot of the patient-centered medical home model, in which a primary care physician is responsible for monitoring and coordinating nearly all aspects of a patient’s medical care. This is CIGNA’s only such pilot in the Tri-Cities and southwestern Virginia area.

This pilot represents a collaborative approach between CIGNA and the 150 health care professionals of Holston Medical Group to improve patient access to care, to improve continuity, coordination and quality of care, and to lower medical costs. It encompasses:

  • use of electronic medical records to track medical history
  • case management/disease management within the practice
  • onsite urgent care
  • extended hours
  • education to help people navigate their health care system
  • better availability of appointments
  • pay for performance – doctors will be rewarded for improving quality and lowering costs

The pilot program, which began August 1, focuses on individuals, especially those with chronic illness or ongoing medical needs, who receive care from Holston Medical Group’s primary care physicians who practice family medicine, internal medicine and pediatrics.

Holston Medical Group passed a significant review process by CIGNA before qualifying for the patient-centered medical home pilot program.

Currently, more than 10,000 individuals who are covered by a CIGNA health plan receive ongoing medical services from Holston Medical Group. Of these, approximately forty percent are employed by Eastman Chemical Company or are beneficiaries covered by Eastman Chemical Company’s CIGNA health care benefit plan.

“We are honored to be designated a medical home for our patients who are employees and families of Eastman Chemical Company and CIGNA health plan-covered individuals,” Dr. Scott Fowler, president of Holston Medical Group, said. “We are excited to participate in this opportunity with CIGNA and to formalize a concept our physicians have been pursuing for some time.”

Eastman’s Director of Integrated Health David Sensibaugh said, “The current U.S. health care system is not sustainable. Self-insured employers like Eastman are very interested in innovative models of health care delivery that reward clinicians who provide high-quality and cost-effective care. It is critical that all health plans and health care professionals work collaboratively to drive systemic quality improvements that will in turn result in a more sustainable model of health care delivery.

“We commend CIGNA for being proactive in advancing new approaches to improve quality of health outcomes in our region. We also appreciate the leadership and foresight of Holston Medical Group to partner with CIGNA in a new model of health care delivery. This model will result in better health outcomes for the individual in addition to controlling costs for both the individual and company.”

Primary care physicians affiliated with Holston will be paid as usual for the medical services they provide and will also be rewarded through a “pay for performance” structure if they meet targets for improving quality and enhancing access to appropriate health care. According to Dr. Robert McLaughlin, CIGNA’s senior medical director for Tennessee, emphasizing the value of the primary care physician as the overall coordinator of their patients’ health will help increase the professional satisfaction and financial rewards for doctors who practice in primary care.

To obtain the benefits of the medical home pilot, people simply access care from one of the numerous Holston Medical Group primary care physicians participating in the program. There is no change in choice of primary care doctor or in any plan requirements regarding referrals to see specialists.

“We think a patient-centered accountable care model that pays doctors for improving outcomes, lowering medical costs and providing greater value to their patients is a better model of health care than the current system that rewards doctors for performing more procedures,” Dr. McLaughlin said. “By shifting the focus from specialization to coordinated primary care, patient-centered medical homes can help improve outcomes and patient satisfaction.”

CIGNA will evaluate results after the program has been operational for at least 12 months. The pilot is one of many that CIGNA participates in nationally and is intended to help the company gather data about the effectiveness of the patient-centered models of care. CIGNA’s programs include multi-payer pilots in Colorado, New Hampshire, Pennsylvania, and Vermont, as well as CIGNA-only accountable care pilots in Connecticut, Georgia, Missouri, New Hampshire and Texas. 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. CIGNA offers products and services in over 27 countries and jurisdictions and has approximately 60 million customer relationships throughout the world. To learn more about CIGNA, visit www.cigna.com. To sign up for email alerts or an RSS feed of company news, log on to http://newsroom.cigna.com/rss. Also, follow us on Twitter at @cigna, visit CIGNA’s YouTube channel at http://www.youtube.com/cignatv and listen to CIGNA’s podcast series with healthy tips and information at http://www.cigna.com/podcasts or by searching “CIGNA” in iTunes.

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.

UnitedHealthcare Wins Innovation Award from National Business Coalition on Health for Programs that Improve Consumers’ Health.

The National Business Coalition on Health (NBCH) gave UnitedHealthcare a 2009 eValue8 Health Plan Innovation Award for programs that help engage physicians and patients to achieve better health outcomes.

National Business Coalition on HealthUnitedHealthcare’s Patient-Centered Medical Home (PCMH) program and Diabetes Health Plan were recognized by the NBCH for their ability to help enhance health care safety and quality while reducing costs. Both initiatives use UnitedHealthcare’s industry-leading technology and data resources and integrate patient and physician information in order to help drive more informed health care decisions.

“UnitedHealthcare’s Patient-Centered Medical Home program and Diabetes Health Plan were selected because both are the kind of innovations that are significant drivers of health status,” said Dennis White, senior vice president of value based purchasing at NBCH. “Purchasers are very interested in innovations like these as they align incentives, restructure care delivery and provide tools that keep people healthy.”

“We are honored to receive this award from the National Business Coalition on Health as recognition that our company’s continued innovation is helping people live healthier lives. The Patient-Centered Medical Home and Diabetes Health Plan are examples of how consumer information and education, comprehensive program support, and financial incentives help physicians and patients tackle rising health care costs while driving better health outcomes,” said Sam Ho, M.D., UnitedHealthcare executive vice president and chief medical officer.

Coordinating Care At A “Medical Home”
UnitedHealthcare’s PCMH program involves primary care practices in Arizona, Colorado, Ohio, New York and Rhode Island and was developed in close collaboration with national primary care specialty societies including the American Academy of Physicians, American College of Physicians, American Osteopathic Association and American Academy of Pediatricians. In the PCMH model, patients receive coordinated care from their primary-care physician, or “medical home,” rather than fragmented and episodic care from various health care providers or facilities. The model promotes enhanced disease prevention and care of chronic conditions. It also emphasizes behavioral health support and patient education, not just the diagnosis and treatment of injury and illness.

UnitedHealthcare provides participating PCMH primary care practices with technology, infrastructure support and care-coordination services. These improved information systems are designed to enhance patient access to care; help improve the quality and safety of the care experience as well as the delivery of preventive and chronic care; and drive patient satisfaction. All medical home projects include innovative payment models to primary care physicians, derived from anticipated savings due to better coordination of care and prevention of complications in chronic diseases.

Diabetes Health Plan
UnitedHealthcare’s Diabetes Health Plan is designed to help employers control the escalating costs of insuring diabetic and pre-diabetic employees and their families while improving their health. According to the American Diabetes Association (ADA), one out of every five health care dollars is spent caring for someone diagnosed with diabetes, while one in 10 health care dollars is attributed directly to diabetes.

The first-of-its-kind Diabetes Health Plan goes further than traditional diabetes wellness programs by providing patients with financial incentives for adhering to certain routine preventive care compliance requirements such as having regular blood sugar checks, routine exams and preventive screenings, which can result in better self-management of their care. Plan benefits, which can include some free diabetes supplies and diabetes-related prescription drugs, as well as lower co-payments for related doctor visits, can potentially save individuals up to $500 a year in addition to their regular health care benefits.

In addition to helping people live healthier lives, the preventive steps under the Diabetes Health Plan can help significantly lower a diabetic employee’s total health care costs, which average more than $22,000 a year, according to UnitedHealthcare data.

About the National Business Coalition on Health and eValue8
NBCH is a national, non-profit, membership organization of 60 business and health coalitions, representing over 7,000 employers and 25 million employees and their dependents across the United States. NBCH and its members are dedicated to value-based purchasing of health care services through the collective action of public and private purchasers. eValue8 is a product of the National Business Coalition on Health and is the nation’s leading evidence-based request for information (RFI) tool used by coalitions and major employers to assess and manage the quality of their health care vendors. For additional information visit: www.nbch.org.

About UnitedHealthcare
UnitedHealthcare (www.unitedhealthcare.com) provides a full spectrum of consumer-oriented health benefit plans and services to individuals, public sector employers and businesses of all sizes, including more than half of the Fortune 100 companies. The company organizes access to quality, affordable health care services on behalf of more than 25 million individual consumers, contracting directly with more than 600,000 physicians and care professionals and 5,000 hospitals to offer them broad, convenient access to services nationwide.UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company.