Blue Cross and Blue Shield of Oklahoma is starting a pilot in that state to determine the effectiveness of care coordination when it is coupled with health IT in a medical home model.
Beginning with 45 primary care physicians, Blue Cross is piloting the first phase of the medical home model through July 1, 2011, with about 20,000 patients enrolled through the insurer. Blue Cross will spend the next three months engaging doctors, and plans to create metrics and targeted outcomes in July. The insurance company then will spend the coming year analyzing how well the pilot meets those outcomes, and hopes to then expand the project to more physicians.
The goal is to create the right mix of financial incentives for providers while closing gaps in care, reducing waste in the system and improving patient outcomes, according to Joseph Nicholson III, a physician who is vice president of health care management and chief medical officer for Oklahoma Blue Cross and Blue Shield.
The medical home model is defined by the Association of American Medical Colleges, which has given a preliminary endorsement to the approach, as an online care-delivery concept that includes an ongoing relationship between a provider and patient. It also involves around-the-clock access to medical consultation, respect for a patient's cultural and religious beliefs and a comprehensive approach to coordination of care through providers and community services.
The pilot is a way to "really try to engage physicians in a way we have not before," Nicholson said during a presentation.
The medical home model has gained traction in the past few years as payers try to design reimbursement plans around results, instead of using the traditional fee-for-service model. Industry professionals are beginning to view that traditional model as one that encourages waste in the system, and lacks incentives for doctors to coordinate patient care with other providers or to ensure follow-up communication with patients.
In addition to the its results-based payment structure, the medical home model takes advantage of health IT to make care coordination easier for doctors and patients. The Blue Cross Blue Shield pilot will use patient management tools that alert doctors to close gaps in care -- for example, when a patient needs a certain medication or hasn't received a test in a number of years and is due, Nicholson said. The pilot also will use electronic clinical summaries so participating doctors will be able to see a patient's medical history at the point of care.
Caregivers having the same, up-to-date information will absolutely boost efficiency in many ways.
Joseph Nicholson III, D.O., chief medical officer, Blue Cross and Blue Shield of Oklahoma
Caregivers are fed information across a single platform, so everyone participating in the system -- from primary care doctors and nurses to the insurer -- has the same, up-to-date information that is needed for care, Nicholson said. "That will absolutely boost efficiency in many ways."
Other medical home pilots have had some success in improving efficiency and care, according to Matt Adamson, vice president of medical home initiatives for MEDecision Inc. in Wayne, Pa. The health IT developer hosted the presentation during which Nicholson discussed his pilot project.
MEDecision has begun to see the medical home model move away from pilots into the implementation stage, as health care organizations begin to see a return on investment and quality improvement, Adamson said. "Pilots build upon one another as we learn from previous pilots."
Doctors embrace the model but caution against medical homes relying too heavily on technology. The American Academy of Family Physicians, which also has developed a patient-centered medical home model, said a study in the peer-reviewed Annals of Family Medicine shows that, although it is the doctor-patient relationship that works best in the model, medical home programs tend to place too much emphasis on the technology used to support that relationship.
Let us know what you think about the story; email Jean DerGurahian, News Writer.