The United States Supreme Court is scheduled to rule very soon on the constitutionality of the new federal health care law just as some of the more innovative aspects of the law are going to be tested locally. Last week the federal government announced it had reached agreement on a memorandum of understanding by which six major Hudson Valley payers — Aetna, CDPHP, Hudson Health Plan, Empire Blue Cross, MVP and the Teamsters’ health plan — will reimburse selected local medical practices providing comprehensive primary care.
The seven payers have agreed to cooperate with each other and with about 75 selected primary-care providers in the 12-county region for four years. The ambitious — even revolutionary — plan is intended to allow the Hudson Valley physicians to get the financial and technical resources they need to strengthen the primary care they provide, the payers to reduce their costs through better coordinated and data-driven care, and the patients to enjoy the outcomes of better access and better care.
“Ultimately it comes down to patient-centered care,” said Dr. Kyu Rhee, vice president of integrated health services at IBM. “It is important to give physicians and their teams the tools, data and analytics to better integrate and coordinate care and improve the healing relationship between patients and their doctors. Such multi-stakeholders are essential. Payers must be involved if we are to achieve care that is continuous and collaborative.”
Primary-care practices which enroll in the five-point program must agree to provide a range of enhanced services for their patients. They will offer longer and more flexible hours using electronic health records. They will deliver preventive care. They will take the responsibility of coordinating care with patients’ other health care providers (“coordinating care across the medical neighborhood”). They will engage patients and caregivers in managing their own care. And they will promise to provide individualized, enhanced care for patients living with multiple chronic diseases and higher needs.
Innovative financial carrots for participating physicians will include a monthly care-management fee on behalf of their fee-for-service Medicare beneficiaries and after the first year of the initiative the potential to share in savings to the Medicare program. Practices will also receive compensation from other payers participating in the initiative, including private insurance companies and other health plans, which will allow them to integrate multi-payer funding streams to strengthen their capacity for quality improvement.
Point of contact
Why this focus on primary care? “A primary-care practice is a key point of contact for patients’ health care needs,” explained the website of the federal Center for Medicare and Medicaid Innovation. “In recent years, new ways have emerged to strengthen primary care by improving care coordination, making it easier for clinicians to work together, and helping clinicians spend more time with their patients. All around the country, healthcare providers and health plans have taken the lead in investing in primary care. Employers across the country have found that with health coverage policies that emphasize primary care, coordinated care, and other strategies that keep their employees healthy, they not only support a healthier workforce, they create a healthier bottom line.”
The seven pilot markets chosen for the Comprehensive Primary Care (CPCi) initiative include four entire states — Arkansas, Colorado, New Jersey and Oregon — and three regions: the Hudson Valley, Cincinnati-Dayton in Ohio and Kentucky, and greater Tulsa in Oklahoma.
Why was the Hudson Valley chosen? Fishkill-based Thinc (Taconic Health Information Network and Community) is probably one of the reasons. The Hudson Valley’s premier health information technology think tank, Thinc’s primary purpose has been “to advance the use of health information technology through sponsorship of a secure health information exchange network, the adoption and use of interoperable electronic health records, and the implementation of health improvement activities.”
In pushing toward these goals, Thinc’s training activities have provided the Hudson Valley one of the most technologically linked population of primary-care providers in the nation. The organization has explored quality improvement initiatives that include public health surveillance and reporting, pay for performance, patient-centered medical-home-practice transformation, care-coordination activities and public reporting.
Thinc has also been working for several years to strengthen multi-stakeholder collaboration. These years of preparation are finally about to lead to a new level of cooperation. The new announcement from Washington confirms the willingness of the payers to provide innovative primary-care physicians with the tools they need to be the central building block of a more rational health care system.