Through the Calhoun County "Pathways to Health" initiative, the community of Battle Creek, Mich., has been refining and applying a chronic care model to improve clinical outcomes, boost health and reduce healthcare costs.
Local healthcare systems and physician offices, major employers, the municipal government and health plans are participating in the effort.
"This initiative is a new way of providing care and the way things will happen in this county," said Ruth Clark, executive director of Integrated Health Partners (IHP), a joint venture between the Calhoun County Physicians Organization and the Battle Creek Health System, and one of the main leaders in the community's efforts.
IHP became a participant of Blue Cross Blue Shield of Michigan's Physician Group Incentive Program in 2006. The incentive program promotes information sharing among physicians throughout Michigan to improve healthcare delivery through a chronic care model.
IHP helped develop the "Pathways to Health" initiative's leadership team, which comprises advisory councils for the community's multi-stakeholders - consumers, employers, health plans and physicians. The consumer advisory council focuses on barriers to care, the employer and health plan advisory council is working on benefit design, and the physician advisory council is implementing a chronic care model to transform the way they provide care in their offices.
The initiative is focused on treating and closing the healthcare delivery gap for diabetes, congestive heart failure, coronary artery disease and asthma. Clark noted that diabetes and obesity rates are significantly high in Calhoun County.
All the local health plans are part of the initiative in some form, including Blue Cross Blue Shield of Michigan, which provided the impetus and infrastructure funds; the Blue Care Network of Michigan, UnitedHealthcare, Priority Health, Cofinity (an Aetna company) and Aetna Foundation, which also provided funding. The Medicaid HMOs have also participated in the leadership group to learn how to implement improvements in their programs, said Clark.
The Kellogg Company joined the Pathways to Health initiative a couple of years ago, according to Bill Greer, vice president of benefits. "We recognized a big need," he said. "If employers worked together with providers and health plans on this chronic care model, there was a chance to make a big difference in the community. This had a lot of momentum."
Project participants developed a registry to track data for population health management and built interfaces to connect providers. Hospital and labs also feed data into the registry. "This is one of the key foundations to the initiative," said Greer. "This is a great way to track and measure chronic diseases community-wide."
Battle Creek is using the Wagner Chronic Care Model developed by Edward Wagner, MD, director of the W.A. MacColl Institute for Healthcare Innovation at the Center for Health Studies, Group Health Cooperative of Puget Sound in Seattle, Wash. A consultant is working with primary care physicians and specialists to implement best practices for treating diabetes.
Employers such as the Kellogg Company are supporting these efforts by implementing the Center for Health Value Information's value-based insurance design, which calls for lower deductible rates and co-insurance on services that make a difference in improving employees' health. "CHVI is a way for us to drive the employer piece of this initiative," Greer explained.
In surveys and focus groups, employers identified benefit design a barrier to care, said Clark. "Our hope is if we combine our work with physicians, patient engagement and benefit design, the progress can be exponential," she said.
A handful of employer groups, including the Kellogg Company, Battle Creek Health System and Denso Manufacturing Michigan Inc., have committed, beginning Jan. 1, 2009, to implementing a value-based insurance design model.
"This is a big moment for us," said Cyndy Nayler, president and executive director of CHVI. CHVI's value-based design is being layered over the community's patient-centered collaborative medical home model. In order to achieve a successful patient-centered medical home, Nayler said that provider efforts must be reimbursed. "The Center has called for more evidence of financial and healthcare improvements for incentive-based design," she said. The value-based model will teach the industry how to align incentives and how to track community health improvements, Nayler said.
Employers Kellogg, the Kellogg Foundation, the City of Battle Creek and Trinity Health System-Battle Creek Health System have committed to test the model, said Nayler. "The first step is being at the table," she said.
Greer said that the community would collect and measure data and monitor the health of its diabetics to see if the initiative is making a positive impact on their health. The initiative can work in bigger cities, he said, if the big provider groups and employer groups in those communities work together. "We're trying to do some leading-edge help in the Battle Creek community and other communities in the U.S.," he said.
Nayler anticipates seeing clinical and financial trends from the initiative within one year to 18 months. CHVI's Health Evidence Committee, comprising health plans and employer groups around the country, will be assessing the initiative as it develops to determine whether Battle Creek's model is replicable in their communities.
Ultimately, Clark said, "My belief is that healthcare reform is going to occur on the local level."