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FISHKILL, NY – Six health plans –Aetna, CDPHP, Hudson Health Plan, MVP Health Care, UnitedHealthcare and Empire BlueCross Blue Shield – have provided $1.5 million in incentive payments to 236 separate primary care physicians in 11 practices that achieved patient-centered medical home recognition by the NCQA.
The New York-based medical home initiative, now roughly one year old, has been managed over the past year by the Taconic Health Information Network and Community (THINC), with significant participation from the health provider network Taconic IPA.
The seeds of the project stretch back more than three years, said Susan Suard, executive director of THINC.
"Back in 2007 and 2008 the concept of medical home was just beginning to emerge," said Suard. "There was willingness on the health plan side to explore the new model and I think that we were able to put forward a robust evaluation plan that would look at performance on quality measures over the course of the project and also the opportunity to assess cost and utilization measures."
Payer support in the project has been important, Suard said. The health plans represent 65 percent of the commercial insurance market in the Hudson Valley and 43 percent of Medicaid managed care. In all, nearly half a million patients in the upper Hudson Valley use one of the physicians in the medical home project – a figure Suard considers to be "critical mass" for the coverage area.
To move to the next level, a handful of practices in the program have begun using the ProvenHealth Navigtor program from the Pennsylvania-based Geisinger Health Plan, which has four years of data on 15,000 Medicare Advantage members designed to help improve care in a medical home model.
"Through the ProvenHealth Navigator model we closely manage the care of patients with chronic diseases to help them regain or maintain a state of wellness," said Thomas Graf, MD, chairman of the Geisinger Community Practice. "By providing a resource at the first sign of a complication, this program has significantly reduced the number of unnecessary hospitals admissions and readmissions."
For doctors like Mark Foster, MD, chairman of THINC's board and lead physician at Hudson Valley Primary Care, moving toward a medical home model "transforms the practice so it can fully utilize the tools of an electronic medical record and align the goals of the practice with the patients to improve the quality of care that the patient receives."
THINC hopes that piloting the ProvenHealth Navigator program will generate additional improvements in cost and quality of care for high-risk patients. It also hopes it will be a proving ground for the program outside of an integrated health system for individual practices.