SAN FRANCISCO – Three hospitals are expected to soon implement a new approach to delivering primary care, testing a concept projected to provide cost-effective options for insurers and reduced healthcare expenses for low-income, high-risk patients.
The demonstration project, developed by San Francisco-based HealthTech, also aims to show how ambulatory intensive care units, or A-ICUs, can help providers and payers reduce the enormous costs of treating the sickest 10 percent of the population.
HealthTech, which announced the project last April, said it received responses from 10 hospital networks to participate in tests of the concept. HealthTech declined to identify the networks.
“We have three very viable and interesting models for how A-ICU can be effective,” said Steve DeMello, HealthTech’s director of research and forecasting. Of the three hospitals, one is a private system with a union trust fund, one is a public facility with an institution acting as a safety net, and one is a mission-driven Catholic charity hospital.
“These hospitals are very different in terms of their needs, profiles, market conditions and strategies,” DeMello said. “But they’ve all found common values to A-ICU.”
The A-ICU model relies on a “floor” system in which providers are organized into separate levels of care. The first floor is where non-physician, non-nurse healthcare workers promote patient education and condition management, thus reducing physician involvement. Physicians and nurse practitioners work on the second floor of care, and specialists work on the third.
“What’s common to the success of these programs is a strong, thought-out launch of the floor idea,” DeMello said.
In addition to the three facilities preparing to implement A-ICUs, the demonstration involves several of HealthTech’s partner organizations, including Egg Harbor Township, N.J. -based AtlantiCare Health System.
Ira Peezick, AtlantiCare’s vice president for strategic planning, and Jim Nolan, senior vice president of finance, said the promise of savings and chronic care management made the A-ICU an attractive option for their company, which manages both hospitals and health plans. “The fact that we have the payer involvement helps us understand why something like this is necessary,” Peezick said. “Right now, no payer pays for this type of system.”
On the provider end, Peezick said the A-ICU model is based on the idea that the primary care reimbursement model is broken. “Primary care physicians cannot possibly spend enough time to do the things that most PCPs went into medicine to do in the first place,” he said.
Nolan said the A-ICU could also be used to better manage the care of patients covered by Medicaid programs and self-insured employers.
HealthTech originally estimated that A-ICUs could reduce primary care costs for treating high-risk, low-income patients by as much as 30 percent to 40 percent, but DeMello said the final average may be lower.
“We firmly believe that there are savings in chronic disease management,” Nolan said. “It doesn’t have to be 30 to 40 percent to be a winner for us.”