ALBANY, NY – A two-year-old patient-centered medical home pilot spearheaded by physician-directed health plan CDPHP has resulted in major declines in the growth of the cost of care and improved outcomes at the three participating primary care practices.
The insurer is poised to roll out the model to as many as 40 other practices in the next two years.
According to an analysis conducted by Verisk Analytics, the three practices reduced the overall rate of medical increases by 9 percent compared with other area physicians, a savings that equates to $32 per member per month.
Bruce Nash, MD, chief medical officer of CDPHP, who has overseen the pilot since its launch in May 2008, said the findings mark “an important first step in improving quality and transforming the way we pay for primary healthcare. While there are still significant opportunities for improvement, we know we’re headed in the right direction.”
To attract providers to the new model, CDPHP officials knew they would need to provide incentives that could allow primary care physicians to earn as much as $85,000 more than their current rates. Of that sum, $35,000 was paid simply for participating in the model, while another $50,000 in bonus money is paid out using IHA’s “triple aim” for patient satisfaction, 18 separate HEDIS quality measures and 8 utilization metrics to determine provider efficiency.
“What this ensures is that we pay for high quality and high efficiency. If we paid them for low quality high efficiency, that would take you back to the capitation of the old days,” said Lisa Sasko, CDPHP’s director of practice transformation. “We also didn’t want to pay for low quality high efficiency, because that is clearly unsustainable.”
According to Leonard Leonidas, MD, a provider with participating practice Community Care/Schodack, moving to a patient-centered model required some operational changes, but the transition has been well worth the effort both in terms of enhancing his compensation and providing better care to his patients.
“I find it more rewarding and I get the sense we are doing much better at hitting the quality metrics for our patients and doing it in an appropriate manner,” Leonidas said. “Another reason this is attractive is that it provides a way for us to earn money that is closer to what other specialists earn.”
Under the current pilot, the payments from CDPHP are blended between the usual fee-for-service payments, the extra $35,000 payment for participation and the bonus payments from the $50,000 pool. But that won’t be the model in the future.
“Knowing what we know now, and the goal that we have set for ourselves, by 2014 we want to have 80 percent of our appropriate primary care practices under this model,” Sasko said. “That is the principal component of the program: to get them off of fee-for-service and onto risk-adjusted base capitation.”
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