Health systems as well as independent providers have an opportunity to drive best practices in specialty care and secure sustainable revenue with a new business and care model.
Blue Cross and Blue Shield of Illinois is starting the state's first intensive medical home program in a partnership with the state's largest independent GI practice, the Illinois Gastroenterology Group.
The speciality intensive medical home will focus on the highest-risk, multi-chronic patients with the complication-prone inflammatory condition known as Crohn's disease.
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The Illinois Gastroenterology Group has developed its own care management model and online and mobile communications platform called "Project Sonar," specifically for GI clinicians to consult with Crohn's patients in between office visits.
"Studies have shown that the rate of these complications decreases with improved patient communication," said Lawrence Kosinski, MD, a member of the group's clinic in Elgin, a city in Chicago's suburbs.
Crohn's patients receive monthly contacts from the practice, including screening questions that help calculate symptom intensity and track it over time. "This monitoring can lead to intervention by the physician earlier than a patient would have initiated it," and "has led to a decrease in emergency room visits, hospitalization rates and their associated complications," said Kosinski.
For the specialty medical home Blue Cross is starting, a nurse care manager conducts initial outreach with 200 of the insurer's members with the most severe Crohn's disease, inviting them to join the program and come in for an initial visit, where a long-term plan can be created. Nurse managers track the patients progress over time, discuss symptom management with them and bring in physicians as needed.
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This intensive medical home or IMH model "represents a continuing shift in the evolving nature of how we pay for medical services," said Walter Hollinger, MD, medical director at Blue Cross and Blue Shield of Illinois, an insurer of Chicago-based Health Care Services Corporation. The arrangement "enables the IGG providers to utilize clinical data and best practices to help drive medical decision-making and improve quality of care."
It's also "a first step for providers that aren't able to be part of a larger accountable care organization, but do want to be part of a value-based care model," said Hollinger. "The next step for us will be launching two more specialty IMHs this year."