The state of Oklahoma is collaborating with Blue Cross Blue Shield to launch a medical home pilot in hopes of elevating its national health ranking.
“I have had a lot of people ask me, ‘why Oklahoma and why now?’” said Joe Nicholson, vice president of healthcare management and CMO at Blue Cross Blue Shield of Oklahoma. “It’s really a function of what has happened in the state of Oklahoma.”
In 2009, Oklahoma was rated as the 39th healthiest state in the nation, down from 38th in 2008 and in a steady decline from 32nd in 1990.
BCBS is partnering with Hillcrest Medical Center in Tulsa, Okla. About 45 primary care physicians who serve approximately 20,000 BCBS members will participate in the endeavor.
“We’re heading off a looming primary care physician shortage, particularly in rural areas,” said Nicholson. “We have adequate resources in the dense metro areas, but there are only two or three of those in the state. There isn’t just a looming shortage in our rural areas – there’s a real contraction of primary care.”
The pilot is expected to provide new revenue streams to providers. BCBS hopes to revamp reimbursement models with a focus on reducing wasted resources, said Nicholson. Physicians in the pilot will use a ‘virtual EHR’ platform from MEDecision, enabling E-Visits and freeing doctors to see the sickest patients during the day.
Population management tools should enable doctors to identify and close gaps in care with the help of payers, and to align incentives to encourage appropriate use, said Matt Adamson, vice president of Medical Home Initiatives at MEDecision.
Adamson said primary care payment models need to change to provide better care coordination and better outcomes for patients.
“The fee for service model in primary care doesn’t provide incentives to coordinate care,” he said. “We need to focus on teams – with the PCP as the quarter back. The FFS reimbursement model must be enhanced.”
The pilot also focuses on the improved management of patients with chronic conditions, said Adamson, as a quarter of Medicare beneficiaries who have 4 (or more) chronic conditions account for 80 percent of Medicare spending.
The Tulsa-based project is just one example of how states are pushing primary care innovations to improve their healthcare delivery strategies.
“Without prompt and significant changes in the way that healthcare is organized, financed, and taught in this country, the ‘collapse’ of primary care is imminent,” said Ricahrd Glickman-Simon, MD, of the American College of Physicians. “What will remain in its place is an increasingly fragmented jumble of poorly coordinated sub-specialized services, even higher costs for even lower quality of care, reduced access, rising inefficiency and more patient dissatisfaction.”