“First in Health” to Offer Employees Option of E-Enabled, High-Touch Care Coordination
Regardless of where they stand on health care reform, most employers don’t expect health care legislation to lower costs in the near future. That leaves businesses looking for ways to get more value for their health care dollar and move costs toward more sustainable levels. Employees want more time with health care providers and help navigating a complex health care system. Physicians and hospitals want public and private payers to coordinate efforts on quality and health information technology.
Enter “First in Health,” a public-private partnership that will enable private-sector employers to tap into a “medical home” infrastructure created for Medicaid recipients by a nonprofit organization on behalf of the State of North Carolina in the last ten years. “Medical home” is an approach to coordinating healthcare that relies on a patient’s primary care physician to use health information technology, best practices and care managers to coordinate care among a patient’s various health care providers.
Partners in the First in Health effort include Community Care of North Carolina (CCNC), GlaxoSmithKline (GSK), the State Health Plan of North Carolina (SHP), local pharmacy chain KERR DRUG, business analytics company SAS and Blue Cross and Blue Shield of North Carolina (BCBSNC), the state’s largest health insurer. They are joining forces to promote medical homes, change the way care is delivered and demonstrate that increasing the focus on managing chronic diseases, which account for 75 percent of the nation’s healthcare spending, can improve outcomes and hold down costs. The partnership, which is unprecedented in size and scope given CCNC’s network, was announced today at the annual meeting of the N.C. Institute of Medicine.
CCNC is known for providing the state’s Medicaid program with “on the ground” care management, health information technology infrastructure and population-based health initiatives that have raised quality and saved Medicaid nearly $1.5 billion over just three years. CCNC’s performance is in the top 10 percent nationally in HEDIS measures for diabetes, asthma and heart disease, compared to private Medicaid managed care organizations. Now, private sector companies are joining the effort in hopes of realizing similar quality and cost-saving benefits for employees, their dependents and retirees. The Brookings Institution, a nonprofit public policy organization based in Washington, DC, will evaluate the program’s impact on cost and quality.
First in Health builds on several federal demonstration projects already underway across much of North Carolina including the Beacon Communities program, Medicare 646 waiver and the Multi-payer Advanced Primary Care Practice initiative (MAPCP), a demonstration program of the Centers for Medicare and Medicaid Services (CMS). All of these feature on-the-ground local care managers, population-based initiatives, and a broad cross-section of public and private payers linked by HIT to provide services to 1.1 million North Carolinians.
GSK will begin offering its employees in the North Carolina the option of joining a medical home beginning in January, 2012. Employees from GSK will have the option of adding the First in Health benefit to their existing health benefits. GSK will waive copayments for primary care doctor visits for employees choosing this option and pay participating doctors a “per member, per month” fee for each GSK employee assigned to a medical home. These resources will fund an enhanced level of care coordination including improved HIT and “high-touch” assistance from local care managers.
The State of North Carolina will begin offering employees access to CCNC medical homes in targeted counties in the fall of 2011. SHP plans to offer the option to 400,000 enrollees in 100 North Carolina counties within two years of launch through a cooperative agreement with Active Health Management.
KERR DRUG is working through its benefit process with an eye towards offering employees access to medical homes in the company’s 2013 benefit year. KERR DRUG brings to the partnership extensive experience in collaborative efforts to provide education and personal oversight to North Carolinians with chronic health problems.
SAS brings to First in Health sophisticated analytical tools, experienced health data consultants and support for a detailed evaluation of First in Health’s medical home approach.
BCBSNC is a major partner in North Carolina’s seven-county MAPCP demonstration that integrates efforts of public and private payers to lower costs and improve health care quality. BCBSNC is also involved in the Model Practice project, a collaboration with UNC Healthcare to create an expanded medical home model that better coordinates patient care and enables teams of health care providers to work collaboratively with patients and families in delivering high quality care.
First in Health Partner Quotes
“CCNC has shown that effective primary care – supported by ‘high-touch’ care management, solid health care IT and population-based quality improvement – can be a game changer that saves money and dramatically improves the quality of health care received by patients,” said L. Allen Dobson, MD, president and CEO of Community Care of North Carolina.
“GSK believes adding the medical home option to our existing health benefit package will improve healthcare for our employees through a better connected and coordinated delivery of care,” said Jack Bailey, GlaxoSmithKline's senior vice president, policy, payers and vaccines.
“We’re excited about the possibility of our members having access to a medical home. Better care coordination and improved information technology will reduce cost while making sure that members get the right care. We anticipate this transition will provide more support for our members to improve their health and well-being, particularly those with multiple, chronic conditions that are complex to manage,” said Anne Rogers, director of integrated health management at North Carolina State Health Plan.
“The medical home model provides practicing physicians a coordinated team approach to health care. It incorporates pharmacy and other health care services as value elements, which both improve quality and restrain health care costs," said Ralph Petri, executive vice president of pharmacy and supply chain operations at Kerr Drug.
“SAS has extensive experience analyzing complex health and organizational data to improve patient care and reduce costs. As a renowned provider of robust employee health and wellness benefits, this is a perfect partnership for SAS, technologically and culturally,” said Paula Henderson, vice president of state and local government practice at SAS.
“We believe strongly that a team approach to care improves clinical interaction and patient engagement. Better coordination of care should also lead to improved health and fewer complications for patients – both of which will help control rising health care costs,” said Brad Wilson, president and CEO at Blue Cross and Blue Shield of North Carolina.
CCNC is a community-based, public-private partnership that takes a population management approach to improving health care and containing costs for North Carolina’s most vulnerable populations. Through its 14 local network partners, CCNC creates “medical homes” for Medicaid beneficiaries, individuals eligible for both Medicare and Medicaid, privately-insured employees and uninsured people in all 100 counties.
What is a Medical Home?
The AAP, AAFP, ACP, and AOA, representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the Patient-Centered Medical Home:
- Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
- Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
- Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.
- Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the right care.
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