Pilot project may revolutionize how health care is managed
By: Health Insurance
Submitted: 2009-11-24 09:25:50 | Word Count: 656
If you’ve always wished you had someone to help manage and coordinate your health care, you could be in luck.
A pilot program is helping 13 area doctors’ offices convert to doing that for their patients.
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The two-year program, backed by Blue Cross and Blue Shield of Kansas City and Leawood-based TransforMED, involves 13 primary care, family practice and pediatric medical practices.
The practices will get help adopting the new setup, which will include use of electronic medical records to coordinate care. And by the time the study is complete, Blue Cross has pledged to change the way it compensates those doctors.
The changes are “fairly dramatic … not just picking at the edges or tweaking things,” said Terry McGeeney, the president and chief executive of TransforMED, a wholly owned subsidiary of the American Academy of Family Physicians.
Advocates say patients will get better, more efficient care if their primary care doctor, leading a team of other providers, takes a leading role in ushering them through the health care system.
If the patient needs to see a specialist, for example, the primary care doctor will oversee the referral and stay on top of the outcomes. If the patient hasn’t been in to have his blood pressure checked, the primary care doctor will reach out with a reminder.
The system also relies on adopting electronic medical records to help multiple doctors share patient information and reduce redundant tests or treatments.
Blue Cross officials said they were committed to investing more than $1 million in the project over the next two years.
The insurer will help pay for the TransforMED teams that will work with the participating practices to get the system up and running.
Blue Cross also will pay for an electronic registry to help physicians track patients.
“It’s the right thing to do and it’s the right way to go forward,” said David Gentile, president and CEO-elect of Blue Cross and Blue Shield of Kansas City.
Gentile said insurers, physicians and patients all had a vested interest in the success of the pilot, which should improve quality and reduce costs.
TransforMED is involved in about a dozen similar pilot programs around the country.
The one in the Kansas City area represents the first in the Midwest. McGeeney said other pilot projects are already seeing signs of success, such as fewer emergency room and hospital visits.
Jennifer Botten-Molina, director of clinical services with Kansas City Internal Medicine, a participant in the pilot study, said, “We believe this is the future of primary care in health care — that primary care is kind of the coordinator for the patient to make sure things are done in a timely and proper way with high quality.”
As the pilot project moves forward and new systems are put in place, Blue Cross has pledged to change some of the ways it compensates those physicians.
Rather than just pay doctors based on the volume of services they provide, the insurer will look at things such as quality of treatment and patient outcomes as measures of compensation.
“This is a vehicle we can use for transformation ourselves,” said Blake Williamson, vice president and senior medical director of Blue Cross.
Many medical experts agree that the “medical home” approach could improve care and lower costs — if there’s a big cultural shift within health care.
And, most agree, that won’t be easy.
“This is about change, frankly, and any time you make this kind of transition in the way you do things, that’s a big deal,” said Williamson.
