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Kathleen McCarthy

One integration strategy employed by high-performing hospitals and health systems is the expansion of lower-cost, geographically distributed primary and ambulatory care services to improve access to care. Adirondack Health Institute in Queensbury, N.Y., is an example of a health system that has expanded access to primary care for a disproportionately older population.

Adirondack Health Institute, which serves a five-county rural region in upstate New York, initiated a pilot program for better serving the healthcare needs of its older population nearly five years ago. The catalyst for the program was to recruit and retain primary care physicians to preserve and expand access to care for the population Adirondack serves, which is disproportionately older, sicker, poorer, and has fewer physicians per 1,000 people than the state's overall population.

The initiative is a public-private partnership intended to improve access and quality of care, lower the overall cost of care primarily through management of chronic diseases and care transitions, and avoid unnecessary utilization. This unique all-payer pilot includes Medicare, Medicaid, and seven private insurers, in addition to more than 200 practitioners, 30-plus practices, and five hospitals that collectively represent most of the care provided in the region.

Physicians are paid an incremental $7 per member, per month to direct patient care management and coordination across the service continuum, and they have an opportunity to receive bonus payments linked with quality goals. Average annual dollars paid per physician through this program have ranged from $85,000 to over $100,000 per physician since the pilot's inception, which has had a positive impact on physician recruitment and retention in the region. Without the compensation increase to competitive levels, recruitment efforts would have lagged due to the national physician shortage and the challenges of attracting physicians to rural areas.

The nearly $20 million in IT infrastructure investments required to support the pilot have largely been funded through a grant allowing for development of a regional health information exchange. Initial results indicate a decline in emergency department utilization and readmission rates for participating hospitals in the region, although the quality and comparability of data across providers are still being analyzed.

All but one pilot practice have been designated as Level 3 patient-centered medical homes by the National Committee for Quality Assurance (NCQA), which is the highest level of achievement, and most practices have met Stage 1 meaningful use requirements. The pilot recently received designation to serve as a PCMH for Medicaid patients, which will expand the pilot to enhance coordination of medical and behavioral health care and focus on patients with multiple chronic illnesses. The pilot also positions providers to take advantage of future opportunities in the evolving regional health care system, including ACO participation and an ambulatory care residency training site (Burke, G., and Cavanaugh, S., The Adirondack Medical Home Demonstration: A Case Study, United Hospital Fund, 2011).

For more information, visit www.adkmedicalhome.org

Kathleen H. McCarthy is vice president, Health Strategies & Solutions, Inc., Clifton Park, N.Y. (kmccarthy@hss-inc.com). 

For more information, see Kathleen McCarthy's "5 Strategies for Building a Top-Performing Hospital", hfm, November 2012


Publication Date: Thursday, November 01, 2012

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