• Leadership E-Bulletin: September 2012 Issue

    Sep 24, 2012

    N.J. Medical Home Collaboration Pays Off for Patients, Physicians, and Insurer
    A New Jersey medical home program reduced hospital admissions by 25 percent and emergency department use by 26 percent in 2011. Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) is providing the 145 collaborating physician practices with a paid nurse to coordinate the care of high-risk patients, a care coordination fee, and shared savings payments for reaching outcome-based benchmarks related to clinical quality, patient experience, and utilization.

    Vanguard Medical Group was one of the first New Jersey practices to join Horizon's medical home program. "We were trying to figure out how to do things better for our patients and to find opportunities to get away from the current fee-for-service business model in which we are basically just paid for office visits," says Thomas McCarrick, MD, a primary care physician at Vanguard.

    The now statewide program began with a new type of working relationship between Horizon BCBSNJ and participating physician groups. "From day one, what has made this program so unique is the collaboration?and it is absolutely a leading factor in why we've been able to achieve positive results," says Jim Albano, vice president, network management and Horizon Healthcare Innovations at Horizon BCBSNJ, which is the largest insurer in New Jersey.  

    What Virginia Mason Learned From Toyota
    A crisis drove an innovative breakthrough at Virginia Mason Medical Center. In 2004, Aetna threatened to exclude the hospital from contracts with major employers in the area, including Starbucks, Costco, and Alaska Airlines. Aetna was not doing this on a whim. The insurer's data found that Virginia Mason was more expensive than its major competitors in a number of specialties.

    Robert Mecklenburg, MD, chief of medicine at Virginia Mason, took a cue from the Toyota Production System to solve quality and cost issues, as detailed in this excerpt from the book Pursuing the Triple Aim. He invited Starbucks and Aetna to form a marketplace collaborative to improve efficiencies around uncomplicated back pain, a major health issue and cost to Starbucks.

    CenterLight PACE Approach Is Keeping Elderly at Home, Reducing Costs

    CenterLight Health System, a provider of a broad spectrum of long-term care services, runs one of the nation's largest and oldest PACE programs. (PACE stands for The Program for the All-Inclusive Care for the Elderly.) PACE is funded through a capitated model. CenterLight receives a certain amount of money per patient per month?in a combined payment from Medicare and Medicaid?to coordinate care for frail, dual-eligible elderly patients.
    The focus of PACE is to keep the patient at home, living independently with a community social network, as long as possible. CenterLight makes this possible through a combination of managed care, coordinated care teams, and physician waivers. In addition, adult day-care centers offer recreational therapy and primary care in the patient's neighborhood.

    "Understanding everything about patients' needs goes far beyond their medical care," says Mary Wehrberger, vice president of clinical operations. "We look at social, emotional, mental, spiritual, and cultural norms for each patient so that the care we provide meets those needs."

    Only 6 percent of CenterLight Health System's PACE program participants reside in nursing homes, compared to around 50 percent of New York State's Medicaid fee-for-service patients. The CenterLight PACE model costs New York State tens of thousands of dollars a year less per patient than residency in a nursing home.

    Two CAHs Team Up to Achieve Meaningful Use
    Jersey Shore and Fulton County, two small rural hospitals in Pennsylvania, reduced EHR implementation costs by $300,000, through a collaborative effort managed by the Pennsylvania Mountains Healthcare Alliance. Both critical access hospitals (CAHs) expect to attest to Stage 1 meaningful use by fall of 2013.

    Today, the hospitals share a CIO, as well as IT resources including:

    • A healthcare information system
    • A cloud-based hosted server facility
    • New physician practice management software
    • Clinical and financial IT specialists
    • A help desk for IT support