Medicare Pilot Aims to Improve Healthcare

Dayton Daily News (OH)

April 18, 2012

The Dayton-Cincinnati area of Ohio is one of seven regions nationwide chosen for a pilot project that will initially transform how doctors and other clinicians care for 330,750 U.S. Medicare and Medicaid enrollees. But it could have implications long-term for the nation’s entire healthcare system.

The project is part of a broader effort by the federal government to carve billions of dollars in costs out of the Medicare program in coming years to make it sustainable. Other regions taking part in the program are the Tulsa region of Oklahoma and Hudson Valley region of New York, as well as the entire states of Arkansas, Colorado, New Jersey and Oregon.

The cost of the project—called the Comprehensive Primary Care Initiative—wasn’t immediately available Tuesday. Modeled after private-sector approaches, it’s part of the federal healthcare overhaul and will transform how 75 of the region’s primary-care practices are paid to care for patients.

Participating practices will initially be paid an average of $20 per patient per month to better coordinate patient care. Later, those practices will have the chance to share in a portion of any Medicare savings.

“This is probably the biggest change in the delivery of primary care since primary care was defined as a specialty,” said Evan Steffens, director of clinical and quality services for Premier HealthNet and Premier Health Specialists, which are part of Premier Health Partners.

“Prior to now, the practices managed the patient that presented at their door or called the office for a visit,” she added. “In this (new) system, the practice reaches out to their patient community and manages everybody, whether they contact the office or not. It’s a very different way of looking at care.”

Through electronic health records, primary-care practices taking part in the pilot program will focus not just on treating patients when they are ill, but also on keeping them healthy by managing chronic health conditions such as diabetes, and heading off the need for more expensive surgeries and other procedures.

The practices also will work to intensively manage care for high-need patients, ensure access to care beyond regular business hours, provide more preventive care and encourage patients to be more engaged in their care.

Ohio itself will spend $1 million in the next two years to train 50 practices to become “patient-centered medical homes,” which—like the federal pilot program—involves greater coordination of the care a patient receives.

Ted Wymyslo, M.D., director of the Ohio Department of Health, advocated for the approach for years as a doctor practicing in Dayton. He said he will encourage southwest Ohio practices selected for the state’s pilot program to also apply for the federal pilot program.

As of March 1, Ohio had 118 practices that had been certified as patient-centered medical homes by the National Committee for Quality Assurance. The state and federal pilot programs will drive that number higher. “It’s going to drive huge practice change. It’s a movement,” Wymyslo said of the Medicare pilot program. “My prediction is it won’t be long until you see this migrating to all four corners of the state.”

Southwest Ohio’s participation in the four-year federal program is significant, Wymyslo said. It demonstrates insurance companies are willing to embrace and pay for the new care concept.

Practices that make “meaningful use” of electronic health records—and that have a majority of patients covered by health plans willing to pay enhanced reimbursements—will likely have a leg up in vying to become one of the region’s 75 pilot practices in the Medicare pilot, Steffens said. Medicare will also likely want the 75 practices in southwest Ohio to be a diverse group, she added.

Jason Koma, spokesman for the Ohio State Medical Association, said physicians statewide are supportive of the patient-centered concept. “We’ve seen what happens when you pay just (based) on the volume of service. Ultimately, that model is not sustainable.”