Patient-centered care can improve costs and quality, industry panelists say at health summit

Last modified: 9/19/2014 12:45:23 AM
It requires an investment in time, money and a lot of work behind the scenes, but industry officials said they’re optimistic that a more coordinated approach to primary care can both cut costs in the long run and lead to healthier outcomes for patients.

Under what’s called a “patient-centered medical home” model, as described at a summit for health industry professionals earlier this week, the payment structure focuses more on quality of care than on quantity of treatments given to patients. Anthem Blue Cross Blue Shield of New Hampshire, which hosted the summit, started experimenting with this kind of model several years ago and operates its own Enhanced Personal Health Care Program.

Robert Noonan, Anthem’s regional vice president for provider solutions, said this system “pays primary care providers for how well they do, not how much they do.” It supplements a traditional fee-for-service payment to participating primary care practices with an additional reimbursement that accounts for “clinical interventions that occur outside of the visit.” This might mean, for example, following up with patients to make sure they understand the instructions for taking certain prescriptions, Noonan said.

The results of a three-year pilot program were “staggering,” Noonan said: The nine participating practices saw 23 percent fewer hospital readmissions per 1,000 patients, 18 percent fewer avoidable emergency room visits, a 15 percent improvement in diabetic measures and a 9 percent reduction in hospital readmissions.

Wright & Associates Family Healthcare, which is based in Amherst and Concord, participated in the program and was able to hire a full-time medical assistant whose job is to plan the care of “every patient, every visit, every day before they come in,” owner Wendy Wright said at the summit.

Because of the additional preparation, Wright said, “When that patient is in that exam room, we are optimizing the time we are spending with that patient.”

Wright said the eight nurse practitioners on her staff maintain visits of about 30 minutes to an hour with all patients. This gives them enough time to hear patients’ concerns, she said, but also to address issues that the practitioners might want to discuss.

Elsewhere, Mid-State Health Center CEO Sharon Beaty said her center has made a concerted effort to put more of an emphasis on both patients and the clinicians who would be treating them. The center was also a participant in Anthem’s medical home model.

“We have to work really hard to keep good clinicians in our environments,” Beaty said, noting that the rural location can sometimes be a barrier to that.

The center has focused on making sure patients are as engaged as possible in their health care and that the center’s clinicians also feel supported in their work. Over the past decade, the center has implemented several changes to help it achieve these goals, Beaty said. It has embedded a doctoral-level clinical psychologist to support the medical staff, for example, and brought in additional psychology professionals to help the clinicians improve their “motivational interviewing techniques” when dealing with patients across the board.

“You can put the patient at the center of this model,” Beaty said, “but it doesn’t do any good if the patient’s not engaged and the patient’s not trying to participate in their care.”

The challenges of educating patients about the financial side of their health care came up repeatedly at the summit, which focused heavily on controlling health care costs.

Michael Chernew, a professor of health care policy at Harvard Medical School who specializes in health economics, discussed approaches to payment reform in his keynote address. Another panel focused on health care costs for employers, during which the importance of educating consumers about their health care options was stressed as an important step toward getting the most value while keeping rates low.

In informal polls conducted during the event, attendees said that their biggest frustration in the New Hampshire health care landscape stems from costs, while their “biggest headache” related to health care stemmed from figuring out how to motivate employees to engage with their health. Making sense of the Affordable Care Act was a close second as the “biggest headache,” according to the results of the poll.



(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)




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