insurance

25 more doctors join Blue Cross project

PBN FILE PHOTO/ STEPHANIE EWENS
DR. DIANE SIEDLECKI, left, an internist at Anchor Medical Associates and former president of the Rhode Island Medical Society, says, "Under this comprehensive care model, a patient who forgets to go for necessary testing would receive a reminder phone call from our nurse case manager, whereas a different patient suffering with the emotional aspect of an illness would be offered support from a behavioral health specialist."
Posted 6/28/10

PROVIDENCE – Two groups with a total of 25 doctors have joined a major initiative by Blue Cross & Blue Shield of Rhode Island to develop “patient-centered medical homes” for their sickest patients, with coordinated, multidisciplinary care supported by extra payments from the insurer.

The practices are University Internal Medicine group, in Pawtucket, with six doctors, and Anchor Medical Associates, with 19 doctors in Lincoln, Providence and Warwick.

Last month, the Blue Cross project signed a deal with the Rhode Island Primary Care Physicians Corp., an association that represents 162 doctors in independent practices, to enroll the full membership in the program.

The first to join, as a pilot site, was Aquidneck Medical Associates, in Newport, and several more practices are expected to participate, Blue Cross officials have said.

What the doctors are committing themselves to do is to develop medical homes as defined by the National Committee on Quality Assurance, which has set national standards and three levels of recognition, depending on how far a practice is willing to go.

Key tenets of the NCQA model include building relationships with patients that extend between visits, offering enhanced access to providers and to health care information, coordinating care with other providers, and closely monitoring quality and outcomes. Electronic health records are considered essential to these tasks.

Currently, only a handful of Rhode Island medical practices have reached PCMH recognition, though many, including community health centers, have made it a priority. Most are involved either with the Blue Cross program, or with the Chronic Care Sustainability Initiative (CSI-RI), a multipayer project that has been piloting the medical-home model since 2006.

The Blue Cross effort, launched in January, gives practices technical support and pays for a nurse to join them – full- or part-time – to serve as a “care manager.” It also pays monthly stipends starting at $10 and rising to $15, $20 and $30 upon reaching NCQA Level 1, 2 and 3, respectively, but only for patients with “complex” medical needs.

“These types of innovative partnerships with local primary care practices are critical components of health care reform,” said Dr. Gus Manocchia, Blue Cross vice president and chief medical officer. “We strongly believe that broader adoption of the patient-centered medical home model will allow us to successfully reduce system inefficiencies, while also improving health care delivery and affordability.”

Blue Cross officials say they expect its members, especially those with conditions such as cancer, heart disease, or chronic renal disease, will greatly benefit from this model, which takes a comprehensive approach to health care and includes extensive patient education and support with behavioral health, nutrition and more.

“Under this comprehensive care model, a patient who forgets to go for necessary testing would receive a reminder phone call from our nurse case manager, whereas a different patient suffering with the emotional aspect of an illness would be offered support from a behavioral health specialist,” said Dr. Diane Siedlecki, an internist at Anchor Medical Associates and former president of the Rhode Island Medical Society. “We simply don’t have the infrastructure to offer that type of customized care and follow-up today.”

Dr. David Marcoux, of University Internal Medicine, said the new model, “with its emphasis on preventive, proactive and coordinated care,” would allow him and his colleagues to provide “even more integrated and individualized care for our patients than we do today.”

Along with the PCMH initiative, Manocchia noted, Blue Cross is working to realign physician reimbursements in general, shifting away from piecemeal payments – for each visit, test or treatment provided – and toward a focus on patient outcomes.

“With these contracts, we are moving away from traditional fee-for-service arrangements to value-based reimbursement incentive models,” he said, “which reward superior care and improved efficiency instead of the volume of services provided.”

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