Med. homes key to health reform?

SEEKING ANSWERS: Beau Stubblefield-Tave, principal and co-founder of the Center for Culturally Fluent Leadership, poses a question to the panel during the PBN Health Care Summit on Feb. 16 in Warwick. / PBN PHOTO/RUPERT WHITELEY
SEEKING ANSWERS: Beau Stubblefield-Tave, principal and co-founder of the Center for Culturally Fluent Leadership, poses a question to the panel during the PBN Health Care Summit on Feb. 16 in Warwick. / PBN PHOTO/RUPERT WHITELEY

Faced with the challenge of addressing rising costs that threaten the quality of patient care, members of the health care community gathered at the Crowne Plaza Providence-Warwick on Feb. 16 for the annual Health Care Summit hosted by Providence Business News to discuss the future of health care in Rhode Island.

Dr. Kathleen Hittner, state health insurance commissioner, said her office has received $20 million in federal grant funding through the State Innovation Models initiative to support changes in the state’s health care delivery and payment systems. She believes reform of Rhode Island’s health care system will start with moving away from traditional fee-for-service transactions toward value-based models such as patient-centered medical homes, where advanced, cross-disciplinary treatment is coordinated through a primary care physician.

Dr. Steven Lampert, president of Lifespan Physician Group, offered an alternative to medical homes in the form of accountable care organizations, which are risk-based systems that incentivize improved outcomes and decreased costs.

Todd Whitecross, vice president of network contracting for commercial products at Tufts Health Plan, said the company initially rolled out risk contracting in a control group and quickly found “risk groups improve quality at a faster rate than fee-for-service.”

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Hittner expressed doubts the state’s PCPs will be ready to participate in risk-based ACOs.

“We weren’t taught much – or anything – about finance in medical school,” she said. “We weren’t taught how to run your office; how to measure quality indicators; or how to participate in risk contracting. This is all new and [primary care practices] need help to get there.”

Lifespan is among 2,900 PCPs nationwide that recently announced its participation in a new Comprehensive Primary Care Plus Program, a partnership through the Centers for Medicare & Medicaid Services that aims to strengthen primary care by advancing the patient-centered medical home.

If the repeal and replacement of the Affordable Care Act moves certain mandates from the federal to the state level, many fully insured employers may transition to self-insurance, said Al Charbonneau, executive director of the Rhode Island Business Group on Health.

Hittner sees this as bad news. “As we get more and more small companies going self-insured, that’s less and less people in the commercial market. All of those rates will go up,” she said. “The solution is not to go self-insured, but to address the big issue of cost in the commercial marketplace.” •

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