This year, Central Ohio employers have an opportunity to improve the medical care provided to their employees.
In 2012, the cost of employer-sponsored health coverage is expected to rise by an average of 8 percent, less than the annual double-digit increases experienced in recent years. In response, many employers will use cost control strategies focused on plan design, such as adjusting employee cost sharing, increasing co-pays and deductibles, and requiring the use of health savings accounts. While these strategies help to control costs, they do not address the cause of the problem: rising health-care costs.
While many people debate what causes health-care costs to rise, no one disputes that costs are incurred when people get sick and escalate when people receive specialty, emergency and hospital care. Under the current system, health-care providers are paid on a fee-for-service basis, with financial incentives for higher-cost services such as acute care delivered by specialists and hospitals. These incentives conflict with the efforts of employers to keep costs down.
The health-care system has been slow to move away from incentives for acute care, but changes are starting to occur. During the past two years in Central Ohio, more than 24 primary care practices serving 140,000 patients have become patient-centered medical homes—an approach that aims to provide comprehensive primary care. In collaboration with employers, insurers, patients and public health officials, these practices have adopted standards for providing and coordinating care, tracking patient outcomes, managing chronic conditions and avoiding preventable illness—all within a framework of compensating primary care providers for cost-effective rather than acute care.
The Patient-Centered Primary Care Collaborative of Central Ohio is coordinated by nonprofit AccessHealth Columbus with support from the Columbus Medical Association Foundation, Franklin County, the city of Columbus and other corporate and nonprofit partners.
How Medical Homes Work
Although there are various approaches for implementing medical homes, the participating Central Ohio payers and providers have agreed to a common set of standards established by the National Committee on Quality Assurance (NCQA). To understand what a medical home is and how it can improve patient care, it is helpful to look at the NCQA standards, which fall into six categories:
Access to Care: A primary care practice must provide greater access to care, such as same-day appointments, after-hours phone numbers and business practices to ensure patients see their own doctor, not just any doctor. The result is more timely and personal care and less urgent, expensive and emergency care.
Management of Patient Population Health: A practice group must identify the characteristics of its patient population and manage population health. This requires collection of demographic and clinical information from all patients, assessment of prevalent risks and adoption of patient population treatment goals. For example, a practice group might track hospital readmissions by identifying hospitalized patients, monitoring hospital care and following up after discharge. The results include improved care, better population health and overall savings.
Management of Individual Patient Health: A medical home must manage individual patient care. The practice must identify specific conditions such as diabetes or high blood pressure, create patient-specific treatment plans and track patient compliance and progress toward goals. For example, a medical home can improve care coordination by reconciling patient medications at each visit. Simple techniques such as this can improve patient care and help employers achieve savings.
Train Patients in Self-Management: A primary care practice must work with patients to self-manage conditions or have family or community support to be successful. Making sure that patients can manage care at home is critical to keeping patients healthy. Medical homes help patients get the support they need to comply with treatment plans.
Coordinate Care: A medical home is the hub of a patient’s care. It must track ordered tests, referrals and care given at other facilities and follow up with patients to avoid unnecessary care. Medical homes must communicate with patients about all the care they receive. This results not only in coordinated care, but also avoidance of unnecessary care.
Track Utilization: A primary care practice must track utilization of services by patients, rates of hospitalization and ER visits, and use patient experience data to assess performance. Medical homes make performance assessment and improvement part of their business processes.
Employers interested in making medical homes available to employees or incorporating medical homes into their benefit plans or wellness programs should discuss the issue with their benefit advisors. By doing so, companies can move away from supporting costly acute care toward cost-effective care that keeps employees and their families healthy.
Doug Anderson is of counsel with the law firm of Bailey Cavalieri. His practice focuses on insurance regulation, benefits and health care law. He is also a board member of Access HealthColumbus. He can be reached at (614) 229-3301 or firstname.lastname@example.org.
Reprinted from the March 2012 issue of Columbus C.E.O. Copyright © Columbus C.E.O.