Large health plans work together on medical home pilots

Participating physicians will be paid both fee-for-service and per-member, per-month fees.

By Emily Berry — Posted July 13, 2009

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Multiple health plans have agreed to cooperate on patient-centered medical home pilot projects across several states.

The pilots not only will reward physicians for participating but also could give everyone watching a better idea of how much money a medical home can save -- and how much it can improve quality of care, backers of the project said.

The patient-centered medical home aims to improve the quality of care and lower costs by coordinating care and focusing on prevention.

The recently launched two-year pilots would pay physicians in Colorado, Maine, New Hampshire and New York extra for coordinating care.

Perhaps the most significant part of pilots supported by multiple insurers is that they represent the "buy-in" of payers, said W. Carl Cooley, MD, a pediatrician and medical director of the Center for Medical Home Improvement in Concord, N.H. He has worked to help practices become medical homes since the idea took shape a decade ago and has assisted some who qualified for the New Hampshire pilot that launched in June.

"It's huge, I think," Dr. Cooley said. "I have felt for years the two things that would drive the medical home model to more widespread adoption were reimbursement reform and electronic records."

While the pilots are not the first time insurers have funded patient-centered medical homes, the effort appears to be at least one of the first to involve multiple insurers in a single region, he said.

The first pilot, supported by WellPoint, UnitedHealthcare, Cigna, Aetna, Humana and the state's Medicaid program launched in Colorado May 1. It includes 17 practices, most made up of between three and five physicians, said Lisa Latts, MD, an internist in Denver, who is also vice president of programs in clinical excellence for WellPoint.

Physicians will be paid both on a fee-for-service basis and with a per-member, per-month fee set by individual insurers, she said.

Dr. Latts said participating plans and physicians will use the same measures to track patient outcomes. The plans will send data to a researcher funded by the Robert Wood Johnson Foundation who will study and publish the results, she said.

The insurers' involvement isn't guaranteed for the long run, Dr. Cooley said.

"I can't help but be suspicious that the plans' interest is primarily cost savings," he said. "If that doesn't materialize fairly quickly in the pilots, [I worry] that the plans will simply say, 'That was interesting,' and move on."

American Medical Association policy calls for payers to reward physicians who participate in the patient-centered medical home model without diminishing the pay or restricting access to specialists. It also calls for plans to use a common definition and methodology to designate and grade medical homes.

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