UPMC Expanding Patient-Centered Medical Home Model

Source: Pittsburgh Business Times
 
Better managing primary care resulted in a remarkable 160 percent return on investment with improved medical care for patients, insurer UPMC Health Plan reported.
 
Between 2008 and 2010, the University of Pittsburgh Medical Center for-profit subsidiary introduced a souped-up version of the health maintenance organization, where doctors oversee care designed to keep the patient healthy and out of the hospital. That may sound like what should have been done all along, but it’s because insurance and government reimbursement historically has been based on volume, not quality of care.
 
Experts call this misaligned incentives, but that’s changing as Medicare moves toward bundled payments for a group of services, rather than individual billing for each service rendered.
 
“It’s not new. We didn’t just make this up,” said Pamela Peele, chief analytics officer at the Insurance Services Division of UPMC. “But clearly we have found an implementation model that’s extremely efficient. The return on investment has been phenomenal.”
 
Based on the results, UPMC is converting all of its primary care practices to the patient-centered medical home model. The shift, which is being used by physician practices nationwide, positions UPMC for bundled payments from Medicare, a new way of reimbursing doctors for a group of services rather than piecemeal.
 
Only UPMC Health Plan members are eligible to participate, and the plan is closing in on 2 million members, up from 1.6 million members a year ago. UPMC doctors treat patients with all kinds of health insurance, but only UPMC Health Plan members are eligible for the new patient-centered approach.
 
Monroeville-based Premier Medical Associates also has implemented the patient-centered medical home concept, using nurse practitioners and physician assistants to handle sudden medical problems such as the flu or sore throat, freeing doctors to manage chronic health problems in patients, such as diabetes and congestive heart failure.
 
“When you get it right, the ROI can be pretty darn dramatic,” said Dr. Terry McGeeney, president and CEO of TransforMED, a Leawood, Kan., consultant that advises medical practices in making the change to patient-centered care. McGeeney said he wasn’t aware of any higher rate of return for institutions that have switched to the patient-centered medical home model.
 
UPMC began the shift in 2008 when it expanded to 10 primary practice sites and 162 doctors serving 23,930 patients. The annual estimated cost to the health plan of implementing the patient-centered approach was $6.09 per member per month, which includes salary and benefits for six nurse managers, data collection and related expenses.
 
The net result: $9.75 per member per month in avoided medical expenses, which would have otherwise been paid. This calculation doesn’t include the quality of life improvements resulting from fewer hospitalizations.
 
UPMC has some 2,300 primary care doctors who are either employed or affiliated with the health system, and 146 doctors are participating in the patient-centered medical home.
 
Medical homes save money by eliminating duplication in medical testing and better managing prescriptions, according to Diane Zucker, an independent health care consultant from the Cleveland area.
 
“It’s not about rationing care. It’s not about not being able to see your doctor when you want to. But when you see your doctor, it’s more appropriate,” she said. “It really does make better care. It really does streamline the whole process.”
 
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