Patient-Centered Project Invests $33 Million in Improving Care, Reducing Net Costs
HARRISBURG –Gov. Edward G. Rendell recently announced that as part of national health care reform, Pennsylvania is one of eight states selected by the federal government to join a demonstration project to improve treatment for people with chronic diseases – a major driver of health care costs.
It could also bring as much as $33 million in additional Medicare funds that will result in better health outcomes and lower net health care costs.
“Pennsylvania has been a recognized leader for our ongoing work in transforming primary care and addressing chronic health conditions,” Rendell said. “Being selected by the federal Centers for Medicaid and Medicare Services to join this demonstration project is evidence of the success the Pennsylvania Chronic Care Initiative has had — and will continue to have — as we reform our health care system.”
Expected to begin next spring, the three-year demonstration project will expand Pennsylvania’s highly regarded Chronic Care Initiative, which is helping more than 150 primary care practices provide more effective treatment for patients with chronic diseases such as diabetes, asthma and congestive heart failure.
In the Chronic Care Initiative, practices learn to use electronic disease registries to identify patients who have skipped appointments or are not improving and to monitor progress on key clinical outcome measures. Support staff learns to work as a team to make sure patients receive lab tests, specialist care and referrals to community agencies they need while also helping patients learn how to better manage their own health. These steps result in healthier, more-satisfied patients as well as fewer hospitalizations and emergency room visits.
Pennsylvania’s commercial health insurers and Medicaid are heavily involved in the Chronic Care Initiative, contributing $30 million over the initial three years of the project to compensate practices for the extra costs of adding care managers and gaining recognition as a Patient Centered Medical Home.
Being selected for the demonstration project means that Medicare will join current participating insurance carriers to invest in practices to improve the chronic care management of low income and elderly patients. The resulting decrease in avoidable hospitalizations and emergency room use will ultimately result in cost savings.
Practices will have the opportunity to receive additional payments when their efforts result in overall health care savings.
In order to be chosen for the demonstration, Pennsylvania had to show that increasing resources for primary care practices to support patients with chronic conditions will end up saving money by reducing the use of more expensive health care services. Although individuals with chronic conditions make up only 20 percent of the state’s population, their care needs account for 80 percent of health care spending and are a major contributor to rising health care costs.
The statewide implementation of the Chronic Care Initiative began in May 2008 as part of Rendell’s “Prescription for Pennsylvania” and the recommendation of the Chronic Care Management, Reimbursement and Cost Reduction Commission. The initiative currently includes seven regional collaborative, with two more in development, including 900 primary care practitioners which serve more than 1.4 million patients.
Ann Torregrossa, director of the Governor’s Office of Health Care Reform, said the federal demonstration project will enable the Chronic Care Initiative to expand in the southeast, south-central and northeast regions of the state. The practices will receive incentive payments based on their participation and ongoing improvement in several key process and outcome measures.
“The Chronic Care Initiative is the best public-private partnership that I have ever had the pleasure of working with,” Torregrossa said. “When the state, all the major payers, physicians, nurse managed centers, consumers and other advocates all work together to improve care for and with patients, there have been dramatic improvements in health process and outcomes, and we are driving down costs.”
“The single-greatest catalyst for transforming primary care delivery in Pennsylvania in the past decade has been the rollout of the Chronic Care Initiative, blending the Wagner Chronic Care Model and the Patient-Centered Medical Home to improve access and quality of care,” said Dr. Richard Snyder, chief medical officer for Independence Blue Cross and co-chair of the state’s Chronic Care Commission. “Pennsylvania’s selection for this new federal pilot project will further raise the visibility and accelerate the adoption of this model of care delivery in Pennsylvania.”
The state’s selection for the demonstration project is a result of the hard work of the Governor’s Office of Health Care Reform and the continued commitment to practice transformation by the following health plans in Pennsylvania: Aetna, Americhoice of PA, Blue Cross of Northeast Pennsylvania, Capital Blue Cross, CIGNA, Gateway, Geisinger Health Plan, Health Partners, Independence Blue Cross, Keystone Mercy.