Insurer Trains Nurse Care Coordinators

At an accelerating pace, the nation's health insurance companies are embracing the latest trend in care delivery: An ounce of prevention is worth a pound of cure. 

Last month, WellPoint Inc. said it would increase payments to physicians who transition to patient-centered medical homes. Some observers believe the announcement by one of the nation's largest commercial health insurers, covering 34 million lives in affiliated plans, represents a seismic shift in the movement toward coordinated care and preventive medicine.

The plan calls for care management fees for primary care physicians, who could see fee increases of about 10% with incentives that could improve payments by as much as 50%.

And in another sign that the landscape is shifting, Horizon Blue Cross Blue Shield of New Jersey this month announced that it would fund a collaborative to train 200 nurses in the Garden State over the next two years as "population care coordinators."

Horizon Healthcare Innovations, a subsidiary of Horizon BCBSNJ, said the  "first-of-its-kind initiative" is designed for nurses who work in primary care physicians' offices. The program uses curriculum developed in collaboration with Duke University School of Nursing and Rutgers College of Nursing.

The nurses who graduate from the 12-week program will work with primary care physicians, other care team members, and the patients themselves to coordinate follow-up care and create individualized health plans that empower and engage patients.

"This innovative leadership role for nurses is an example of how we are implementing the recommendations from the landmark report: the Institute of Medicine: 'Future of Nursing: Leading Change, Advancing Health' in New Jersey," Edna Cadmus, project director, and Clinical Professor at Rutgers College of Nursing, said in a media release announcing the project.

"Through this collaborative partnership we are working to shift care delivery from an illness model to one of keeping our citizens healthy, using nurses as the linchpin to analyzing data on high-risk patients and developing coordinated plans of care. These nurses are being given a unique leadership opportunity to contribute to pioneering this new model in the state," Cadmus said.

The first class of 37 population care coordinators began their studies last month. Most of the courses are delivered online and are supplemented by three "face-to-face sessions" on the Duke and Rutgers campuses. The nurses will also take part in a residency program that integrates their coursework and skills to provide a real world experience for their new roles as care coordinators.

The Horizon project courses will focus on:

• Case management of patients with complex health conditions
• Engagement and communication strategies with patients
• Using databases, including disease registries and Electronic Medical Records
• Coordinating care of "frequent flier" patients and discharged from care facilities
• Implementing and managing change in healthcare organizations
• Operations of a PCMH
• Role of care coordinators in improving patient care and patient experience in a PCMH

The announcements from WellPoint and Horizon should be welcomed by  anyone who cares about healthcare reform and the move toward the patient-centered medical home. If the commercial plans aren't on board, it's not going to work.

The initiatives also show that payers clearly understand that ongoing political dog fights and the court challenges to "ObamaCare" are just static. The plans know that regardless of who gets elected president, or who controls Congress, or which way the U.S. Supreme Court rules, there is no going back to the old fee-for-service model. It is simply too wasteful, and too unaffordable.

The plans are planting a stake on the future of healthcare and they're betting that primary care physicians and nurses will lead the way.