"The collaborative model basically took the idea of networking and best practices sharing and added a third element to the planning," says Bill Greer, a compensation consultant for Kellogg. This is the use of value-based insurance design, which focuses on lower deductible rates and coinsurance on services that make a difference in improving employees' health.
Pathways to Health also has meant moving in other directions that "have just made sense to us," says Benzik. It has, for instance, emphasized a patient-centered medical home among its many small practices.
"You create the system. You create the kind of work environment that you want to be in—and the kind of relationship you want with your patient and your team while putting a whole community of support around you," Benzik says. "It's just fun watching reenergization of providers. It's fun watching physicians return to the joy of practicing primary care."
No major changes—such as reducing patient panels—were made in setting up the medical home concept. Emphasis, though, is placed on keeping accurate patient data and putting the PDSA (Plan-Do-Study-Act) process into action to see what is working and what is not. "It's just been organic—how healthcare can be and should be—but someone keeps putting a name on it," she quips.
Assisting in the move toward medical homes is a payment structure that rewards improved care. "We created a model that basically defrayed many of their costs of participation," says Thomas Simmer, MD, a BCBSM senior vice president and chief medical officer.
These physicians are compensated for lost revenue—for instance, the times they go to meetings or receive instruction. They also are "rewarded for their patient improvement and performance along the way," Simmer says. They could receive up to a 10% increase in their office visit fees—if they achieve the patient-centered medical home designation.
And while the information is preliminary, BCBSM has found that for the three years the patient medical concept was in effect, the hospitalizations "for those conditions that better ambulatory care can prevent" dropped by 40%. "It's an example of the costs that you want to take out of the system. It's not rationing care—but simply never getting sick enough to need the care that costs so much," Simmer says.
The next stage is building "around the primary care foundation" of an ACO that allows the entire system to work effectively between "fragmented parts of the delivery system," Simmer says. "I suspect that as more definitions develop nationally about what it means to be an ACO, we're going to be applying those principles in Calhoun County."