Healthcare Business News

Colo. medical-home pilot seen to cut ER visits

By Maureen McKinney
Posted: September 5, 2012 - 12:00 pm ET

It was a bumpy road, but leaders from Colorado's patient-centered medical home pilot say the effort seems to have reduced emergency-department visits and hospitalizations, especially among patients with chronic disease.

Coordinated by HealthTeamWorks, a Lakewood, Colo.-based not-for-profit organization, the Colorado multipayer patient-centered medical home pilot ran from May 2009 through April 2012. Six health plans, including Aetna and Cigna Corp., agreed to participate under an enhanced compensation model that blended fee-for-service, monthly per-member care-management fees and pay-for-performance payments.

Final results are pending, but preliminary data is encouraging, according to an article in Health Affairs. In addition to lower ER visit and hospital admission rates, one of the payers reported a return on investment of 250% to 400%. And the participating practices, which have approximately 100,000 patients, improved their use of team-based care, health information technology and care coordination.

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But the pilot faced a wide range of challenges, including antitrust laws, problems with reporting data and health plans that sometimes failed to comply with obligations.

The authors advised a number of safeguards, including the use of complex-care managers; an agreed-upon measurement and payment structure used by all participating payers; and increased price transparency.

“We hope that payers and providers can use our experiences to inform their initiatives, address or prevent obstacles and enable long-term success," they said in the report.

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