The medical school has the research expertise; the Blues has the database.
That marriage of complementary components will result in improved access to healthcare, better medical practices and a healthier population in Georgia and beyond, if all works out as hoped.
Last week the Medical College of the Georgia announced a joint project with Atlanta-based Blue Cross and Blue Shield of Georgia to create the Center for Healthcare Improvement. Billed as a first for Georgia, the center will combine the research and educational capabilities of the Augusta-based health sciences university with the patient population, physician network and data management expertise of the statewide health plan.
"Historically, in medical centers, we've done studies on effectiveness of individual drugs or treatments," says Darrell Kirch, dean of medicine at the Medical College of Georgia. "The goal here is, how do we go about preserving the overall health of the population?"
For example, Kirch says, look at the universe of people with diabetes in Georgia. How well do they do over time? How often do they show up in the emergency room? How often must they be hospitalized? What is their overall quality of life given the treatments they get from the health system?
Well, nobody can really say just yet. The same goes for people with asthma or high blood pressure. The traditional system delivers good medicine to specific patients with these chronic illnesses but fails to get needed care to all who suffer from them.
"(The illnesses) not only take a terrific personal toll on patients, they also represent a significant portion of healthcare spending in the U.S.," Kirch says.
The Blues can use its database of 1.6 million Georgians to identify diabetics based on medications they're taking and data from physician and hospital claims and initial enrollment surveys. It then can check on which patients have had their eyes or feet examined and which have had their average blood sugar checked. But the insurer has never identified patients who are getting less than the minimal standard of care, nor has it figured out a way to help physicians reach out to those patients and educate them.
"This project will try to get the individual patient better care and hopefully expand best practices into all our physicians' offices," says Wayne Hoffman, M.D., the Blues' vice president of medical management.
The union of the Medical College of Georgia and the Georgia Blues is not the only such quality-improvement project around. Blue Cross and Blue Shield of Michigan operates a similar center in conjunction with Michigan State University.
The Michigan State University Managed Care Institute in East Lansing was founded in 1995. A collaboration of the Michigan Blues and the MSU College of Human Medicine and Osteopathic Medicine, it helps educate doctors, nurses and administrators in managed-care principles.
"We were very interested in partnering with a program that deals with primary-care physicians," said Helen Stojic, a Michigan Blues spokeswoman. "We think Michigan employers and patients will benefit."
"This is the beginning of a large-scale trend, which invites new, interesting, very productive collaborative opportunities among people who don't have a history of working together," says Karen Ignagni, president of the American Association of Health Plans, as she rattles off a list of five such partnerships.
The AAHP is sponsoring a conference on the subject May 7-8 in Oakland, Calif.
"We're focused on the best that managed care as a movement in American healthcare has to offer," says Daniel Rahn, M.D., vice dean for clinical affairs at Medical College of Georgia. Rahn thought up the joint research project.
The Blues, he notes, manages a large population throughout Georgia, including 300,000 to 400,000 HMO enrollees. "That's the population we're most interested in," he says. "Through the management of care, is the health of the population being improved, not improved or impacted adversely?"
Augusta has minimal managed-care penetration compared with Atlanta, where more than 80% of the employed population is in managed care. In Atlanta physicians are used to seeing utilization profiles and Health Plan Employer Data and Information Set, or HEDIS, scores.
One of the goals will be to train medical students and residents from the Medical College of Georgia to manage the health of their patient populations through managed care, rather than just managing individual patients when they get sick. "Fee-for-service medicine was very focused on the individual," Kirch says. "For most people it provided very good care but at high cost. We then entered the era of managed care, where we did a better job of containing costs." But maybe people's needs haven't been met, he adds.
The Georgia center intends to publish its results in peer-reviewed medical literature. Also, the Georgia Blues regional medical directors meet monthly in Atlanta. It should be easy to disseminate results of studies of best medical practices to them for implementation in their regions. The first phase of the project is oriented to physicians only. In later stages, perhaps, care in hospitals and nursing homes could be addressed.
The two sponsoring organizations are funding the center's expenses 50-50 through in-kind contributions of staff time and resources for the first year. The initial budget is about $250,000, allocated from internal funds. The proj-ect managers intend to apply for grants from the government and large foundations to continue the work into the second year.
"I'm very excited about this center and its possibilities," Rahn says. "I really believe that physicians, providers, academic medicine and the managed-care organizations need to work together," especially to improve "how we go from what's learned to actual practice.
"We all know there's a large gap between our understanding of best practice and common practice," Rahn continues. "It's not just a matter of disseminating continuous medical education."
