Representatives from seven major health plans and four major physician groups announced that they will collaborate on a new initiative, the Patient-Centered Medical Home, which will conduct a series of pilot projects aimed at utilizing primary-care physicians to coordinate continuousrather than episodiccare while exploring methods of provider reimbursement that will sustain a healthcare system based on this model.
The initiative will be supported by the Patient-Centered Primary Care Collaborative, an alliance of the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, the American Osteopathic Association, AARP, plus numerous other health plans, employers and business groups.
Specifics on how many pilots would be conducted and how much financial support they would receive were not available. As an example of what these pilots might look like, Paul Grundy, director of healthcare technology and strategic initiatives for IBM, cited a North Carolina program that enrolled Medicaid beneficiaries into a physician-directed medical home. After an initial investment of $10.2 million, an analysis showed a savings of $244 million in overall healthcare costs in 2004.
Grundy said that there could be as many as 100 different pilots launched. He said that, previously, health plans were somewhat reluctant to get involved in such an initiative because there were few regions where they had enough of a market share to make a difference individually. The participation of so many plans allows for a common infrastructure and for something close to universal participation in various projects.
Bruce Bagley, the AAFPs medical director for quality improvement, said it was important to get all the plans on board.
We need to have all the payers involved because you cant make systematic changes with just 10% of your patients, Bagley said, adding that Rhode Island might be the site of one of the first pilots. Clearly everyone is interested in reshaping the payment environment to foster more robust primary care because primary care has to be the centerpiece of any healthcare reform.
The plans involved are: Aetna, Blue Cross and Blue Shield Association, CIGNA, Humana, MVP Health Care, UnitedHealthcare and WellPoint.
The PCPCC will hold a call-to-action summit Nov. 7 in Washington, in which the organizations four medical society members will be joined by the National Committee for Quality Assurance to announce standards primary-physician practices must meet to qualify as a patient-centered medical home. -- by Andis Robeznieks
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