Physicians who demonstrate that they have created a "medical home" for patients resulting in proven positive outcomes could be eligible for annual rewards of $125 per patient under a new program developed by the Bridges to Excellence coalition.
The program builds upon the group's existing Physician Office Link program and the National Committee for Quality Assurance's Physician Practice Connections program. The medical home conceptas formulated by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Associationinvolves patients having a personal physician who receives compensation for leading an integrated team of healthcare professionals providing coordinated acute, chronic, preventive and end-of-life care facilitated by information systems.
Bridges to Excellence Chief Executive Officer Francois de Brantes noted that an "information system" does not necessarily mean a fully implemented electronic medical record. What is needed, he said, is some sort of system that tells a physician who their patients are, what their diagnoses are, what kind of treatment they are receiving, and a way of tracking outcomes.
The medical home concept as defined by the medical groups mentioned above also includes giving patients "enhanced" access to their physicianswhich includes secure electronic communication options.
De Brantes promised that this would not be like other physician-reward programs where "the juice isn't worth the squeeze," adding that "nobody is going to invest 5,000 bucks to make $50." To accomplish the "practice re-engineering" required for the program takes about 18 months with some $25,000 to $30,000 in upfront costs, de Brantes said, adding that money for an information system is included in that total.
The program would award doctors a $125 per patient bonus-provided the patient is covered by a participating employer with a suggested maximum annual incentive of $100,000.
The bonus is based on studies that found that providing the type of care coordination that a medical home offers could result in savings of $250 to $300 per patient a year, he said. Under the Bridges to Excellence Medical Home program, that savings would be split between the patient's physician and health plan.
De Brantes said he would like to see about a dozen pilot projects testing the program in the months ahead, adding that physicians participating in three medical home pilots up and running in New York, North Carolina and Massachusetts already meet the requirements of this new program.
While acknowledging that the medical home concept makes common sense, some skeptics note that it could lead to physician turf battles with specialists unwilling to take direction from a primary-care physician, but de Brantes said he doubts this would happen.
"It does boil down to: what are you holding people accountable for, and that's achieving good results," de Brantes said. "You can't do that without collaboration, and it's not about the primary-care physician telling the endocrinologist or cardiologist, 'Here's what you have to do.' "
De Brantes added that, in many cases, a family physician would fill the role of care coordinator, but it could also be an internist, cardiologist or other specialist.
"Patients are not going to get better with a closed gate-keeper model," he said. "And 'management' does not mean doing it all yourself."
(For more on the medical home concept, see Modern Healthcare's Nov. 12 cover story "Of primary importance".)
What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.