Project highlighted Marshfield's strengths

Marshfield (Wis.) Clinic improved as a result of its participation in the five-year CMS Physician Group Practice demonstration, but according to Craig Pederson, a partner with Edina, Minn.-based Health Care Futures consultants, the pieces were already in place for the organization to do well.

Pederson spoke along with Dr. Theodore Praxel, medical director at Marshfield's Institute for Quality and Innovation and Patient Safety, at the Medical Group Management Association's annual conference in Las Vegas, and Pederson had some fun comparing the healthcare landscapes of 1993 and 2011. He noted how the terminology was different—“managed care” versus “value-based payment”—but the objectives of improving quality and driving down costs were the same.

One major difference between 1993 and 2011 is that the previous goal was to treat chronic and acute illness while the current and future goal is to prevent illness and maintain wellness. The other major difference and, according to Pederson, a reason why current reforms might succeed where past attempts failed, is the implementation of electronic health records.

Praxel noted how Marshfield's own “home-grown” EHR, known as CattailsMD, helps physicians track 50 quality indicators “from newborn to end of life” and is designed to “make it easy for physicians to do the right thing.”

The goal of the CMS demo was to learn how coordinated care could improve quality and lower costs—with a bonus plan in place for practices to be rewarded if savings hit certain levels.

Praxel said that Marshfield—an integrated health system with more than 780 physicians practicing at 56 locations—received about $56 million from shared savings over the five years of the demonstration and hit 31 of 32 quality targets.

Pederson said the “three-legged stool” supporting value-based payments includes patient-centered medical homes, pay for performance and the total costs of care. During the demonstration, Praxel said 35 Marshield locations were recognized by the National Committee for Quality Assurance as medical homes, and Marshfield is putting 55 nurse care managers into those locations to further assist in care coordination.

Praxel noted that “quality is not enough” to generate savings and that efficiency must also be improved—and this will become more critical in the future.

Everyone's revenues are going to change “and likely to go down,” Praxel said.

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