Todd Sandman, vice president of strategy and customer engagement at Presbyterian Healthcare Services, says his organization expects to spend “a few hundred thousand dollars” as part of their Pioneer participation.
“Because we're a large integrated system already, we have a lot of the infrastructure we need,” he says. “Of course, any time you take what is going to be for us 16,000 patients and make sure we're giving them that approach to care management, we'll spend a little bit more to do that.”
The potential upside his system expects from its participation is not more money but a lower likelihood that it will face the same cuts other providers endure when policymakers begin to ameliorate long-term federal deficits.
Short-term challenges include persuading Medicare beneficiaries in the fee for service program to participate in the intensive care management not traditionally associated with the program, he says.
Similarly, Dr. Barbara Spivak, president of the Mount Auburn Cambridge Independent Practice Association, tells Modern Healthcare that her group's managed-care experience will give it a leg up in providing the types of improved care that the Pioneer program calls for.
The biggest potential obstacles include working with patients who may not be cared for at their own institution. Possible approaches include educating patients and their families to let her group know when they are seeking such care, so that they still receive the post-discharge care needed to avoid complications and re-hospitalizations.
Another potential problem is that patients may opt out of the electronic health record used to coordinate care among their Pioneer providers. In Mount Auburn's experience, most patients agree to put their information in EHRs, but the program can work regardless.
“It's just a lot more complicated,” she says. “And it's harder for the patients.”
Follow Rich Daly on Twitter @MHRDaly.