LITTLE ROCK – Arkansas Blue Cross Blue Shield has launched a patient-centered medical home pilot project with seven family and internal medicine practices to test whether the concept will work in the state.
Under the two-year project, ABCBS will pay patient-centered medical home consultant TransforMED to create detailed implementation plans and help guide the practices to implement a PCHM model.
“We believe that proactive population-based health management is the future of healthcare being affordable,” said Steve Spaulding, vice president of enterprise networks for the insurer. “This particular method really supports a change in the culture and the processes in the clinic that will touch all patients and achieve that goal.”
To be eligible for the pilot, practices needed to show they are using an electronic medical record. Using this backbone, ABCBS has provided each practice with disease registries, which provide alerts based on patient histories to suggest care based on national quality standards.
“Not all pilots we have seen require an EMR, but requiring it is now part of trend,” said Terry McGeeney, MD, president and CEO of TransforMED. “If you are a part of pilot and you are still implementing an EMR that can really slow you down.”
For Mark Mengel, MD, project director with the University of Arkansas Medical Sciences, working with ABCBS on the pilot was virtually the only way the university could commit to changing the delivery model in its two family practices.
“The PCMH model requires a lot of change and a lot of new activities among providers. If you don’t’ have the reimbursement mechanism to support those new activities, it doesn’t work well,” he said. “If you don’t align incentives – and that includes the reimbursement model – it is tough to get a system that controls costs, yet gets good outcomes. That is why we had to work with a payer. There is no other way we could have done it.”
McGeeney said he is encouraged by the Arkansas pilot on a couple of different fronts. “It is great what Blue Cross Blue Shield is doing,” he said. “The southern states have been a little slower to move in this direction compared to the Northeast and upper Midwest. I think the leadership we are seeing in Arkansas is to be commended.”
Spaulding noted that a successful pilot would likely encourage other practices to change their method of providing care, but also acknowledged the sweeping changes needed from his company and the providers in the pilot.
“We need to change the way we compensate in order to cover the costs of things we have not typically paid for,” said Spaulding. “This includes things like telephonic consults with patients, e-mail back and forth with patients, while providers need to be ready for things like being available with longer, flexible hours, so we can lower the inappropriate use of emergency rooms.”
Mengel, whose two locations run family practice residency programs, thinks the new reimbursement models can help bring doctors back to primary care.
“I think Blue Cross sees there is a huge need for more family doctors and primary care physicians in the state and without a viable model of both practice and reimbursement, it is just not going to happen,” he said. “We are in the business of education, and I hope that the new model increases family physician reimbursement so that more of our medical students will go into family medicine.”
