Health plans ante $1.5M for Hudson Valley medical homes

By Bernie Monegain
10:07 AM

Nearly half a million patients in New York's Hudson Valley are now associated with a patient-centered medical home, created in part with the help of $1.5 million in incentives provided by six health plans. The Taconic Health Information Network and Community (THINC) brought the plans together.

The health plans – Aetna, CDPHP, Hudson Health Plan, MVP Health Care, UnitedHealthcare and Empire BlueCross Blue Shield – represent about 65 percent of the commercial insurance market in the Hudson Valley and 43 percent of Medicaid managed care, according to THINC.

Setting aside competition in favor of cooperation with THINC, the health plans paid $1.5 million to 236 primary care physicians in 11 practices that achieved patient-centered medical home (PCMH) recognition from the National Committee for Quality Assurance (NCQA).

The incentives were paid to providers for transformation to a PCMH and for the improved services patients receive in a medical home.

THINC and Taconic IPA managed the project over one year. The goal, officials said, was to boost quality, safety and efficiency.

"A majority of the commercial and public program insurance plans serving the Hudson Valley worked together to support the foundation of primary care – bring better preventive care, improved chronic condition care, and better access to coordinated care,” said Susan Stuard, THINC's executive director. “Ultimately, this project shows that those caring for the people of the Hudson Valley can move beyond competition to enhance quality."

The PCMH is an emerging model of care in which patients select a primary care practice to be their medical home. Vital to the model is the use of health information technology.

[See also: Physician groups release 13 new guidelines for PCMH accreditation programs.]

The workflow at practices is redesigned to emphasize a team-based approach to care. Core components include better access to care through open scheduling and use of electronic health communication tools, care coordination among providers, a focus on preventive care and the use of health information technology tools such as electronic health records and electronic prescribing.

Adoption of the medical home model was shown in a national demonstration project to improve measures of quality of care by 8.3 to 9.1 percent and measures of clinical preventive and chronic care services by 5 percent. Outcomes from independent demonstration projects across the country have produced reductions in emergency room visits of as high as 39 percent because of better care for chronic conditions, and significant cost savings, say THINC executives.

[New patient-centered medical home standards align with MU.]

"The process of becoming a medical home transforms the practice so it can fully utilize the tools of an electronic medical record and align the goals of the practice with the patients to improve the quality of care that the patient receives," said Mark Foster, MD, chairman of THINC's board and lead physician of Hudson Valley Primary Care, a participating PCMH practice. "Some of this is obtained by improved care coordination, access and more complete care. This enhanced value for patients and insurers will allow for lower medical costs in the long term as patients are receiving more preventative services on time.”

More work ahead
Following on the success of its medical home incentive program, THINC, in partnership with Taconic IPA and supported by technical expertise from Geisinger Health System, seeks to bring a model of embedded care management within NCQA Level 3 patient-centered medical homes to achieve gains in efficiency and quality.

Geisinger's ProvenHealth Navigator program will be tailored to meet the specific needs of the Hudson Valley. The program will start with a small pilot at several sites with the ultimate goal of rolling out to medical home recognized primary care providers across the community.