Everything the health care industry has learned about changing the way care is delivered and paid for so far has come in fragments, but a Centers for Medicare and Medicaid Services demonstration New Jersey providers are participating in could have the critical mass to make significant changes.
sive Primary Care Initiative demonstra-
tion, or CPCI, has been launched in seven markets, including the entire state of New Jersey. The demonstration has the triple aim of most CMS initiatives — better health, quality care and lower costs — achieved by implementing patient-centered medical home strategies, but it differs in that it opens the door for private insurers to participate.
In New Jersey, five private insurers and 252 physicians in primary-care practices have been accepted into the CPCI. Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth New Jersey, UnitedHealthcare, Amerigroup and Teamsters Multi-Employer Taft Hartley Funds are the insurers participating.
"It's great that this is a multipayer effort, because you really can't transform your practice for only some of your patients," said Dr. Richard Corson, past president of the New Jersey Academy of Family Physicians. "Since most of our patients are part of it — either through Medicare or Horizon or AmeriHealth — we'll really be able to keep everybody in the same system."
The demonstration focuses on coordinating care for entire patient populations through increased access for patients, information technology and team-based care. Patients are organized by CMS into different risk groups, with care coordination funds allocated by CMS to the physician, who receives between $8 and $40 per patient per month, depending on the risk level. Private insurers participating in the process contract their own monthly care coordination fee with each physician's office.
Corson's independent practice already participates in several patient-centered programs with private insurers, but the CPCI makes the model feasible. He said 80 percent of his patient population now falls under the demonstration's umbrella.
"It puts some money behind what's a very good idea," said Corson, who runs an independent practice in Hillsborough. "It has allowed me to hire somebody to do the patient management that is really an integral part of this whole initiative."
After the first year of the four-year demonstration, practices and payers can engage in shared savings programs.
Private insurers have expressed excitement about being able to participate with the federal government and other payers in the demonstration.
Dr. Lisa Blondin, senior medical director for AmeriHealth New Jersey, said working with other plans gives them the opportunity to coordinate reporting metrics and best practices, as well as be able to make financial investments without shouldering all of the risk.
"We've been talking for a couple of years about how can we transform how we pay for primary care, and we really felt it didn't make sense to do it by ourselves," Blondin said. "One of the nice things about this was, not only was it multiple payers in the state, but it was also with CMS … this is kind of the best of everything for us."
For physicians in the six participating Hunterdon Healthcare Partners practices, the CPCI is an extension of work already happening in their offices.
Christine Bogard, the administrative director for Hunterdon's hospital-affiliated practices, said finding the resources to provide full care coordination for all patients — not just those with the highest risks — was nearly impossible before the funding from the CMS demonstration.
She said nearly 60 percent of the six practices' patients are covered either by Medicare or one of the five private insurers, meaning there will be enough funding to recruit one central care coordinator for all of the practices, as well as a pre-visit planner for all of the practices.
The system already has experienced success with limited care coordination implementation. A follow-up medicine reconciliation call from a care coordinator prevented one recently discharged patient from taking a potentially dangerous amount of medication. The coordinator realized the medication the hospital gave the patient was the same as the medication at home, but under a different brand name; the patient assumed both were to be taken.
"Because we've got a care coordinator in place who reached out to do medicine reconciliation upon release, it was caught before it could potentially become a problem," said Jeffrey Weinstein, executive director of Hunterdon Healthcare Partners. "These programs are not windfalls for the practices. What these programs do is put (practices) in the position to afford to put the right programs in place."
Blondin said that, in addition to the triple aim to be achieved through the demonstration, she hopes the scope of the project will emphasize the importance of primary care to patients. Blondin called New Jersey's health care market "specialist focused."
"Primary care is not as robust as it should be," Blondin said. "I would love the publicity surrounding this to get the people of the state to understand the importance of primary care, and how valuable primary care physicians are … that triple aim should mean something to patients."
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