PA insurance companies pay doctors to practice differently.
On TV, Cheers was the kind of bar where everybody knew your name. Some people think a doctor’s office should be the same kind of place, and Pennsylvania is trying out that idea with a new model of primary care called “the medical home.” Some doctors are getting bonuses to test whether an in-touch, high-tech approach can improve health and cut costs.
At Greenhouse Internists in northwest Philadelphia, health care sometimes happens outside. On most Tuesday evenings a health educator leads patients through stretches and a walk around the neighborhood.
Givens: My Name is Debi Givens and I live right down there on Mt. Airy Avenue.
Givens has diabetes, arthritis; and after two knee replacements, she sometimes uses a cane. Her doctor suggested the walking group.
Givens: She wrote it on a piece of paper, and told me to call. She didn’t ask me anything, she just told me to do it. We have that kind of relationship, she tells me to do something, most times I do it.
Greenhouse is one of those medical homes. The practice was redesigned to give people more support to manage their health.
Dr. Jeffrey Brenner tried the medical home model in Camden. He says the switch usually begins with digital records to better track patients.
Brenner: So in a new model of care, a doctor would walk into their office on Monday morning, press a button and out would print a report of all of their diabetic patients who hadn’t refilled their prescriptions; their asthmatic patients who’d been to the emergency room too often. And they would sit with a team of other people and plan out what they are going to do for those patients.
A health educator might teach a patient how to use an asthma inhaler; while a care coordinator begins phoning and emailing patients who haven’t checked in.
Greenhouse patient Allen Hinkey got one of those messages.
Hinkey: I was supposed to call in my blood pressure every week or so, and of course I always forgot.
Hinkey’s wife Ena Rosen.
Rosen: I new that this is something that he needed to be doing, and when I raised this with my husband, it was a little bit of a sensitive issue, I was perceived to sort of be nagging.
“In primary care practice, the only thing doctors get paid for is face-to-face time with patients.” – Dr. Richard Baron.
When the doctor’s office called, Hinkey was more receptive.
Hinkey: Well, it was different in that here’s a doctor and he’s taking the time out of his practice to review his patient’s records and then following up with a reminder to send in the readings.
Primary care doctors say the team approach provides better care, but most health plans only pay for the doctor’s time during face-to-face visits. Jeffrey Brenner:
Brenner: The fundamental problem holding a lot of this back is the way insurance pays doctors and the way specifically insurance pays primary care doctors.
That’s changing. Pennsylvania and the state’s largest health insurance companies have begun rewarding doctors who switch to the medical home model. Physicians in the pilot program get a lump-sum bonus. It can be as much as an extra $85,000. That pays for the new technology and the extra staff it takes to re-design a practice.
Baron: Many of us believe that this will decrease total costs of health care.
Mt. Airy physician Richard Baron …
Baron: Lots of health care leaders have spoken about that, that trying to strengthen primary care is part of the national health care agenda.
“A lot of times patients know what they should do to help improve their health, but there’s a huge difference in knowing and doing.” – Health educator Emily Desnouee .
Baron says he’s seeing better results for his patients with diabetes, hypertension and high cholesterol. But that might not be enough.
Baron: One of the biggest questions is: Do patients who receive care in primary care offices that are set up this way, ultimately cost the insurance companies less?
Camden doctor Jeffery Brenner says insurers won’t be fully convinced unless the program prevents unnecessary hospital stays and emergency room visits.
Brenner: If you help a diabetic become better controlled, it could take a long time before you see the financial benefits of that at the insurance company level.
Medical home pilot projects are under way across the country. Early reports show steady health gains, but it may take years to know if the model saves enough money to justify the extra cost.