Effecting Change – From the Local Level to the National Scene

By John Bennett, M.D.

Health care is a hot topic these days. With the Supreme Court ruling on the Affordable Care Act and the presidential election in full swing, it is at the forefront of the news.

The polling group Gallup says health care and its associated issues – quality, access and cost – are a “latent concern” for Americans – essentially something that is always on the minds of the people. When specifically asked about the topic, Americans rank health care high among their concerns.

A Gallup report on June 29 (a day after the health care ruling), showed that in a recent poll, Americans put the cost of health care at the top of their list of economic issues. In addition, the “availability and affordability of health care” ranked as high as federal spending and the budget deficit.

With these statistics in mind, it is not hard to see the need for change. So the timing of the federal government’s nationwide Comprehensive Primary Care (CPC) initiative couldn’t be better. The program is the Centers for Medicare & Medicaid Services’ (CMS) plan to “deliver higher quality, better coordinated and more patient-centered care.”

The goal of the CPC is to test payment models to improve the quality and efficiency of health care. It invites payers to invest in primary care doctors who are committed to care coordination. Primary care practices that are selected by the government will be given financial incentives and other resources to better coordinate primary care for their Medicare patients.

CMS recently selected New York’s Capital District-Hudson Valley region as one of seven markets in the nation to participate in the CPC initiative.

While Capital District Physician’s Health Plan (CDPHP) is part of this federal initiative, the strategies that we will implement as part of the CPC initiative are not new for the company. In fact, CDPHP launched its own Enhanced Primary Care (EPC) program in 2008 that has helped transform the way physician practices in one region care for their patients.

The EPC program has gained national attention after demonstrating that patients get higher-quality, more cost-effective health care when primary care doctors are paid in a manner that supports spending more time with the sicker patients and organizing their office workflows to enhance access for the patient and coordinate their care.

On July 18, CDPHP’s Senior Vice President and Chief Medical Officer Bruce Nash, M.D. testified at a congressional subcommittee hearing on Medicare payment reform in Washington, D.C.

Since its inception, CDPHP’s innovative program has steadily grown. EPC now includes 75 local physician practices, encompassing nearly 100,000 CDPHP members and 384 network physicians. A new phase of the EPC program kicks off in August. The expansion will double the number of participating practices and cover an additional 70,000 members.

An independent analysis of the CDPHP’s Enhanced Primary Care initiative has shown a 15 percent reduction in inpatient admissions, a 9 percent reduction in emergency room visits, and $8 per member, per month savings.

CDPHP now has the chance to prove that this model can work more broadly – in other communities across the country. The spotlight is shining on this relatively small geographic area. The best health care ideas for our country often are rooted deeply in our communities. What CDPHP is doing locally can change health care for millions of people.

With an eye toward the future, CDPHP, like many other health plans that are part of the Alliance of Community Health Plans, is doing its part to keep up with the rapidly changing health care landscape. The big question is how will other communities – patients and their families, physicians and hospitals, health plans and employers – approach the challenges that lie ahead?

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Dr. Bennett is president and CEO of Capital District Physicians’ Health Plan in Albany, New York. To learn more about CDPHP, visit www.cdphp.com.

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