How Health Plans Are Working To Transform Primary Care - ACAP Case Studies Show Innovations To Improve Medical Care

Main Category: Health Insurance / Medical Insurance
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 04 Aug 2010 - 2:00 PDT

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As policy makers and health-care experts increasingly discuss the need to revamp the way medical care is delivered to focus more on patient-centered care, such as a "medical home" model, a new paper released today provides concrete examples of how health plans are working to transform primary care.

The Association for Community Affiliated Plans (ACAP) prepared the study, which looks at seven of its members, all Medicaid-focused health plans, to provide short case studies of innovative programs that incorporate key elements of the concept into the way they operate.

"Far too often, the health care system focuses on the roles of various medical care providers, instead of on the individual patients who really matter," the paper notes. These concerns have prompted growing calls for emphasizing the role of primary care and what the patient needs. The goal of transforming primary care is to improve access to medical services, care coordination, patient satisfaction, and the quality of care. "An additional benefit of this approach is the potential to reduce costs," the study said.

The report focuses on the following key elements for transforming primary care:

• Increasing access to primary care.
• Coordinating patient care at the primary care provider level.
• Emphasizing quality and safety.
• Engaging patients.
• Improving communication between providers and patients and improving education.
• Aligning financial incentives for providers.
• Employing team-based care.

"The concept of primary care transformation is not really new," said Margaret A. Murray, ACAP's CEO. "The idea's essential elements have been a cornerstone of managed care organizations since their inception. This study shows some specific examples that other health plans can adapt and replicate."

ACAP represents 51 nonprofit safety net health plans in 25 states serving more than seven million people through Medicaid, Medicare, and other public health programs. The report notes that, "Most of these plans employ some or all of the elements" identified in the report. "They are working to transform primary care in a way that is flexible, scalable, and accountable."

The report gives examples for each of the key elements that are critical for improving primary care. Neighborhood Health Plan of Rhode Island, for example, is working with local community health centers to encourage more multi-disciplinary care, provide same-day, 24-hour access, use more sophisticated information technology, and foster patient self-management.

Contra Costa Health Plan of California uses five case-management programs, tailored for different populations and health needs, to enhance the coordination of patient care and address related social needs. To similarly improve the coordination of care, Network Health of Massachusetts employs a customized integrated care model to ensure the continuity of care, supported by clinical teams of nurses, behavioral health care clinicians, and social workers.

CareSource in Ohio has developed a system for sharing electronic health records to improve the quality of care by reducing duplicate services and medical errors while improving the tracking of the use of prescription drugs. CareSource also uses financial incentives to encourage better patient engagement.

To foster greater communication with patients and the better management of their care, Monroe Plan for Medical Care in New York took the lead in creating the Rochester Regional Quality Improvement Initiative for Diabetes Care.

Aligning financial incentives for providers, AmeriHealth Mercy in Pennsylvania is part of a medical-home collaborative that includes pay-for-participation and pay-for-performance components. CareOregon has implemented the Primary Care Renewal project that, focusing on practice sites, works to improve access to care and support team-based care. CareOregon has developed a system that rewards participation, quality improvement, and improved outcomes.

"Primary care transformation is an evolving process," the report said. Future challenges, it said, include getting optimal use of electronic medical records, refining models to make sure they are "both effective and sustainable," and considering how well models that work for one type of patient can be adapted to new populations.

"The strategies outlined in this report show that Medicaid-focused health plans are leading the way in transforming the delivery of primary care," said Deborah Kilstein, ACAP's Director of Quality Management and Operational Support. "While there is much discussion about new models for delivering health care, this paper helps take a concept and show how health plans are already working hard to undertake innovative new approaches," Kilstein said. "Safety net health plans will continue to play a central role in transforming primary care and developing new and better approaches for making sure we are always putting patients first."

"How Safety Net Health Plans are Transforming Primary Care: Case Studies from the Field"

Source: Association for Community Affiliated Plans (ACAP)

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