CMS Takes the Next Step in its Primary Care Practice Initiative

One physician who is participating in the initiative is Stacy Zimmerman, M.D., an internal medicine and pediatrics physician from Clinton, Ark., who is a practitioner at Ozark Internal Medicine and Pediatrics. Zimmerman has recently converted her practice to a patient-centered medical home (PCMH), following a two-year pilot project. The PCMH concept embodies many of the goals of the CMS initiative.

“When I started my practice nine years ago, I was motivated to improve healthcare in an underserved area,” she said. It wasn’t long before she was bogged down in patient charts. While she purchased an electronic health record, she found that even a great computer program could not instantly fix everything or make her patients well.  “It became obvious that the health and welfare of my patients depended on a partnership between the patients, the physician, and the healthcare team.” This was the foundation of the transition of her practice to patient-centered care, she said.

She outlined some results of the transformation:

• Same-day open access for her patients. If patients are sick, they can get same-day appointment, no exceptions.
• The practice’s web site offers a secure portal access for the patients to connect with their electronic medical record and access their chart. They can request appointments, refills, referrals and email their doctor. The functions also allow messages to be routed to the correct individual, bypassing the receptionist, thereby improving efficiency and response time.
• The clinic operates in a real time system. At end of the visit, when the doctor signs off on a visit note, a visit summary is triggered that is sent to a patient’s email along with patient information materials; prescriptions are electronically sent to the pharmacy; referrals and orders are sent to the staff, and the chart is sent to the billing module. All of the functions are done when the patient exits the exam room.
• The practice uses its Facebook page to reach out to patients with announcements and health tips. It has developed educational modules and tools on its website. There, patients can find condition trackers such as blood sugar trackers, can record their home readings, send the results directly to their charts through the portal, along with an alert to the doctor to review those results.

Zimmerman said that since implementing these features, the practice has seen “a marked decrease in ED visits and a marked decrease in the hospital readmission rates compared to other clinics in its geographic area.  This model demonstrates how a clinic can decrease healthcare costs.”

A HEALTH PLAN’S EXPERIENCE

John Bennett, M.D., is president and CEO of the Capital District Physicians’ Health Plan (CDPHP), a health plan located in upstate New York, which is a participant in the initiative. Five years ago, the CDPHP board of directors came up with a directive to save primary care. “The local medical school was no longer graduating and sending significant numbers of physicians to choose primary care as a career,” he said.

CDPHP launched its Enhanced Primary Care Initiative, which uses the PCMH features of patient-centered care and combines it with a global payment model, he explained. “It allows primary care physicians to be rewarded for better health, better care, and lowering costs,” he said. The initial pilot of three practices has been successful. An independent analysis of its Enhanced Primary Care Initiative showed per member per month savings of $8 per member per month, resulting from a 9-percent reduction in emergency room visits and a 15-percent reduction of inpatient admissions, he said.

He added that, as a regional payer, CDPHP participates in all lines of business, both commercial and New York State funded and federally funded Medicare Advantage plans. “We found this [to be] true of the population as a whole,” he said. As a result of that, the health plan’s Enhanced Primary Care Program is thriving, and it will soon cover close to half of all 400,000 CDPHP members within the next year, he said.

An example of its success from a population health level, was an Albany, N.Y. practice whose physicians have achieved a drastic improvement in blood glucose levels in their diabetic patients, as measured by their hemoglobin A1C levels, he said.

He said that, as a regional plan, CDPHP has engaged the local business community by introducing a Shared Health product portfolio that rewards employers to promote healthy lifestyles and behaviors. “We believe that better health and better care leads to lower costs, and we are seeing it every day,” he said.