Franchising the Chronic Care Model

Aligned Incentives and IT Infrastructure
Instead of emloying a fee-for-service model, these primary care practices develop a global budget or a flat rate per member per month. Partnerships are made with self-insured groups to share costs of operation, and all staff receive bonuses for improved quality. Patients receive waived office visits and prescription copays to join. The Special Care Center started with two payers and has grown its partnerships to nine insurers that now include Horizon Blue Cross Blue Shield of New Jersey and the Medicare Advantage plan. Festa says that due to this model, the average patient’s healthcare spend decreases by 12 percent after the first year of care.

The Special Care Center is now looking at other disease states to target that could possibly include a medical home bundle for cancer care or infectious disease. “It’s about reducing the gaps to seamless transitions,” adds Festa. “We’re stiching up the seams so to speak.”

The Special Care Center has always been electronic and uses an electronic health record (EHR)  from the Westborough, Mass.-based eClinicalworks. What Fernandopulle and his colleagues recognized early on though was that an EHR by itself would not be enough for population health management. Subsequently, a standalone registry (provided by DocSite, now the Detroit-based Covisint) was installed, which AtlantiCare is now mounting throughout all of their ambulatory practices.

Because of the difficulty to tailor EHRs and registries and “after getting tired of beating our head against the wall,” Fernandopulle and his team decided to build their own homegrown IT system for Iora Health primary care practices. “Building software in 2011 is not as hard as it used to be,” he adds, “and we can build software that really does what we want to do.”
 
Iora Health has since built a native web app in the cloud using agile software development with a development team making iterations every two weeks. “The focus unfortunately on most EHRs is how do I bill a code higher,” says Fernandopulle. “That is sorta the business model of a typical practice. [EHRs] are very fancy cash registers with a bunch of clinical stuff laid on it. At Irora, we don’t need any of that. We don’t do any billing. We wanted a system that would enable us to better manage a population.”