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S.C. Medical Home Targets Medicaid Patients

November 16, 2010
by Jennifer Prestigiacomo
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Network utilizes cloud solution to manage patient care

In early July, Palmetto Physician Connections, a medical home network of physicians, formed with the goal of coordinating better care at a lower cost for South Carolina’s Medicaid population. According to Palmetto’s Medical Director and family physician Gerald Harmon, M.D., his goal is to recruit 2,000 OB/GYNs, internists, family physicians, and pediatricians by 2011 Q1 to bolster the around 200 providers currently in the Palmetto network.

Seeing Opportunities in the Medicaid Population
Dr. Harmon notes that his network is targeting the 100,000 eligible Medicaid patients that aren’t a part of a medical home because of the population’s accessibility or because of resource containment issues. “We’re limited in Medicaid budgets in most states, matched by the federal dollars, so we’re looking for the best population to apply medical homes to give them value-based care,” he says.

Gerald Harmon, M.D.

Harmon admits the medical home approach is not entirely altruistic, as he is looking for capitalization and sees the Medicaid population as being particularly underserved, yet having an increasing demand. “Without the Accountable Care Act [the legislation that comprises one element in the broader Patient Protection and Affordable Care Act (PPACA)], we’re going to have more and more eligible for Medicaid in our state because we have 12 to 15 percent unemployment,” Harmon says. “We anticipate 10,000 to 200,000 being eligible [for Medicaid] by next year.”

Harmon has been in the medical home business for five years. He was involved with the Covering Carolina Collaborative, a non-partisan coalition started by the S.C. Chamber of Commerce, the S.C. Hospital Association, the S.C. Medical Association, and the S.C. Alliance of Health Plans. From that group Robert Kerr, the Collaborative’s executive director and former director of the S.C. Department of Health and Human Services, along with Cesar Martinez and Harmon, went on to found Palmetto Physician Connections.

An Answer in the Clouds
To cut down on overhead, Palmetto decided to engage the Tampa, Fla.-based Medhok, a cloud-based solution, to manage patients’ care. Medhok’s case management solution utilizes claims data to gather patient information, since Harmon’s practice, as well as most of South Carolina physicians, does not have an electronic medical record. A case manager, along with a utilization review R.N., collects and packages data and sends it to Harmon to review on a daily basis, flagging any items he needs to address. “I can see it [results] on the Internet, and I don’t have to shuffle [through paper],” Harmon says. “My other colleagues who do medical homes networks, goodness, they carry briefcases around, and it takes days for stuff I can do really after hours when I have a moment free.”

The physician network meets monthly to identify claims or care coordination outliers. Palmetto’s physicians use federally recognized guidelines from the Agency for Healthcare Research and Quality’s (AHRQ) National Guideline Clearinghouse to systemize their care for chronic patients with diabetes, hypertension, and chronic obstructive pulmonary disease (COPD). “If I see an outlier, I can call the provider—they can look at the data if they want to,” Harmon says. “We can talk about it online or on the phone. I like that aspect of it.” Palmetto also has a quarterly meeting to review quality and look for improvement opportunities.

Physicians’ Benefits
Palmetto network physicians can receive added reimbursements with their membership. Although not a guaranteed benefit, Harmon notes that his providers could possibly qualify for higher reimbursements for current procedural terminology (CPT) codes and evaluation and management (E/M) services through federally qualified health center (FQHC) legislation. Physicians can also receive a per month bonus if they manage the health of their patients well.

In the future, Harmon wants hospitals integrated into his medical home network, as they are the only major piece of the equation not currently involved. He also sees that with bundled payments on the horizon for 2012, hospitals will become more interested in higher patient care. But for now Harmon is excited by the visibility of patient data in his network. “I can respond to the patients’ needs and get a little bit better quality check earlier on,” he says.