Contents tagged with medical home
Register for the 2013 Texas Health/Medical Home Summit in Austin April 4-5
The Texas Health/Medical Home Summit – April 4-5, 2013 in Austin – is the first-ever … more
Save money. Live better. It’s Wal-Mart’s corporate motto, but put it in the context of health care and add a third line targeted at improving care for individuals and you’ve got something awfully close to Don Berwick’s triple aim for health care reform. If cost is the real cancer in the U.S. health care delivery system—and we think it is—why not look to America’s low-cost leader for the cure?
When reports started hitting the news this week about a request for information Wal-Mart sent out to its vendors in late October announcing the mega-retailer’s intent to “build a national, integrated, low-cost primary care health care platform that will provide preventative and chronic care services that are currently out of reach for millions of Americans,” alarms went off in health policy circles across the country.
The company has since backpedaled on the statement of intent. John Agwunobi, M.D., M.P.H., M.B.A., head of Wal-Mart’s health and wellness division, released a statement on Nov. 9, 2011, saying, “We are not building a national, integrated, low-cost primary care health care platform.”more
Following the most basic model for success in business means minimizing overhead and maximizing revenues, Dr. Mark Laitos pointed out at TAFP’s Payment Reform Summit last Saturday. For doctors in private practice and other health care providers, this means billing for as many relative value units, or RVUs, as possible at the best conversion rate, and maximizing ancillary revenue, when possible.
And while this strategy is simple enough, Laitos said it has reduced the “proud field” of medicine to “conveyor belt medicine.” Worse, as payers – including health insurers, employers, and patients to some extent – strive to minimize RVUs, the solution to the cost crisis in a fee-for-service system is to slash payment to physicians and deny care to patients.
Of course neither patients nor doctors (nor the organizations that advocate for them) would allow this to happen considering the scale needed to rein in escalating health care costs. The solution, then, as speaker after speaker suggested, is to trade the volume-based model for a value-based model. This is also the cover story of the latest Texas Family Physician magazine.more
By Greg Sheff, M.D.
I am fortunate to be a part of a multi-year patient-centered medical home and shared savings pilot at Austin Regional Clinic. ARC is an approximately 300 physician multi-specialty group delivering care at 18 clinics and seven hospitals throughout the Austin area. Earlier this year, ARC joined a multi-year medical home pilot administered by Blue Cross and Blue Shield of Texas. The pilot was initiated in large part in response to Texas legislation requiring the Employees Retirement System, the self-funded insurer for state employees, to experiment with alternate payment and delivery models in an attempt to reduce the state’s ever-increasing health care costs. We are one of five physician groups in the state participating. Our program serves roughly 45,000 patients, including both the ERS (whose health care benefits are administered by BCBSTX) and BCBSTX fully-insured populations.
In addition to the traditional PCMH goal of comprehensive, coordinated, accessible, patient-centered care for all, ARC is also implementing processes to proactively identify high-risk patients and then deploy intensive, focused, physician-led care management interventions to these high-risk patients.more
San Antonio residency program receives NCQA medical home certification
Million-dollar HRSA grant to aid in implementation
By Erin Redwine
The Christus Santa Rosa Family Medicine Residency … more
Finding a home: Blue Cross medical home pilot targets quality, costs
By Ken OrtolonSenior Editor, Texas Medicine
Plano family physician Christopher Crow, M.D., M.B.A., says Village Health … more
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Cover: The session of what might have beenNow that the 82nd Legislature and … more
Last Friday, the medical community was shocked and saddened by the sudden death of pediatrician and primary care advocate Barbara Starfield, M.D., M.P.H. During her decades spent at Johns Hopkins, she authored and co-authored numerous studies on the value of primary care that provided proof that many of us believed in our hearts but couldn’t quantify—that patients are healthier and costs are lower in a system based on primary care.
However, her work provided more than just facts; it provided the footing for a movement to redesign the fragmented system to one that is better for patients. She inspired us to really take a look at family medicine’s contribution and advocate for its importance. The process has been slow, but her momentum kept it going.
Because of her tremendous contributions to health care research and patient care, several organizations have released poignant and appropriate statements in tribute that must be shared. The first is the full statement from Roland Goertz, M.D., M.B.A., president of AAFP, and the second is an excerpt from Richard Roberts, M.D., J.D., president of the World Organization of Family Doctors.more
An important piece of legislation designed to improve quality and lower costs in our fractured and inefficient health care system has received a second chance in the Special Session after dying in the House when time ran out on the 82nd Texas Legislature. However, because of other actions taken by our legislators that defund primary care residency training and other programs to bolster the physician workforce now and in the future, Senate Bill 8’s laudable goals are left without the means to achieve them.
The overarching goal of S.B. 8 is to reverse the negative trend in our health care system, to bend the cost curve by testing and implementing various performance-based payment methods that provide incentives for improved patient outcomes. It achieves this through two key mechanisms: the creation of health care collaboratives and the creation of the Texas Institute of Health Care Quality and Efficiency.
As envisioned in the bill, health care collaboratives clinically integrate physicians, hospitals, diagnostic labs, imaging centers, and other health care providers, aligning financial incentives to keep patients healthy and out of the hospital and emergency room. They are designed to move the delivery system away from a fee-for-service based system—where physicians and hospitals are paid for quantity of services over quality—to one in which doctors, hospitals, and other providers are accountable for the overall care of the patient and the total cost of the care provided.more
By Greg Sheff, M.D.
I was fortunate to be one in a group of primary care physicians who met with Lt. Gov. David Dewhurst this February to discuss possibilities of payment reform in Medicaid, the Children’s Health Insurance Program, and the private insurance market. This meeting comes on the heels of the introduction of two major pieces of legislation, Senate bills 7 and 8. These bills would implement a host of pilot projects to test bundled payments, payments based on episodes of care, and quality incentives. It continues the positive momentum the state needs to move us away from a fractured health care system into one that provides the right care for Texans.
The unrelenting march of increasing health care costs is unsustainable, both for Texas and for the nation. Payment reform that aligns physician and hospital incentives with our society’s goals—affordable, coordinated, evidence-based, quality-measured care—is critical to rein in health care costs. The patient-centered medical home, driven by a strong primary care workforce, is a proven cost-effective method for delivering this coordinated and integrated care.more