Texas can improve care and cut costs with medical home, shared savings initiatives

Tags: texas family physician, perspective, medical home

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.

At ARC, we have discovered a definite tipping-point phenomenon in committing the resources necessary to develop adequate infrastructure to effectively and comprehensively manage patients’ well-being across the care spectrum. We have been approached by a number of payers investigating our capability to transform our care delivery model. However, not until we were approached with a payer as large as ERS were we able to make a compelling internal business case for investing the resources to transform our own workflows in what is currently still an overwhelmingly fee-for-service market. Now that we have had an opportunity to begin to transform our delivery system, we are much more able to explore opportunities to efficiently extend the benefits of a medical home to all of our patients.

For me, this is the real pearl in the ERS medical home initiative: Large payers, be they employer-driven (as with ERS), or public (as with Medicare shared savings initiatives), or commercial (for fully-insured beneficiaries), have the opportunity to change the cost of care delivered across Texas, not by mandate but by example.

However, a primary-care-led health care system cannot exist without actively nurturing and growing the primary care workforce. Since its inception, ARC has emphasized the importance of long-term doctor-patient relationships, coordination of care, and a strong primary care physician base—three major tenets of the medical home model. Drawing upon ARC’s 30 years of experience, I cannot overstate the importance of supporting initiatives to increase the number of medical school graduates choosing a career in primary care. Unfortunately, our state’s ability to train this primary care workforce has been diminished in this last legislative session.

Payment and delivery system reform, such as that being driven by the ERS medical home and shared savings pilots, coupled with an investment in growing our primary care workforce, helps not only the Texas budget in the short and long term, but provides the seeds to transform all care in Texas.

Greg Sheff, M.D., is the medical director for the Austin Regional Clinic Medical Home Program.

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