CDPHP’s medical home care model enters a new phase today with the addition of 67 new practices from around the Capital Region and Mohawk Valley, 70,000 new CDPHP members and 274 new clinicians.
The Enhanced Primary Care initiative will essentially double in size in this fourth phase, said Bruce Nash, CDPHP senior vice president and chief medical officer.
“We’re now able to touch more lives, improve our members’ experience of care, and reduce health care costs,” he said in a news release on the Albany-based health insurer’s website.
The EPC program began as a pilot program in 2008 and included just three medical practices, then underwent an intensive 12-month effort to improve teamwork, efficiency and their ability to treat “the whole patient.”
Working under the “medical home” model of care, the practices would emphasize preventive care, use electronic technology to improve service, and offer appointments at convenient times. By 2010, the EPC program grew to include 21 more practices. By 2011, it added 53 more in phase three.
Today, the program will include 143 local practices, 170,000 CDPHP members, and 660 network clinicians.
The health insurance company first launched the medical home initiative in an effort to address the shortage of primary care physicians and improve the quality of care for patients. But it’s also unique, said Nash, in that it’s one of few health insurance providers to address payment reform.
Historically, a person’s insurance company will pay for a doctor’s visit based on a fee-for-service payment model, which pays for the quantity of care and not the quality.
“That type of reimbursement just leads to more visits and doesn’t reward quality,” said Nash. “So we pay a fixed amount for each member each month to the practice so that it’s a comprehensive payment, because we want to provide comprehensive care.”
The payments are made on a risk-adjusted basis, he said, meaning physicians will receive more compensation for sicker patients.
Essentially, the savings that come from improving health outcomes and using resources more efficiently go toward greater reimbursement to primary care physicians. Even more, these savings are expected to combat the inflation of medical costs over time.
An independent analysis found that since the EPC program began in 2008, it has reduced inpatient admissions by 15 percent, emergency room visits by 9 percent and saved each member $8 a month compared to other area physician practices. It has also achieved significant reductions in the use of advanced imaging procedures.
Results of a more expansive study on the initiative will be released in late 2013. The Commonwealth Fund awarded a grant to Brigham and Women’s University to conduct the study.
The not-for-profit health plan serves members in 24 New York counties. Some of the most recent local practices to join phase four of the project include: Bassett HealthCare, which includes practices in Canajoharie, Cobleskill, Schoharie, Middleburgh and Sharon Springs; CapitalCare Medical Group, LLC, which has a practice in Niskayuna; Community Care Physicians, PC, which has practices in Clifton Park and Niskayuna; Saratoga Hospital; and St. Mary’s Family Healthcare, which has practices in Canajoharie, Gloversville and Johnstown.