Faced with a marketplace shifting to outcomes-based payment, Adventist Healthcare decided to launch a pilot in a patient-centered medical home. And it began with its own employees.
James Lee, executive vice president and CFO at Adventist, described the I.T.-centric effort at the HFMA annual conference--offering hard data about its success. Costs for PCMH members enrolled in the pilot declined 14% from 2010 to 2011, Lee noted, adding that the program is now being expanded to a broader group of employees.
As part of the effort, physicians and patients gained access to a portal of claims history data. The portal is operated by the health system’s third-party administrator. The initial data analysis that preceded the pilot included some eye-opening information. Some high-cost members were seeing as many as 15 physicians and getting prescriptions from 9 of them. And no single physician understood that. Now, a nurse case manager, employed by the TPA, monitors the care of the patients, and physicians can see a history of procedures and prescriptions using the portal. Patients are also given a plan of action to address their condition, including diet and exercise.
Adventist has also added a number of financial incentives for its employees. Smokers pay 20 percent more on their premium. And employees undergo a risk assessment profile. Adventist also added performance bonuses for physicians treating patients in the project, granting bonuses above and beyond their fee-for-service pay for meeting certain quality measures. Physicians can monitor their quality adherence via a dashboard that is part of the set-up. Physicians are encouraged to use an EHR in their practices, as Adventist is helping to subsidize the purchase through the Stark exception program.
Rockville, Md.-based Adventist runs three hospitals and its self-insured plan covers 7,200 lives.
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