Healthcare delivery reform has been a buzz phrase in New Jersey for several years. Care providers got a chance yesterday at a meeting of the Assembly Health and Senior Services Committee to highlight ways they have turned those words in action.
Providers reported making progress in their efforts to rein in runaway healthcare costs, while still improving the quality of care, by coordinating efforts by all providers a patient sees.
For example, Summit Medical Group – a large doctor-owned practice with 382 practitioners – has instituted a patient-centered medical home model for providing care to many of its patients. This model, launched as a pilot program with Horizon Blue Cross Blue Shield of New Jersey, pays for providers to coordinate care more closely.
The results are impressive: The cost of care for Summit’s pilot program was $336 per patient per month, compared with a statewide cost of $433 for patients who are not in patient-centered medical homes.
Lower costs are just one half of the equation. Another measure of the quality of the patients’ healthcare also was positive: Summit patients in the pilot program were admitted to a hospital at a rate of 49 per 1,000 patients, compared with a statewide rate of 85 per 1,000.
“The patient-centered medical home had a major impact on cost of care, quality of care,” said Dr. Robert W. Brenner, Summit Medical Group’s chief medical officer.
A related approach known as an accountable care organization (ACO) also has paid off for Summit. In ACOs, providers share in savings that result from increasing care coordination. In another Horizon-Summit pilot program, an ACO resulted in lower costs in direct correlation to how much patients stayed within Summit Medical Group.
Patients who had 75 percent of their visits with Summit providers had the cost of their care lowered by 20 percent; those who had 50 percent of visits with Summit providers had their costs lowered by 10 percent; and those who had at least one visit with Summit providers but without enough visits to increase care coordination actually saw their costs increase by 7 percent.
“What that says is, the more we can do comprehensive, integrated care, the more that we have the ability to lower the costs of care and improve the quality,” Brenner said.
Brenner urged lawmakers to consider ways to provide incentives for providers across the state to have teams of healthcare providers manage every patient “transition,” such as when patients go from their homes to a hospital, or when they move from a hospital to a nursing home.
These transitions have traditionally been a source of problems as care is interrupted – for example, a patient might not receive or pick up prescriptions after leaving a hospital.
Both patient-centered medical homes and ACOs are alternatives to the traditional system in which providers are paid for each service they provide to patients.
Summit has started having geriatricians, rehabilitation doctors and advanced practice nurses visit patients who recently arrived in nursing homes from hospitals. The early evidence shows that the program has reduced the hospital readmission rate for these by patients by one-sixth, Brenner said. I
In addition, Summit Medical Group operates an urgent care center for patients who require immediate attention but whose needs fall short of a trip to a hospital emergency room.
The overall savings from these efforts to reduce hospital visits was more than $49 million over three years, Brenner said.
In addition to Brenner, the committee heard testimony from representatives of southern New Jersey healthcare system Virtua; Meridian Health, which is focused in Ocean and Monmouth counties; Geisinger Health Plan, an insurer working with Meridian to manage the care of Medicare patients; and Lifeline Medical Associates LLC, a Parsippany-based Ob/Gyn practice.
Committee chairman Assemblyman Herb Conaway Jr. (D-Burlington), a primary care doctor, said the testimony showed the importance of encouraging care teams. He said this undermines the case for legislation that would allow advanced practice nurses to operate their own practices without agreements with doctors, since this could reduce opportunities for coordination.
Assemblywoman Nancy F. Munoz (R-Morris, Somerset and Union), an advanced practice nurse, reached the opposite conclusion from the testimony. She said the use of APNs by practices like Summit Medical Group showed the increasing importance of APNs in providing care.