Deadline for Application to New Health Initiative Approaches

Jul 20, 2012

It’s difficult to talk about healthcare in Oklahoma without also talking about how we lag behind most other states in key areas—at least one study by the Commonwealth Foundation ranks us dead last in overall healthcare.

The recent kerfuffle over the Supreme Court’s decision to uphold the Affordable Care Act has focused on the individual mandate, Medicaid Expansion and medical exchanges. One thing that hasn’t been getting talked about is an organization established by the ACA: the Center for Medicare and Medicaid Innovation.

In Tulsa, however, there’s a group of doctors and insurance providers to whom that part of the ACA means a lot. That’s because it’s testing a new program for primary care, and selected Tulsa as one of the pilot regions. It’s called the Comprehensive Primary Care initiative.

To understand what the CPCi is, you first have to understand the concept of what’s called a patient centered medical home. Think of it as a place where your doctor is, but where other types of providers are also involved in your healthcare.

CEO of My Health Access Network Dr. David Kendrick says that it’s the place that connects you with specialists if you need them, “but I can also know that that group of providers led by the physician is going to being working on my behalf even when I’m not sitting in their clinic.”

Right now, he says, care like that isn’t typical…at least for people.

“If you think about it, your car dealership does this, and your veterinarian does this. They send you reminders: it’s time to get your oil changed or to have your dog treated,” he said. “Why in the world can’t we get that right in healthcare?”

Dr. Jack Sommers is Chief Medical Officer of Community Care Oklahoma, one of the insurance providers involved in the CPCi. He says as it stands, there’s no financial incentive for doctors to provide that type of care.

“Right now, we only pay for visits,” he said. “So any kind of non-visit care, whether it’s a telephone call or an email, we don’t pay for. This would take that out of the equation.”

The Mechanics

Here’s how it works. During the application process, insurance providers—in Oklahoma, Community Care, Blue Cross and Blue Shield, and the Oklahoma Healthcare Authority (that’s the state Medicaid agency)—agreed to pay bonuses to doctors who pledge to remodel their care-giving after the patient centered medical home. For the seven regions selected, including Oklahoma, federal Medicare will also provide funds for those bonuses.

“In this model, the doctor gets paid per month, every month, gets a small payment for each patient in their practice,” Dr. Kendrick said. “Using these funds, they can hire a nurse case manager or care manager who can look through the charts and identify people who probably need some care that aren’t getting it, or who can take some calls and triage them so that the doctor can handle them, set aside an extra hour a day where they don’t have to see patients but can instead focus on population health.”

As of a few days before the deadline, applications from doctors in the Greater Tulsa area to join the CPCI lagged behind some of the other test regions. So people like Dr. Kendrick as well as the member insurance providers are doing their best to encourage local doctors to apply.

Dr. Joe Cunningham is Chief Medical Officer of Blue Cross and Blue Shield of Oklahoma, one of the three payers involved.

“What’s really in it for them is improved health for their patients,” he said. “Allowing them to have the resources to do that is what’s going to lead to the improved health.”

Benefits for Many

Today at 5 p.m. is the deadline for Greater Tulsa area doctors to apply to join the Comprehensive Primary Care initiative. Many in the medical community say that in other places in the country, the model of the patient centered medical home, on which the CPCi is based, have shown a lot of results in improving patient health. But they also say it’ll be good for the other participants as well.

“From a mercenary standpoint, we would like to see our costs go down. Right now our cost healthcare is terrible,” Dr. Sommers said.

Community Care and Blue Cross both say their foremost goal is improving the health of Oklahomans. But they also say it’s to their advantage that better health comes with lower costs.

So, the insurance companies benefit too. But Sommers says that’s still not all.

“The other thing that we see is that when we go to the patient centered medical home is that it also generally makes physicians happier in their practice,” he said. “They’re so overburdened with regulation and paperwork and trying to run patients in and out, that they’ve really lost the joy of practice. The patient centered medical home reestablished the way care is delivered, and they really enjoy it a lot more.”

Dr. Robert Hauger is a primary care physician with the Warren Clinic. He’s applying for the CPCi because he’s excited about what he calls the “transformative effect” it could have on the way he delivers care. In fact, he’s already tried out a few of the techniques that the new program would incentivize.

“I met with a group of patients two or three weeks ago who had congestive heart failure, as a group,” he recalled. “And that was something that I’d never done before, and I learned a great deal about that and saw the value after talking with those people in a group setting that I really hadn’t appreciated as I went through my day and saw people individually.”

“It was really quite amazing to watch how they interacted with one another, how they taught one another, and the opportunities that I had to teach them in that setting,” he added.

Group care is one of those things that Dr. Hauger doesn’t actually have a lot of time for right now, but with extra help from the new program, he could do more of.

Role of the ACA

Dr. Sommers says he’s had some concern from doctors about what might happen to the program if the Affordable Care Act were to be repealed. But he says, that shouldn’t stop people applying.

“Medicare and these health plans have agreed to give you this much money for four years,” he said.

“As a community we’ve been doing our homework to prepare for this for years now,” Dr. Kendrick said.

He says this isn’t the first initiative the local medical community has taken up to address Oklahoma’s suffering system.

It turns out, this might not even be a story about the Affordable Care Act after all.

“Truthfully, ACA legislation didn’t sway me one way or another to believe in this program,” Dr. Cunningham said.

He says, while the federal money that will come in is important, “it’s not prohibitive to this process going forward.”

“What it did allow us to do,” he said, “is to discuss with other payers or competitors, if you will, options (about) how we can partner to truly improve the health of Oklahomans.”