Of all of the things needed to reduce cost and improve outcomes, effective and efficient care coordination is one of the most elusive, yet one of the important. Here’s the story of a group that gets it right and how they do it.
As a preface, today’s primary engine to coordinate care is information technology. It can be powerful, but current technology, however sophisticated, cannot match the analytic proficiencies of a trained human. Using technology as a solution instead of a tool is the flaw in most approaches.
I recently met with the executive management team of Partners In Care (PIC), a large New Brunswick, N.J. physician-owned healthcare provider and management service organization, while supporting another client. I was highly impressed with how the team is managing care coordination within its system and asked if they would mind sharing their technique.
At the core of their strategy, PIC staff has redefined the traditional reactive method of care and care coordination to be a consistent, proactive, patient-centered approach. They have made it work by combining advanced analytics and evidence based medicine guidelines into a physician-friendly tool set to address chronic conditions such as diabetes and cardiac disease. PIC also makes it financially viable for physicians to properly coordinate care with an innovative reimbursement program that fairly compensates them for the extra time it takes to do the job properly.
The key to their success, according to John Marrotta, RPh, vice president of clinical operations and interim COO, is using a physician-driven approach to identify and monitor high-risk patients. By using actionable data coupled with evidence-based suggestions to improve outcomes and an interrogative approach, the Partners In Care model advances traditional care management by bringing a new level of efficiency, effectiveness, and quality of care to all of their treating teams.
While their goal is to support a team approach, ensuring each patient receives the right care at the right time, in practice, they restore the physician/patient relationship, engaging physician teams around the patient much more effectively. Because they have access to patient data across their continuum of care, care teams and treating physicians have on demand comprehensive information that allows them to make better-informed decisions. This not only reduces costs and eliminates redundancies; it results in more effective care leading to improved outcomes.
Patients benefit from effective care coordination across their teams. Physicians benefit by being fairly compensated and both patients and insurers benefit from reduced costs, better care, and better management of chronic conditions, which are historically very expensive.
Clearly, PIC is on the right track. CMS recently added five new CPT codes to compensate for care coordination and is considering two more, as I reported on November 1.
Since PIC’s coordination model precedes the Affordable Care Act, the medical group is “exploring new ways to impact the health care delivery system,” according to Marrotta. The goal is to improve population clinical outcomes while reducing costs. The group is also looking into ways to better manage hospital discharges to reduce readmissions and is expanding its patient management services to accountable care organizations in partnership with Cigna and PIC’s United Medical Group physician’s network.
“We have had great success in improving outcomes and reducing costs, one patient at a time,” Steven Goldberg, MD, PIC’s chairman, added. “And we firmly believe that our success in reconnecting and restoring the patient-physician relationship is essential in moving from fee-for-service-based reactive care to pay for performance and risk-based proactive care. That’s where the industry is going, and must go.”
PIC has an excellent model to bridge fee for service to pay for performance, shared savings, bonus for quality, and risk reimbursement arrangements.
Now that the Affordable Care Act matter is settled, at least until the mid-term elections, and its implementation continues from popular benefits to the business of reducing and controlling costs to pay for them, efficient and effective care coordination systems are at the leading edge, having crossed from nice to necessary.