In medicine we have the primary care physician. And while it may sound counterintuitive, the truth is that too often our healthcare system does too little to encourage coordinated care—which is a more integrated, team-based approach to providing healthcare.
In Medicare fee-for-service for example, where doctors and hospitals are paid for specific services they provide, the average patient sees seven different physicians in four different practices each year, with little or no coordination (Pham, 2007). Millions of fee-for-service Medicare and Medicaid patients undergo numerous and sometimes redundant or even harmful procedures each year, with little or no coordination among their physicians.
A strong primary care workforce is key to increasing care coordination and reducing costs throughout the entire healthcare system, but experts agree there is a significant and growing shortage. Just 37 percent of physicians practice primary care medicine, and only 8 percent of the nation’s medical-school graduates enter family medicine (Health Resources and Services Administration, 2008).
To deliver optimal results—improved quality—care coordination must be integral to Primary Care so people can get the care they need, when they need it, with greater efficiency, less redundancy and fewer return trips to the hospital or doctor’s office.
By coordinating care to better manage chronic illness, by enhancing the practice and delivery of primary care, and by investing in the primary care workforce, the Blue Cross and Blue Shield companies are working with local doctors and hospitals, developing new ways to approach healthcare delivery that improves quality and lowers costs.
Horizon Blue Cross and Blue Shield of New Jersey, Inc. pays for telephone consultations and proactive reminder outreach to patients to keep them on track with doctor visits and medication management. Horizon uses claims’ data to identify and alert providers when patients need routine tests and screenings. In one of these programs covering 7,000 State Health Benefit members with diabetes, patients’ compliance with tests rose substantially, and overall healthcare costs decreased by nearly 10 percent in one year.
Blue Cross and Blue Shield of Texas launched a Pre-Admission/Post-Discharge Outreach Program which resulted in a 23 percent lower readmission rate among members in the Program. Participating members were taught how to effectively engage in their own care. The lower readmission rates resulted in an estimated potential cost savings of $1.2 million in 2009.
Blue Cross of Idaho provides one-on-one nurse health coaching and outreach to members who visit the ER or receive inpatient services as part of a “Disease Management Program”. By using a team-centered approach, the program helps ensure that members take the correct medications and receive the necessary screenings and follow-up care. The program collectively achieved more than $1 million in medical claims cost savings in a single year. Blue Cross of Idaho offers disease management programs for members with diabetes, chronic obstructive pulmonary disease, coronary artery disease, asthma and depression.
But without investments in the primary care workforce—the physicians on the front lines—none of these programs could be effective.
Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program (PGIP) connects physician organizations from across the state to encourage information sharing and collaboration among primary care physicians and specialists, with the goal of improving the state’s healthcare system.
Blue Cross and Blue Shield of North Carolina Foundation awarded a grant to the North Carolina Academy of Family Physicians (NCAFP) Foundation to develop a mentoring program to help address the state’s shortage of family physicians. The program aims to increase the percentage of medical students who commit to a residency in family medicine—the core of front line medicine—by approximately 30 percent.
The Blues® believe that care coordination is best directed by the Primary Care Physicians because they are on the frontlines of care delivery. Primary Care Physicians have the best vantage point of the overall health and well-being of the patient. The focus needs to shift towards coordinated care stemming from the Primary Care Physician if we are to see real improvements in treatment outcomes and cost management. Reinforcing Frontline Care is a vital element of what we call building a pathway to high-quality, affordable care in America.