When ABQ Health Partners announced its merger this week with a California-based physicians’ group, it said it was hoping to accelerate its push into coordinated care, a team approach to health care.
The Albuquerque group’s new partner, HealthCare Partners, with more than 8,300 doctors, has been using the coordinated care model for decades, and it seemed like a good way to help ABQ Health Partners acquire the expertise and technology to employ the model.
ABQ Health Partners President and CEO Harry Magnes said coordinated care “turns things on its head so that a healthy patient becomes an asset and a sick patient becomes a liability.”
Magnes said the 184-doctor group had been looking for a merger partner for more than two years. Terms of the deal weren’t disclosed.
Coordinated care, also known as patient-centered medical homes, is a hot topic in health care. The federal government is pushing it, and insurers and health care providers say it will improve quality and lower costs. It’s based on the idea that a team of providers, from doctors and nurses to nutritionists and behavioral health professionals, work together to monitor a patient’s care and communicate with each other.
The idea is to keep patients out of doctors’ offices and hospitals by keeping their health from worsening.
Is it a new idea, or another version of managed care, which swept the industry in the 1980s and 1990s only to be rejected by consumers?
Depending on whom you talk to, it’s both.
Like managed care, coordinated care will restrict patients’ choices. Patients will be limited to narrow networks of providers, and probably won’t be able to see providers outside those networks. It goes beyond managed care because it’s bolstered by new technology and a better understanding of how to care for patients, and a different way of paying for services.
The payment issue will be the key to whether coordinated care will work, experts say.
Under the current fee-for-service model, doctors and hospitals are paid for every test and procedure they perform, with no incentive for providers to keep patients healthy and out of doctors’ offices, said Dr. Martin Hickey, CEO of New Mexico Health Connections, a startup nonprofit health plan.
NMHC will use a patient-centered medical home model that will make primary care doctors the point person, coordinating all of a patient’s care, Hickey said.
Providers would get bundled payments, or so much money per patient, to provide care. If those providers keep patients healthy, they keep the money that’s not spent on those unneeded services.
Dr. John Cruickshank, chief medical officer at the 250,000-member Lovelace Health Plan, said technology has allowed the industry to better collect and use information and determine how to control chronic diseases like diabetes.
The U.S. Centers for Medicare and Medicaid Services has several ongoing payment reform models, and Lovelace is developing new models as well.
A key to making bundled payments work is that “no one is incentivized to withhold care,” as some were by managed care in the 1990s, Cruickshank added.
Kurt Shipley, president of the 320,000-member Blue Cross and Blue Shield of New Mexico, said it will take time for new payment models to be developed. He added that BCBS has signed a new contract with ABQ Health Partners that will pay the provider “in a more level [bundled] way,” rather than a payment for every procedure or service.
Patricia Montoya, program director for the Albuquerque Coalition for Healthcare Quality, said the nonprofit, which works with insurers and providers in the Albuquerque area, hopes to launch a new payment model pilot program at the beginning of 2012 for patients with certain chronic diseases.
“We have had health care quality measures in place for a long time, but we have never paid for that,” Montoya said.