Managed Care - April 2008 - (Page 40) ers who acknowledge that we have to measure, prove their efficiency, then they are probably not study, and improve on a constant basis, and that going to survive from a business standpoint. this is an important part of the work that we do. MC: How is the AAFP helping members change? We can’t remain ignorant of our clinical quality. BAGLEY: It’s a question of getting them engaged. Pedigree is the way that quality has always been We have an approach to enhancing primary care measured in medicine: “I trained at a certain that we call the medical home model. We are school or with a specific physician.” Although trying to reshape the payment environment those credentials are valuable, they don’t say how around the value that medical home services, you did with patients yesterday. It needs to move such as coordination of care, bring to the system. to, “I’m Dr. Bagley. Here is a list of patients our But we also realize that if we clicked a switch tocare team is responsible for, and here are our morrow and health plans began rewarding those numbers.” services in some kind of new and different way, many primary care practices wouldn’t have the MC: When we talk about quality improvement, capabilities to respond right away. So we’re also aren’t we talking about systems? using the medical home concept to help physiBAGLEY: Absolutely. Many practices today are still cians understand the necessity for electronic immature organizational structures that lack a medical records, registries, e-prescribing, and professional approach to the management of everything that is part of operating a practice in their finances, their personnel, and their clinical this day and age. quality. That’s a fancy way to say they are momand-pop shops. Some policymakers and health MC: The medical home is an interesting concept. plans are ready to write off that sector because How are health plans responding to this call? they are hard to work with and don’t have access BAGLEY: We’re working closely with a number of to capital, but that’s where the care health plans in different states and is being delivered, and we need to “When physicians market areas to promote medical help these practices be more sys- begin to see credible home pilot projects. The goal is to tematic and more reliable in their data, they will move have a number of practices make approach to care. There’s no reason the changes we are promoting and and change. Measurwhy a one- or two-physician office then to study whether care is imcan’t be systematized just as well as ing is fundamental, proved and whether costs are ima 100-physician group practice. proved. and once physicians MC: Does that involve setting up indi- see credible data, they MC: Which plans are participating? vidual systems, or does it involve BAGLEY: We’re working with United replicating systems that already are extremely competHealthcare in a number of differitive.” exist, such as an EMR? ent areas of the country, Aetna in the Philadelphia area, the Blue BAGLEY: It’s really about replicating systems. We need to discover approaches and Cross and Blue Shield Association, and others. technologies that work and have practices use Wherever possible we are trying to promote an their energy and resources to install those sysall-payer approach so that an office has a greater tems, rather than invent them themselves. incentive to participate. We have pilot projects starting up in Rhode Island, Florida, and ColMC: How receptive are small practices to change? orado. I believe there’s one coming up in MichiBAGLEY: Unfortunately it’s a beleaguered bunch gan as well. out there, especially in primary care. Because of the way the payment system was designed and MC: Would you say that the establishment of the has evolved over the last 10 or 15 years, primary medical home is going to reduce costs in the care physicians are running as fast as they can on long run? the treadmill just to make the arithmetic work at BAGLEY: It should reduce errors, and it should rethe office. So their capacity for this kind of duce costs in some way. It will reduce duplication change is fairly low. But we are trying to convey of services through better coordination of care that it is a matter of survival. If they don’t imand reduce the premature escalation of the level 40 MANAGED CARE / APRIL 2008
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