Managed Care - September 2008 - (Page 38)

MedPAC can be seen as a follower as well as a leader. ical home require providers to use best clinical “The MedPAC report highlights a number of practices, to be capable of managing the health the key issues that need to be addressed throughneeds of a population, and to use resources effiout the health care system,” says Robert Zirkelbach, ciently. The Minnesota plan, which is integrated director of strategic communications at America's with a health system, expects to start a medical Health Insurance Plans. home pilot in 2009. Two recommendations promote primary care: Although HealthPartners has not yet finalized its Increase primary care pay rates in a way that doesn’t payment strategy, Zimmermann appreciates Medincrease overall costs, which means paying specialPAC’s attempt to hold medical homes accountable ists less than they are now paid in comparison with for the care they provide. The commission proprimary care physicians, and establish a medical poses a pay-for-performance approach in which home pilot program in which a clinical setmedical homes can be financially rewarded ting — either a primary care practice or a spe— or penalized — if they do not meet CMS cialty practice that meets certain criteria — standards. receives monthly per-beneficiary payments “We think it’s really important that we for managing and coordinating the care of don’t just add another care management fee patients with chronic conditions. on top of the current payment system for The Centers for Medicare & Medicaid Medicare,” Zimmermann says. Services is already on board the medicalhome movement: It’s own demonstration Public information campaign project will begin in January. But the pilot Regardless of how Medicare’s medical The MedPAC project recommended by MedPAC differs in plan is good, but home criteria compare to that of private payseveral respects. ers, Zimmermann thinks having CMS proMedicare needs For one thing, MedPAC recommends that to be sure it gets moting the idea will help private payers sucthe pilot project be four times the size of what it pays for in ceed in their own efforts. MedPAC says CMS’s demonstration, which will allow more the area of the Medicare should conduct a public informamedical home, information to be collected and analyzed for says Donna Zimtion campaign on the benefits of comprea quicker understanding of whether the con- merman, a vice hensive primary care as part of its roll-out of cept is working. For another, MedPAC wants president at the medical home pilot. Congress, when authorizing the medical HealthPartners. “When Medicare gets behind something, it home pilot, to establish measurable objecreally can help drive change,” she says. tives and authorize CMS, without further legislaMeanwhile, Cigna in June announced its medical tion, to expand the program nationwide immedihome pilot, available to its 19,000 members who reately if it works as well as hoped. ceive care from one of 391 Dartmouth-Hitchcock MedPAC recommends that the medical home Medical Center primary care physicians practicing initiative initially be limited to patients with at least in family medicine, internal medicine, and peditwo chronic conditions. About 60 percent of Mediatrics. This project does not focus specifically on pacare’s fee-for-service population meets this critetients with chronic conditions. Participating physirion. The most common conditions are heart discians will be paid for the medical services they ease, diabetes, arthritis, congestive heart failure, provide, plus an extra amount for care manageosteoporosis, depression, chronic obstructive pulment, and will receive pay-for-performance remonary disease, and Alzheimer’s disease and conwards if they improve quality and the delivery of ditions related to it. appropriate health care. Donna Zimmermann, vice president for govCigna officials expect that higher up-front fees ernment and community relations at Health for care coordination will be offset by better qualPartners, likes what she sees but wants more: “We ity and lower total medical costs in the long run. would even go a little bit beyond what they’re layThe first evaluation of the program will begin after ing out here.” it has operated for at least a year. Indeed, HealthPartners’ own criteria for a medQuality will be defined as the extent to which pa- 38 MANAGED CARE / SEPTEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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