September, 12 2011
By:
HIMSS Patient-Centered Roundtable The following is a summary of a selected monthly meetings of the HIMSS Patient-Centered Payer Roundtable. Each session has a featured speaker and is focused on a specific topic. Session recordings of each meeting is available on the HIMSS Patient-Centered Payer Roundtable website at no cost.
Health IT-Enabled Medical Home
Presented by Martin Lustick, MD – Senior Vice President and Corporate Medical Director, Excellus BlueCross BlueShield
December 16, 2010
Martin Lustick, MD, discussed health IT-enabled medical home issues, relating his organization’s experiences with their health IT-enabled medical home initiative in the Rochester, NY area. Excellus partnered with a local competitor, MVP, to collaborate on a 3-year medical home pilot project to focus on determining ways to increase primary care physicians’ quality of life and income, increase patient satisfaction, and decrease costs while improving quality, with the ultimate goal of scaling the findings up and sharing successful attributes of the medical home initiative with all primary care physicians.
To enable a successful medical home, several elements are necessary. These include culture and workflow changes, access and communication standards, care management (e.g., on site nurse managers), patient tracking and registry (using a single data aggregator to inform patient registries, gaps in care determinations, and point of service reminders), and performance reporting and care improvement.
Dr. Lustick described the payment model put in place to support both administrative costs and patient costs, the latter of which includes additional payments for care coordination; pay-for-performance for meeting quality, cost, member satisfaction goals; and continued fee-for-service payments for necessary face-to-face care. Initial clinical outcome measures around diabetes, heart disease and cancer screening showed measureable success.
