April 19, 2014

Future of Healthcare

Healthcare Innovations: Ahead of the Curve

| 5/1/2010

Engaging the Consumer

Engaging the consumer
To contain costs, many employers are switching to so-called consumer-directed health plans — high-deductible plans that marry health savings accounts (HSAs) with a tiered benefit plan that kicks in once a deductible (generally in the $2,000 to $3,000 range) is met. As individuals pay more out-of-pocket for their own care, health insurance providers are introducing new tools to help them make informed healthcare decisions. Aetna members, for instance, can go online to research the costs of more than 30 common medical procedures, the rates charged by doctors and other healthcare professionals and the costs of prescriptions filled at retail drugstores or through Aetna’s mail order program.

UnitedHealthcare, meanwhile, operates a Premium Physician Designation program to “help consumers identify better healthcare providers.” The program uses actual utilization data and cost, identifying physicians and facilities that meet either the “quality only” or “quality and cost efficiency” criteria. Consumers access the information online. Surgeons in the company’s network who are designated as “premium” have 59% lower complication rates and 15% lower costs.

— Amy Keller

The Medical Home

Dr. Darla Broderick
Dr. Darla Broderick’s Palma Ceia office in Tampa serves as the medical home for her patients under a pilot program between Humana and JSA Medical Group. [Photo: JSA Healthcare]

In the fragmented world of healthcare, the doctors and specialists who treat a patient may never communicate with each other in the process. Tests are often repeated, money wasted and the quality of care impaired. Each doctor “is just looking at a piece of you, and no one sees the whole picture,” says Dr. Scott Latimer, Humana’s market president for senior products in central and north Florida.

Humana is now conducting a “medical home” pilot project in Florida with physician practices that are part of JSA Medical Group in Tampa Bay and MetCare on the east coast. Medicare Advantage patients who go to those practices are seen by a team of people, with a primary care doctor serving as the medical home — overseeing and coordinating all the other physicians and making sure the patient follows treatment regimens and gets regular checkups.

If patients need to see a specialist, the primary care doctor helps them find the appropriate doctor and makes sure that all the providers — using electronic medical records — stay informed of what the others are doing. Patients who are part of a medical home are able to access the doctor by phone in the evening or over the weekend.

Dr. Scott Latimer
Dr. Scott Latimer, Humana’s market president for senior products in central and north Florida
During its first year of operation as a “medical home,” MetCare’s 30-day hospital readmission rate for Medicare patients was 33% below the average Medicare readmission rate in Florida. The rate of female patients receiving mammograms, meanwhile, was 50% higher in the medical home population than in a similar population in primary care centers not organized around the medical home.

UnitedHealthcare and Cigna also are trying out the concept elsewhere in the U.S. Humana’s Latimer says the key to making medical homes work is doctor buy-in. “If we can show physicians in the community that this is actually a better model as a business proposal that works for them ... it will become more popular.”

— Amy Keller

Tags: Healthcare

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