Next Health Care Effort: To Streamline Care Delivery
By SUSAN HAIGH, Associated Press
WALLINGFORD, Conn. (AP) _ While Connecticut embraced setting up a health insurance exchange and expanding Medicaid eligibility faster than many other places, the state has lagged behind when it comes to modernizing how health care is delivered to patients.
But with the new health care overhaul law and a growing push in the state to cut costs while improving patient care, Connecticut is now moving toward a streamlined and better-coordinated, patient-centered system of medical treatment.
“Connecticut has been a little bit slow to adopt many of these things, but I see it happening very quickly over the next five years,” said Ken Lalime, CEO of the new nonprofit health insurance company HealthyCT.
The Wallingford-based HealthyCT offers small group and individual plans in the state’s new online insurance exchange, known as Access Health CT, as well as outside the exchange.
Using money from a loan from the federal government, HealthyCT is providing hundreds of thousands of dollars to 75 medical practices across Connecticut, representing a total of 440 clinicians. The grants will enable them to become certified as a patient-centered practice. They’re also referred to as patient-centered medical homes, a concept that’s been embraced in neighboring Rhode Island and Massachusetts.
Once certified, these medical practices will take a new and more holistic team approach to treating their patients and anticipating their individual needs. For example, a primary care practice would plan ahead and have other practitioners, such as a diabetic nurse clinician or nutritionist, on hand for a patient’s appointment.
“So when the patient comes through the door, we manage that event differently than we managed it before,” Lalime said. “You are getting the right care at the right time, at the right place _ for the first time, more often.”
Once these 75 practices are trained and certified– a process that takes about eight months– Lalime estimates that about 40 percent of the state’s primary care doctors will operate using a patient-centered approach in Connecticut.
“I think 10 years from now, there will be much more integration of care, and care coordination will be the standard,” Lalime said. “And consumers should be looking for practices that actually function that way.”
Such an approach, Lalime said, should eventually reduce the amount of times a patient might visit a hospital emergency room or inappropriately go to a specialist, both costly scenarios. Lalime estimates that the price of one emergency room visit, about $2,000, would cover the cost of 20 coordinated office visits, while the cost of a typical hospital visit, about $30,000, would cover 300 coordinated office visits.
Unlike managed health care, where insurance companies tend to be the gatekeepers that decide which procedures to cover, this new concept “puts the patient at the hub” while the practitioners and the patient’s primary care doctor are the spokes, Lalime said.
The state of Connecticut has received a $2.8 million grant from the U.S. Department of Health and Human Services to develop an application for a $45 million grant to design a new health payment system in the state that will support coordinated patient-centered care.
In Fairfield County, a new group is trying to make it easier for solo practitioners to provide patient-centered care. St. Vincent’s Health Partners Inc. is a new physician-hospital organization created in 2011 by St. Vincent’s Medical Center in Bridgeport and a group of doctors trying to determine how best to respond to federal health care reform efforts.
The concept allows the member doctors to remain independent but have access to resources available for large medical groups, such as electronic health records, patient management tools, group purchasing discounts and data sharing and quality management. Tracking systems will make sure people don’t get duplicative tests or procedures they don’t need and will remind them of upcoming appointments and tests.
Thomas Raskauskas, the organization’s president and CEO, said a lot of independent practitioners are busy and find it overwhelming to understand all the complexities of health care reform, and they don’t have the money to handle patient population management.
“This allows them to stay in solo practice without having to join a group,” he said.
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