Objectives: To estimate cost savings associated with ProvenHealth Navigator (PHN), which is an advanced model of patient-centered medical homes (PCMHs) developed by Geisinger Health System, and determine whether those savings increase over time.
Study Design: A retrospective claims data analysis of 43 primary care clinics that were converted into PHN sites between 2006 and 2010. The study population included Geisinger Health Plan’s Medicare Advantage plan enrollees who were 65 years or older treated in these clinics (26,303 unique members).
The purpose of this analysis is to report on Medicaid cost savings achieved by the Community Care of North Carolina (CCNC) networks for the Division of Medical Assistance (DMA) during state fiscal years 2007 to 2010 (July 1, 2006 to June 30, 2010). Specifically, this report addresses the following two objectives, which are outlined in more detail in RFP No. 30-DMA-259-11:
Patient-centered medical home (PCMH) projects run by Independence Blue Cross (IBC) and BlueCross BlueShield of Tennessee (BCBST) have proven so successful in improving patient outcomes and keeping medical costs in check, the two Blues plans report that they are looking to increase the programs to more primary care physician (PCP) practices.
Medical care in the United States is plagued by extremely high costs, poor quality, and fragmented delivery. In response, new concepts of integrated health care delivery have developed, including patient-centered medical homes and accountable care organizations (ACOs). This article reviews these concepts and includes a detailed discussion of the Centers for Medicare and Medicaid Services’ ACO and Shared Savings Proposed Rule.
In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality.
First-year results from Cigna's (NYSE:CI) collaborative accountable care initiative with Medical Clinic of North Texas (MCNT) indicate that these types of programs continue to show progress toward achieving the “triple aim” of improved health outcomes (quality), lower total medical costs and increased patient satisfaction. Collaborative accountable care is Cigna's approach to accountable care organizations, or ACOs.
The initial findings of a longitudinal assessment of AQC results, conducted by Michael Chernew, Ph.D. and his colleagues at Harvard Medical School and supported by the Commonwealth Fund, echo these results. Their year-one findings, published in the New England
Journal of Medicine, showed that the AQC was associated with significant quality improvement and two percent slower growth in medical spending in 2009.
Air Force Medical Home integrates the patient into the health care team, offering aggressive prevention and personalized intervention. Physicians will not just evaluate their patients for disease to provide treatment, but also to identify risk of disease, including genetic, behavioral, environmental and occupational risks. The health care team will encourage healthy lifestyle behavior, and success will be measured by how healthy they keep their patients, rather than by how many treatments they provide. Our goal is that people will live longer lives with less morbidity.
