Paying primary care doctors more for delivering better care is not a new idea. It has been championed for years as a way to improve patients’ health and reduce medical costs.
Now, two health insurers with a major presence in Georgia have announced big steps to make the idea a reality. And the prospect has primary care physicians excited.
WellPoint, the parent company of Blue Cross and Blue Shield of Georgia, announced a plan last week for raising primary care pay.
Blue Cross, Georgia’s largest health insurer with more than 2 million members in the state, said it will launch this ‘‘patient-centered medical home’’ payment plan in the state next year. Doctors in the Blue Cross network could eventually earn up to 50 percent more than their current pay.
A central goal is to control health costs. In an announcement last week, WellPoint said some of its pilot medical-home programs have seen an 18 percent decrease in hospital admissions and a 15 percent drop in emergency room visits.
Meawhile, Aetna, a Hartford, Conn.-based insurer with 600,000 members in Georgia, announced a plan Monday to pay some primary care physicians an extra $2 to $3 per member per month.
In both cases, the insurers are focusing on the medical home concept, which designates a specific primary care doctor’s practice as the patient’s “home.”
Under this concept, a primary care doctor (such as an internist, pediatrician or family medicine physician) coordinates care for all the patient’s needs. This would include managing chronic diseases such as asthma and diabetes and delivering other services that aren’t now reimbursed.
It may mean having 24-hour access for patients as an alternative to the emergency room, or bringing in a social worker or psychologist to work with a patient, Dr. Kathryn Cheek, a Columbus pediatrician, said Tuesday.
“We already do it a lot in pediatrics,’’ said Cheek, who is president of the Georgia chapter of the American Academy of Pediatrics. “It’s exciting that somebody is finally realizing the value of what we do and potentially what we can do. I hope it comes to fruition.”
Keeping in touch with the patient
A medical home – by tracking a patient’s referrals, procedures, medications and appointments – helps ‘’make sure your patients don’t fall through the cracks,’’ said Dr. Harry Strothers, an East Point family medicine physician.
If diabetic patients miss any of their regular appointments, for example, the doctor’s office would call them to make sure they get the needed checkups, said Strothers.
Such follow-up care can prevent medical complications – and higher health costs. “Philosophically, it’s what family physicians want to do, but the way that we’re paid now does not encourage it,’’ said Strothers, who is chairman of the Department of Family Medicine at Atlanta’s Morehouse School of Medicine.
Blue Cross said the payment plan would be available to all 5,225 primary care physicians in its network. Aetna said it was targeting doctors or their practices that receive recognition as medical homes by the National Committee for Quality Assurance.
Aetna is rolling out the program in Connecticut and New Jersey before taking it national. The company has about 5,000 primary care doctors in its Georgia network.
Dr. Jack Spicer, an Aetna medical director based in Alpharetta, said the company currently has a medical home pilot with Emory. “We believe it’s the right direction to go,’’ he said.
The new Aetna pay plan will come to Georgia over the next 12 months, the company said. “It’s an important piece in controlling costs and improving quality, and improving care of chronically ill patients,’’ Spicer said. “You really have to have an electronic medical record to make this work.’’
Could Medicaid program be next?
Alexandra Leopold, a Blue Cross executive, said the medical home model “is transforming the way we’re collaborating with providers and aligning our focus on patient health and quality outcomes.’’
WellPoint’s medical home plan will start this year in Ohio and Colorado, states that the company says have more experience in medical homes.
The WellPoint plan could have a major national impact, Paul Ginsburg, president of the Center for Studying Health System Change, a Washington nonprofit group, told the Wall Street Journal last week.
The “scale is so much bolder than things we’ve seen,” Ginsburg said. “This isn’t an experiment.”
Fay Brown, executive vice president of the Georgia Academy of Family Physicians, said her organization ‘‘will heavily promote any insurer that will pay more for physicians who are patient-centered medical homes.’’
“I think other insurance companies who are smart and cutting-edge will follow suit,’’ Brown said.
Strothers said he hopes the medical home arrangement is adopted by Georgia Medicaid. State officials are currently studying new options for Medicaid to improve quality while controlling costs. (Here’s a recent GHN article on the state’s Medicaid ”redesign” effort.)