North Carolina will become a healthcare reform test bed through a new public-private partnership that aims to see if a Medicaid management program that has saved more than $1 billion can also bring savings and efficiencies when applied to the private sector.
The state’s Secretary of Health and Human Services Lanier Cansler formally announced the “First in Health” initiative during the annual meeting of the North Carolina Institute of Medicine today in Raleigh. Participating companies are GlaxoSmithKline (NYSE:GSK), software firm SAS Institute, pharmacy chain Kerr Drug, and Blue Cross and Blue Shield of North Carolina as well as the State Health Plan of North Carolina. They’ll work with Community Care of North Carolina, or CCNC, the non-profit organization that provides care coordinators who work with the state’s Medicaid recipients.
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CCNC care coordinators help Medicaid recipients navigate the healthcare system. The organization uses a concept called “medical home,” in which a coordinator uses health information technology and direct communication with the patient and the patient’s physicians to streamline healthcare delivery. A large medical practice might have one coordinator assigned to the entire practice. In rural North Carolina, coordinators work with multiple practices.
In the medical home system, each patient has a primary care physician, Cansler explained. The coordinator is responsible for taking a comprehensive approach to all aspects of a patient’s care. Those duties include reminding patients to schedule appointments for chronic conditions. Coordinators also make sure all of a patient’s caregivers have access to the patient’s medical records. Savings come from avoiding expensive emergency room visits resulting from neglected preventative care as well as reducing duplicative tests. CCNC also has pharmacists that help patients manage their medications. An analysis from consultant Treo Solutions found that from 2007 through 2009, CCNC saved Medicaid nearly $1.5 billion.
About 90 percent of North Carolina doctors already work with CCNC so they are familiar with the medical homes concept, said Dr. Richard Lord, president of the North Carolina Academy of Family Physicians. Lord, who practices in Winston-Salem, North Carolina and also teaches at the Wake Forest University School of Medicine, has been working with CCNC since its inception in the late 1990s. He said that medical homes don’t create additional work for doctors, rather they save work because the coordinators provide physicians with the patient history information that they need. Lord said CCNC’s impact is particularly evident in patients with chronic conditions such as asthma. A care coordinator’s work with a patient can avoid multiple emergency room visits or a hospital admission.
“It’s trying to engage you in your care,” Lord said. “The more engaged you are in your care, the less likely you are to be admitted for a serious problem.”
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First in Health companies will start to offer the new medical home option to their employees in upcoming benefit enrollment periods. Workers will retain their current health plan choices. But if they decide to also participate in First in Health, a care coordinator will be an additional benefit.
The State of North Carolina is phasing in the program for state employees in targeted counties starting this fall. GSK will begin offering the medical home option to its employees in January 2012. Company spokeswoman Mary Anne Rhyne said that GSK participants in the program will have co-payments for primary care doctors waived. Also, the company will pay doctors who participate in the program a monthly fee for each member assigned to a medical home. Kerr Drug expects to offer its employees access to the program in the 2013 benefits year.
SAS’ participation will come from providing analytical software tools and health data consultants to the pilot program. Public policy group The Brookings Institution will conduct an independent analysis and evaluation of First in Health’s impact on the cost and quality of healthcare. Brookings will evaluate the program over the next two years. In the meantime, a lot of eyes will be watching the program to see whether it can bring savings to the private sector.
“The (federal) government is very interested in this initiative and what happens with it,” GSK’s Rhyne said.
