Anthem Blue Cross Blue Shield released details last week of a new program in Colorado that will increase pay for primary-care physicians who serve as a medical home for their patients. The patient-centered medical home pilot program will hopefully decrease overall spending on healthcare while also resulting in better patient health – and it should also increase pay for primary care physicians. That last part will be welcome news for people who have lamented how few new doctors are entering the primary care field, and those who notice the fact that primary care physicians are adept at focusing on lower-cost interventions for health conditions. Boosting their pay – if done on a broad scale rather than just through pilot programs in isolated areas – should help to attract more medical students to primary care. And more primary care doctors should result in more low-tech (but effective), low-cost treatment plans – particularly with regards to preventive medicine (ie, more focus on keeping patients healthy, rather than fixing problems after they occur).
Of course, that’s all in an ideal world. How it works in reality remains to be seen. As with any changes in healthcare structure, people have all sorts of opposing viewpoints. Some – on both sides of the debate – are quite logical (of course, plenty are just knee jerk reactions that may or may not make sense – check out the comments on this Denver Post forum topic regarding the new Anthem primary care pilot program).
The criticisms that make the most sense are the ones that warn that doctors might avoid performing indicated tests or referring patients to specialists for needed care, specifically so that they could get the bonus money from Anthem for keeping costs in check. One would hope that this problem would be countered by qualitative, objective measures of the quality of care that patients are receiving, and – most importantly – the overall patient outcomes in the program. Dr. Elizabeth Kraft, Anthem Blue Cross Blue Shield’s medical director in Colorado, says that
“By better supporting physicians in managing all aspects of patient health, we are confident that our members will receive higher quality health care and experience more optimal health outcomes. Thanks to this program, primary care physicians will have some of the necessary resources, along with the financial incentive, to begin maximizing the potential of primary care to help our members live healthier lives, while responsibly reducing costs.”
I like everything about this, as long as we’re truly able to objectively measure the program’s success in terms of “higher quality health care”, “more optimal health outcomes” and “[living] healthier lives”. Five years from now, will be we see that the patients who have been part of this medical home program have a lower incidence of illnesses that we know are either caused or exacerbated by lifestyle and/or lack of compliance with medical recommendations?
I can obviously see how this structure can result in lower costs, and I particularly like the fact that it will be paying primary care doctors for “non-visit” services that are not currently reimbursed (the example given in the press release is “preparing care plans for patients with multiple and complex conditions” but I can see how this could be extended to other areas of care and could help to move away from the current ten minute visit + diagnosis + prescription scenario that is so common). But particular care will need to be taken to make sure that the end result is truly healthier patients, as well as lower healthcare costs.
A measure of patient satisfaction could also be beneficial here. This is a tough one though, as patients might tend to have less of a focus on the overall picture (outcome + cost) and more focus on the factors that directly and immediately impact them, such as outcome and convenience. Cost is a factor for patients, but since most of us have health insurance, we tend to be largely insulated from the immediate costs of our healthcare. We get the annual rate increase notification or a letter from our employer saying that our deductible and copays are going up, but most patients probably don’t consider how their own healthcare usage directly impacts the overall “big picture” of healthcare spending (and thus the resulting health insurance premium hikes). But in general, a program that results in an overall improvement in patient health and lower costs should also end up with satisfied patients. Things like more face-time with their primary care doctor (who is being compensated for keeping the patient healthy, not just fixing problems once they occur) ought to improve patients’ overall perception of the care they are receiving.
All told, this seems like a good step for Anthem to take. Well managed, with a strong focus on patient outcomes in addition to cost savings, it will hopefully end up being beneficial for doctors, patients and payers.
