PA health plans pay PCPs to track care

Tue, 13 May 2008 06:59:54 -0400

A group of Pennsylvania health plans have come together to create a program paying family doctors and other caregivers to manage patient care more closely. Among other things, the program will make providers more accessible to patients through phone calls and email, as well as educating patients in better self-care. Plans involved, which include Independence Blue Cross, Aetna and four other insurers, are looking to spend $13 million over three years to finance the first phase of the initiative. All told, more than 150 primary care doctors are participating within 32 primary care practices, and about 220,000 patients in southeastern Pennsylvania will participate, which makes this one of the largest efforts of its kind in the U.S. The program is part of Gov. Ed Rendell's chronic-care model for the state, which should rollout statewide by year-end.

To learn more about the program:
- read this Philadelphia Inquirer article

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Medicare disease management pilot ending this year

Thu, 24 Apr 2008 06:59:56 -0400

Three years ago, CMS hired eight private disease management firms to set up chronic care improvement programs for beneficiaries. The programs, which reached as many as 150,000 seniors enrolled in Medicare, use trained nurses or health coaches to reach out to patients and make sure they were taking the right self-care steps. The idea was that by doing so, patients would have fewer hospitalizations and less trips to the emergency department, saving Medicare some money. During the run of the project, three of the eight firms actually dropped out, citing cost overruns--which is bad enough--but the worst was yet to come.

CMS now is closing the project down, having concluded that it hasn't lowered claims. The agency will end the pilot in at the end of the year unless the remaining five companies can cut Medicare claims by $600 to $800 per patient per month from now through December. Since that's unlikely, it seems the pilot is doomed, despite the fact that some physicians (and members of Congress) are lobbying to keep it alive for other reasons.

To learn more about the pilot's results:
- read this AMNews piece

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self care

PA health plans pay PCPs to track care

Medicare disease management pilot ending this year