Anthem Blue Cross and Blue Shield wants primary-care doctors to play larger role


Primary care gets no respect.

Nevada's second-biggest insurer wants to change that.

Anthem Blue Cross and Blue Shield, which has about 250,000 members statewide, is launching a nationwide initiative designed to make primary-care doctors bigger players in patient care, and to reimburse them more for their preventive and wellness efforts.

"We're reinforcing the primary-care physician's role. We know that primary care does the best job at improving chronic conditions," said Dr. Elizabeth Kraft, medical director for Anthem's Nevada operation.

Anthem's voluntary "patient-centered primary care" program will reimburse primary-care docs in several ways, including through shared savings payments for reduced medical costs and by paying for services that aren't covered now, such as preparing comprehensive care plans for patients with chronic or complex health issues. The insurer says participating physicians could ultimately earn 30 percent to 50 percent more than they make under today's reimbursement system.

Anthem won't shift reimbursements from specialists to help cover the higher payments. Rather, the program is designed to pay for itself through lower hospital and emergency-room admissions.

When patient-centered primary care comes to Nevada in mid-2013, here's what participating patients will see: Their primary care doctor -- or a clinician from his office -- will reach out to them more often to remind them of tests to monitor chronic conditions. They'll call more faithfully with test results, and they'll routinely drop patients a line to talk to them about their health goals or to remind them to take their medications. If a patient heads to the emergency room, she can expect a call from her primary-care doctor asking why she went to the hospital, and if a change in meds or care would prevent future visits.

Anthem decided to up its financial incentives for primary care after experimenting with a five-year-old concept called patient-centered medical homes, which are practices that closely link a patient to a primary-care doctor who oversees and coordinates all care. More communication -- sometimes 24/7 access -- and wellness and prevention are the priorities. Some of Anthem's patient-centered medical home pilots have posted an 18 percent drop in acute inpatient hospital admissions and a 15 percent decline in emergency-room visits.

Like any market, Nevada has "a lot of low-hanging fruit" in terms of widespread chronic conditions that improve with closely monitored care, Kraft said. Consumers with chronic obstructive pulmonary disease, heart disease, diabetes and asthma will benefit the most from patient-centered primary care.

Take asthma. Anthem will pay your primary-care doctor to sit down with you and develop a care plan that identifies asthma triggers in the home and pinpoints the medicines best-suited to your specific case. Follow-up would drill down deeply to find compliance problems. Didn't refill your prescription? Your doctor will find out from the pharmacy, call you to ask why and come up with a solution. Do your pets keep causing breathing trouble? Your doctor will help you find a way to keep them, while reducing their effect on your health.

Patient-centered primary care will also work more closely with smokers and overweight patients to encourage healthy lifestyle changes. Twenty-two percent of Nevadans smoke, according to recent figures from the Southern Nevada Health District. That compares with a national rate of 19 percent. A quarter of Nevadans were obese in 2010, up 90 percent from 13.1 percent in 1995, according to the Trust for America's Health, a Washington-based health advocacy group.

Even with patient-centered primary care, no doctor can make a patient take his medication or stick with a weight-loss plan.

But Kraft said the financial incentive will be there for primary-care providers to at least test the program with their chronically ill patients.

"When this comes to Nevada, we hope most doctors will say, 'Gosh, the fee schedule went up because I really am doing the right thing,' and they will realize they could enjoy more and other resources by offering continuous primary care," Kraft said.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512.

 

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