WILLIAMSVILLE, N.Y., (June 6, 2013) – Thomas J. Foels, M.D., chief medical officer at Independent Health, provided testimony at a hearing of the U.S. House of Representatives' Subcommittee on Health held today in Washington, D.C. to discuss reforms to the Medicare physician payment system.
Because of Independent Health’s efforts to build improved systems of care through a virtually integrated model and the innovative payment reform program established for primary care physicians, Dr. Foels was asked to provide insight as the bi-partisan subcommittee evaluates strategies to shift Medicare physician payment away from fee-for-service and toward a payment model that rewards performance, quality and value.
During his statement before the subcommittee, Dr. Foels illustrated how Independent Health has pioneered local efforts in quality improvement, primary care redesign and implementation of alternative payment systems to help achieve the triple aim of improved health, better care and lower costs through programs like The Primary Connection.
"We believe there are valuable components of our quality, efficiency and effectiveness programs that are potentially scalable and transferrable to other communities beyond our own," said Dr. Foels. "In addition, we have identified a set of critical success factors based upon our experiences that we also believe will help guide innovation on a national level."
As Independent Health was among the pioneering health plans to initiate quality-based reporting and payment incentive programs in 2000, Dr. Foels shared the results of initiatives like Practice Excellence, a pay-for-performance program giving physicians the support they need to focus on proactive care, rather than reactive treatment for certain preventable or manageable diseases.
Dr. Foels also highlighted the impact of Independent Health’s collaboration with local physicians to bring Patient-Centered Medical Home (PCMH) model to the area, and to launch The Primary Connection. He also explained how the alternative reimbursement models for each yielded positive results.
PCMH utilizes the team approach to assist primary care physician practices in developing systems that promote accessible, continuous and coordinated care. Over three years, Independent Health helped 18 local physician practices redesign care within their offices, embrace a patient-centric approach, and enhance coordination of care with specialists, hospitals and other providers.
Independent Health most recently partnered with a diverse group of primary care physicians to develop The Primary Connection, using the PCMH principles as the foundation. The new, innovative program will allow continued investment in the primary care community through achievement of the goals of the triple aim.
While the PCMH program focused on each individual physician’s practice, The Primary Connection creates a virtually integrated model that drives population management on an aggregate level through care coordination and stronger collaboration with specialty physicians and other providers encompassing the entire health care system.
"The shared savings model of the Primary Connection has had a dramatic impact on the interaction of primary care practices with one another, as well as generating engagement with specialists," Dr. Foels said. "Since its launch in July, many practices within the Primary Connection are already seeing improved patient outcomes due to enhanced care coordination and better use of health care resources."
The performance of The Primary Connection practices has grown increasingly more effective and efficient as they have been able to improve quality and reduce costs. In addition to improvements in quality measures for diabetic, asthma and cardiac patients, there was also an estimated savings of $1.4 million in medical costs during the first six months of the initiative, due in large part to better coordination of care, the elimination of duplicate services and reducing unnecessary hospitalizations and hospital readmissions.
"Given Medicare’s prominence as the single largest payer in the nation, fixing the sustainable growth rate (SGR) could become a powerful force in aligning incentives in a way that is consistent with the work already underway in the commercial market. Independent Health is pleased to be able to provide information on strategies we've initiated successfully at the local level to help guide national reform efforts to decrease the cost of health care," Dr. Foels said.