We are transforming our organization’s vision of our own healthcare system from ‘sick care’ to ‘health care.’
with a dedicated group of primary-care providers that committed to providing our associates with care coordination, managing outcomes and using our wellness program services. These physicians have either reached Level 3 accreditation for a patient-centered medical home from the National Committee on Quality Assurance or will acquire this level in the coming year.
The primary-care providers are targeting areas that Penrose-st. Francis, as an employer, identified as needs of our population, including pediatric asthma, cardiovascular disease, diabetes and preventive screenings. The primary-care providers will report patient-centered medical home metrics, as defined by the NCQA, to us over the next couple of years.
Penrose-st. Francis pays these primary-care providers a per-member, per-month fee, funded in part by eliminating some of the care- and disease-management functions we formerly paid our third-party administrator to perform. We realized the market rejection of the gatekeeper primary-care provider referral model—and the subsequent move to an open-access preferred provider organization—had the unintended consequence of disrupting primary-care relationships, leaving our associates to navigate their way through the complex healthcare system. While meaning well, the medical management programs that grew up to fill this void conflicted with, rather than complemented, the efforts of the physicians who were responsible for actually caring for their patients. We felt it was important to pay our primary-care providers for coordinating care, which lowers overall costs and improves quality of care. During the next year, we hope to introduce pay-for-performance or shared-savings models.
While our associates had a choice in selecting their primary-care providers, we built financial incentives in the plan design for choosing a partner primary-care provider that had achieved patient-centered medical home accreditation. About 50% of our associates have chosen to obtain their care from one of these physicians. As a result of the patient’s ability to choose to participate, there has been little disruption to our associates, which has helped with the overall associate satisfaction with our pilot.
We have begun to see some positive changes already. Our employees are becoming (measurably) healthier as proven by our annual health fair biometric screening results. Our absenteeism has decreased and several area employers are offering our wellness programs to their employees. And, not unexpectedly, our area employers and health plans are beginning to embrace the patient-centered medical home concept, and have begun discussions of their own with these primary-care providers.
Most important, we believe we are on our way to a demonstrable, sustainable culture of health. We are transforming our own organization’s vision of our healthcare system from one of “sick care” to “health care” and we’ve aligned our benefits package with that vision. And it’s a highly efficient way to create the infrastructure for population health management.
Our experience served as a pilot program for Centura Health—our parent company and the largest hospital and healthcare network in Colorado—and it is now being adopted systemwide affecting nearly 14,500 associates at 13 hospitals.