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Goal: Affordable, quality health care [The High Point Enterprise, N.C.]

By Paul Johnson, The High Point Enterprise, N.C.
McClatchy-Tribune Information Services

Jan. 15--HIGH POINT -- Dr. Grace Terrell envisions and expects that the future of health care will reflect the improvement of chronic heart condition patient Jane Doe.

At a press conference Tuesday morning in north High Point, Terrell used the example of the symbolic patient to explain a new medical care initiative among Cornerstone Health Care, the insurer UnitedHealthcare and the Optum information technology business of UnitedHealth Group.

For a long time, Doe made unannounced and regular visits to emergency rooms because of her heart problems and related illnesses. The visits not only weren't the most productive way to treat the woman, but also put a heavy financial drain on the local health care system.

Now, through an effort referred to as accountable care, Doe is treated in a better and more effective manner, keeping her out of emergency rooms and preventing hospital stays. She visits a clinic to address her needs, and her health care providers are linked electronically to share information to guide her care. As a result, Doe has stayed out of emergency rooms and improved her health in a way that reduces the overall costs to the health care system.

What officials with Cornerstone, UnitedHealthCare and Optum discussed Tuesday is how they envision treating more patients in the manner of the symbolic Doe, improving outcomes while holding the line on increases in health care spending. The formal name for the effort is an accountable care organization, an alliance that coordinates health care through medical professionals and insurance providers.

"This innovative new program focuses on the whole patient with a team that includes doctors, nutritionists, health coaches and social workers," Terrell said.

The accountable care organization won't directly change the copayments or deductibles of UnitedHealthcare patients who visit Cornerstone practices. But the new structure could lead to changes in reimbursements to medical providers, such as doctor's offices, shifting away from the traditional fee for each service model to one based on meeting quality standards for patient care.

"UnitedHealthcare has extensive data and reporting ... to help care providers implement quality- and efficiency-based reimbursement models that improve care while decreasing health care costs," said Garland Scott, chief executive officer of UnitedHealthcare of the Carolinas.

The local effort is part of a nationwide push under President Barack Obama's Affordable Care Act. Since passage of the Affordable Care Act, more than 250 accountable care organizations have been established across the country, according to the U.S. Department of Health and Human Services.

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An initiative to improve patient care and better link information among health care providers in the Triad was announced Tuesday morning at Cornerstone Health Care Premier Medical Plaza. Here are the players in the effort:

Cornerstone Health Care, a medical group of more than 360 physicians and other health care professionals practicing at more than 80 locations

UnitedHealthcare, an insurer offering a range of health care benefit and wellness programs; contracts with 754,000 medical professionals and 5,400 hospitals nationwide; serves more than 38 million people

Optum, a health care information technology company that aims to modernize health care delivery to patients


(c)2013 The High Point Enterprise (High Point, N.C.)

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Distributed by MCT Information Services



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