Highmark creates alliance meant to change patient care, doctor pay [Pittsburgh Post-Gazette]

July 18--Highmark Inc. announced today the formation of the Accountable Care Alliance, a network of hospitals and physicians meant to better coordinate patient care and change the way physicians are paid.

"We are working to change the health care system to deliver more value for the health care dollar," said Mike Fiaschetti, president of health markets for Highmark's insurance wing, Highmark Health Services, in a statement.

Highmark described the alliance as akin to an "accountable care organization," which is essentially a network of doctors and medical providers who have agreed to assume greater responsibility and risk when it comes to the quality of care patients receive, and the cost of providing that care (that's where the "accountable" comes in.)

At the heart of that care model is a transition away from volume-based "fee-for-service" care -- the nation's dominant system, by which insurers reimburse physicians and hospitals for every test, visit and suture -- and toward a system that rewards doctors for the quality of that care. To do that, the entire health care system has to become more patient-centered.

And the result, it is hoped, is that medical bill will come down, and patient satisfaction will grow.

Highmark's accountable care organization, or ACO, is the next step in the transition.

The health insurer is already in the midst of a multi-year "patient-centered medical home" pilot program, which, in some ways, lays the foundation for the larger, systemwide ACOs.

The patient-centered medical home pilot began 2011, including 160 primary care physicians in 12 practices, cover about 45,000 patients. The pilot has since been expanded to include 1,000 primary care physicians in more than 100 practices.

While the ACOs address both care and cost, the patient-centered medical home programs are more focused on care -- seeking to establish a more comprehensive, continuous relationship among patients, physicians and nurses, particularly when it comes to caring for those with chronic health issues that require regular monitoring and coaching.

Highmark reported that, among patients being seen in the PCMH pilot practices, inpatient acute admissions dropped 9 percent, 30-day readmissions dropped 13 percent, and care costs for patients with coronary artery disease and diabetics dropped.

There are about 500 accountable care organizations in the U.S. Highmark's will initially include physicians from six of the seven Allegheny Health Network hospitals -- Allegheny General Hospital, Allegheny Valley Hospital, Canonsburg Hospital, Forbes Hospital, Jefferson Hospital and West Penn Hospital.

Eventually, physicians from Saint Vincent's Hospital in Erie will join the accountable care network.

Bill Toland: [email protected] or 412-263-2625.

___

(c)2013 the Pittsburgh Post-Gazette

Visit the Pittsburgh Post-Gazette at www.post-gazette.com

Distributed by MCT Information Services