I was sent a bit of information regarding Blue Cross of North Carolina. It seems that they don’t want to pay a management fee for chronic illness care. Instead, they will increase reimbursement for office visits because
…patients who generate the most physician orders for medical services also generate the most office visits, so doctors are getting paid extra to see the patients most in need – rather than getting a capitated rate for both the healthy and sick, Komives says. “When you’re actually spending time with the patient in the office, that’s the value,” she adds.
Is that really the value? Interestingly, Community Care of North Carolina (the Medicaid managed care product) has found differently. By paying for the following:
•Local non-profit community networks that are comprised of physicians, hospitals, social service agencies, and county health departments provide and manage care.
•Within each network, each enrollee is linked to a primary care provider to serve as a medical home that provides acute and preventive care, manages chronic illnesses, coordinates specialty care, and provides 24/7 on-call assistance.
•Case managers are integral members of each network who work in concert with physicians to identify and manage care for high-cost, high-risk patients.
•The networks work with primary care providers and case managers to implement a wide array of disease and care management initiatives that include providing targeted education and care coordination, implementing best practice guidelines, and monitoring results.
•The program has built-in data monitoring and reporting to facilitate continuous quality improvement on a physician, network, and program-wide basis.
They have found significant cost savings and
…asthma patients experienced improved care as evidenced by greater reductions in inpatient hospital admissions and emergency room visits. Diabetes patients had fewer hospitalizations and achieved high rates of performance measures, such as primary care visits, blood pressure readings, foot exams, and lipid and A1C tests.
Some say that what BC/BS of North Carolina is actually doing is benefiting from the changes initiated by North Carolina Medicaid. While thay may not have done the heavy lifting at least they seem willing to pay for improved care. I hope that patients and the doctors realize the value is in the care coordination which can occur when given extra time but doesn’t have to.