This article first appeared in the August/September 2008 issue of the newsletter "States in Action."
In May 2008, Pennsylvania Governor Edward Rendell's Office of Healthcare Reform launched the first phase of a chronic care program among 32 primary care practices serving 220,000 patients in the southeastern region of the state, including Philadelphia. The program, which will eventually be implemented statewide, aims to transform how medicine is practiced by rewarding primary care doctors for keeping patients with chronic conditions as healthy as possible.
What distinguishes the Pennsylvania plan from previous attempts to implement prevention-based health care is the participation of private payers—a $13 million investment over three years from leading health insurers. Around the country, in Michigan, New Jersey, North Dakota, New York, and other states as well as in Pennsylvania, insurance companies are conducting experiments to test whether spending more on primary care can save money by helping patients avoid catastrophic health problems.
Under Pennsylvania's chronic care program, insurers will pay for technology to support chronic care management, including an electronic patient registry for primary care staff to track health status, flag when services are due, and communicate with patients through e-mail. Insurers also will pay doctors more if they add staff members who can provide additional patient care, including health educators, nutritionists, and nurse practitioners.
In return, participating primary care practices must adopt policies and practices that encourage patients to be more active in managing their diseases, such as providing health education as part of routine visits and setting aside time for patients who request same-day appointments. Participating practices also will be expected to complete chronic care management training and meet minimum care standards, such as installing the patient registry or following evidence-based practice guidelines set by the state. The more standards a practice achieves, the greater its reimbursements will be.
For example, a typical four-doctor family practice that achieves all standards could potentially earn an additional $250,000 to $480,000 a year, according to Phil Magistro, a spokesman with the Governor's Office of Healthcare Reform. Currently, the average four-doctor practice earns $1.5 million to $2 million a year.
The program will expand to other parts of the state this fall.