The initiative expands on an approach known as the patient-centered medical home, which is being tested in dozens of public and private experiments across the country as part of the health-care overhaul. Federal policymakers are watching closely to see whether the strategy can improve care and reduce costs.
Instead of doctors waiting to see patients mostly when they have a specific problem, a team of doctors, nurses and other staff members aims to take care of the whole person on a continuing basis, with an emphasis on prevention and comprehensive care, often targeting the sickest patients. The strategy is expected to translate into better care and fewer emergency visits, hospital stays and trips to specialists, clinic officials said.
Many of the experiments are taking place in privately insured networks. CareFirst, with 3.4 million members, has been conducting one of the largest of its kind in the Washington area since January 2011. About 3,100 doctors, or 81 percent of the region’s actively practicing primary-care physicians, are participating in the program, according to Chet Burrell, CareFirst’s chief executive.
The program uses a team approach and relies on a host of financial incentives to encourage doctors to increase the emphasis on helping their sickest patients. Doctors who join the program receive a 12 percent increase in their insurance reimbursements, $200 for each detailed care plan they set up for a patient, and additional fees for improving quality and reducing overall cost.
In the initiative to be announced Tuesday, CareFirst will provide grants to the safety-net clinics to jump-start their own programs. CareFirst will also give technical support and guidance on electronic health record systems, clinic officials said.
Clinics were asked to submit proposals and were chosen based on how well they could coordinate care for the most needy patients.
“We’re not paying for the care, we’re paying for the coordination,” Burrell said.
One of the recipients is the Arlington Free Clinic, which provides free health care to about 1,600 low-income, uninsured residents. The clinic will receive about $350,000 over three years, roughly a third of the total cost of the program, said Nancy Sanger Pallesen, the clinic’s executive director.
The clinic will use the money to hire additional personnel and upgrade electronic medical records to allow the staff to better track the care of “the sickest of the sick” — about 160 people — she said.
For example, medical assistants could make sure the necessary bloodwork is completed before a patient’s appointment with a specialist, Pallesen said. “Otherwise it would be a wasted trip for her and for the physician, who could be seeing someone else.”
With 140 affiliated doctors providing their services free, she said, “the more efficiently we can use them, the more people we will be able to see down the road.”
And the need appears to be growing. The clinic takes new patients through a monthly lottery system. Typically, about 120 show up for the lottery, and the clinic takes 25 of them, Pallesen said — but last week, for the first time, 220 people showed up. “We could only take 25,” she said.
The other clinics include Mary’s Center and Unity Health Care in the District, the Spanish Catholic Center in D.C. and Maryland, and Community Clinic Inc. and partner Greater Baden Medical Services in Montgomery County and Prince George’s County.
Experts say the key will be whether the clinics can sustain the programs over time. “The kind of people who have complex medical problems as well as social and economic issues might be the people who would benefit most by this kind of initiative,” said Judy Feder, a health-care expert at the Urban Institute.
Those patients are most likely to “fall prey to the inappropriate use of health care, whether on the back end with preventable high-cost hospital admissions or on the front end with insufficient primary care,” she said.
Leveling the playing field will be even more important in the run-up to 2014, when primary-care doctors will be in greater demand as insurance coverage expands to millions more Americans, experts said.