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BEDFORD, N.H. (AP) — New Hampshire health care providers who have started getting paid for how well they do instead of how much they do said Tuesday they're optimistic about controlling costs and improving outcomes.
Under an Anthem Blue Cross and Blue Shield program, providers get paid extra for "care coordination," the activity that takes place outside of a patient visit — for example, following up to make sure patients fill their prescriptions and understand how to take their medication. Other insurers, states and medical groups have launched similar programs aimed at containing costs without undermining care, and the federal health care overhaul law created "accountable care organizations" for Medicare, which aim to improve coordination.
Speaking at a health care summit Tuesday, the owner of a nurse practitioners' office in Concord said the Anthem program has allowed her to hire a medical assistant to carefully scan each patient's records before appointments.
"What that means is that record is looked at prior to that patient visit happening, any immunizations that are missing, any mammograms, any preventative care, is highlighted for the nurse practitioner, so when that patient is in the exam room, we are optimizing the time we're spending with that patient," said Wendy Wright of Wright and Associates Family Healthcare.
At Wentworth-Douglass Hospital in Dover, fewer high-risk patients have been readmitted to the hospital since it assigned case managers to work specifically with them and their primary care providers, hospital official Paul Cass said. But the biggest benefit of the new payment program has been getting detailed data from Anthem, he said. As part of a recent effort to get cardiologists and primary care providers to work together to help patients manage high cholesterol, officials used that data to discover that changing fewer than 300 patients to a generic drug could yield significant cost savings, he said.
"The bottom line to all this is data and analytics," he said. "If you can't understand what's going on in the population, if you don't have the data, you won't be able to get at the answers."
The summit, organized by Anthem and Business NH Magazine, also featured a keynote speech by Michael Chernew, professor of health care policy at Harvard Medical School who outlined two approaches to slowing the rate of health care spending. One approach focuses on payment reform, such as reimbursing providers a set amount for an entire episode of care — say six months of diabetes treatment — instead of for each service.
"At the end of the day, what really matters is that the underlying delivery system has to become more efficient," he said.
The other approach focuses on redesigning insurance plans to encourage consumers to seek out value in health care. Insurers can cap what they'll pay for a colonoscopy, he said, or charge consumers less if they go to a lower-cost health system. In so-called "value-based insurance design," consumers would spend less on high-value services, such as help managing chronic conditions.
"Value is not cheap," he said. "Value is low dollar per health gain."
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