Diabetic members had 21 percent lower total medical costs
Philadelphia, PA – Independence Blue Cross (IBC) announces the results of a series of three-year studies that demonstrate significant reductions in medical costs for patients with chronic conditions treated in primary care practices that have transformed into medical homes. Most notably, diabetic members treated in a medical home practice had 21 percent lower total medical costs, driven by a 44-percent reduction in hospital costs. Lower emergency room costs were seen after one year.
IBC also found reductions in costs for members with chronic conditions such as coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, asthma, and hypertension.
“Quality and value in health care begin with strong primary care,” said Daniel J. Hilferty, IBC president and CEO. “In the complex world of health care, one way we’re changing the game is through our support of medical home practices that provide more coordinated, personalized care and give patients the tools and resources they need to take better care of themselves. In this period of unprecedented change in health care, the health care companies that thrive will be those with a bold, clear vision that move rapidly, execute fresh ideas and develop groundbreaking innovations.”
IBC’s studies evaluated 125,000 individuals receiving primary care in 160 medical home practices in southeastern Pennsylvania from 2008 to 2012. The studies, which used a subset of this population, compared members receiving care in medical home practices to members cared for in non-medical home settings, and in practices that became medical homes at a later time.
Patient-centered medical homes improve patient health and lower costs through a team-oriented approach to primary care. This includes more coordinated care among all health care providers, electronic health records to better track care, open scheduling to allow for more flexibility in seeing patients when they need care, and more interaction with the physician and staff between appointments to make sure scheduled tests and consultations occurred.
“We’ve known that many measures associated with improved health quality are better for our members in medical homes, such as better controlled diabetes and blood pressure,” said Dr. Richard Snyder, IBC chief medical officer. “These results tell us that medical homes also help reduce overall health care costs for people with chronic conditions.”
Patient-centered medical homes are one part of Independence Blue Cross’s comprehensive strategy to better serve our customers by increasing the quality and reducing the cost of health care. This multi-faceted effort also includes the Primary Health Coach program, which provides one coach to coordinate a member’s care and help him/her navigate the often confusing health care system; innovative pay-for-performance incentive programs that reward primary care physicians, specialists, and hospitals for providing excellent care and lowering costs; and the Blue Distinction Centers+ program that recognizes hospitals for expertise in quality specialty care and cost-efficiency.
Practices in the Chronic Care Initiative, Pennsylvania’s pilot medical home initiative, also found that chronically ill people treated in their medical homes took more responsibility for their care and showed marked improvements in important health outcomes. For example, diabetic patients in these practices had:
- 60 percent improvement in getting LDL (bad cholesterol) under adequate control
- 45 percent reduction in the number of patients with poorly controlled diabetes
“Medical homes deliver care in a much more coordinated, and team-based way which means that acute problems are addressed in a timely way, preventing an ER visit or complication,” continued Snyder. “The doctors and their staff in medical homes don’t just address the health needs of their patients when they are in the office. They monitor care between appointments to make sure patients are getting the tests they need and are taking their medications as prescribed. And it’s making a big difference.”
Another result from the three-year studies showed that chronically ill and diabetic patients in medical homes more often received necessary cancer screenings and key diabetic tests (eye exams, HbA1c, LDL cholesterol, and kidney function) than patients not treated in a medical home. Specifically, the gaps in care for patients in medical homes for cancer screenings were half that for patients in other primary care settings.
“IBC has invested significantly in building an informatics infrastructure to provide practices with information about gaps in important care and overall quality outcomes. Such timely information is helpful to medical homes to deliver more coordinated care,” said Somesh Nigam, chief informatics officer of IBC. “More and more physicians are relying on this real-time data and these clinical reports to identify patients who may be overdue for screening tests and preventive services. Combined with the increased use of electronic medical records, doctors now have a much better way of tracking patients to ensure they get the right care at the right time.”
Southeastern PA has the greatest concentration in the country of practices recognized as medical homes by NCQA. IBC currently has nearly 300 certified medical homes in its network, serving nearly 40 percent of its members.
Independence Blue Cross