How Independence Blue Cross is changing the medical home landscape


When Independence Blue Cross launched its patient-centered medical home program three years ago, it set out to reach a lofty goal--transforming every primary care provider into a fully functional PCMH. Other medical home programs already existed, of course, but IBC took the idea to a new level by offering sizeable financial awards that can increase doctors' base pay by as much as 220 percent.

FierceHealthPayer caught up with Rich Snyder, chief medical officer for IBC, to find out how the insurer's medical home program has fared since last year.

FierceHealthPayer: Has IBC implemented anything new to the medical home program?

Rich Snyder: The thing that's going to start changing the landscape is that we have now sold our first product that will motivate our members, through a lower out-of-pocket expense, to select a patient-centered medical home rather than a practice that isn't a medical home. Meaning their co-pay will be smaller if they choose a medical home. The intent there is to steer people to the medical homes.

FHP: How has IBC's medical program grown in the last year?

Snyder: We've stayed the course and continued the program and continued to grow. We had almost 200 primary care practices with 1,000 physicians in April last year. We're now at 280 primary care practices and 1,339 unique physicians. So that equates to 37 percent of all the primary care physicians in the Philadelphia metro area who are now practicing in patient-centered medical homes.

It's a journey and a lot of the transformation will continue for years. All the physician practices are in different stages of maturation as patient-centered medical homes. The practices that I've talked to, including Thomas Jefferson University Hospital residency program, view it as an ongoing transformation. They're in their fifth year and still continue to make changes and add features that strengthen their engagement with their patients.

FHP: What do you think drives the upswing in practices that have joined the IBC medical home program?

Snyder: We provide a very large carrot for practices. Contained within the incentive program is the ability to earn an incremental per member per month fee once you become a medical home. That alone is well worth the effort to become a medical home. But on top of that, it makes it so much easier for you to achieve larger incentive payments because if you max out, you can achieve 220 percent of base pay--and that's unheard of. You're not going to find many plans that offer that kind of incentive.

Half of it is based off of high-quality, high access, highly coordinated care and the other half is based on reducing or bending the cost curve. With those very large carrots hanging out there, practices are very interested in trying to achieve them. That's the motivator, if you will.

FHP: Does IBC reach out to physician practices to recruit them into the medical home program? Or do the practices approach IBC directly?

Snyder: A lot of these practices are getting together and talking with each other. So it's almost like the Starbucks phenomenon--if there's one in your town, then I want in my town. People are interested in going there. Most of the medical homes have actually approached IBC. They're asking for help to become medical homes.

FHP: How does IBC help practices reach their goal of becoming a medical home?

Snyder: We've had a lot of communications with physicians around the value and merits of a medical home. When they're interested, we are willing and able to support them. We provide licenses, generate reports and offer daily census hospital reports so they can see who is in the hospital from their practice. We make high-risk patient lists available. Plus, at the point of care, every member of ours has a care alert, which is a one-page summary of the gaps in care. And we invest in technology substantially.

We also provide them a free copy of the American College of Physicians medical home builder software, which is a very good way to assess the readiness of your practice to apply to be a medical home and shows gaps in your practice so you can fix them and be prepared to submit your application. Within that tool are a lot of assistive-type devices that, for example, refer you to companies that sell software to meet the open access scheduling requirement, information on registries and policies that you need to implement in you practice, information about how to change the roles of the people in your practice to achieve a medical home.

FHP: Does IBC get involved in the day-to-day running of the medical home? Or does it let each practice operate as it chooses?

Snyder: The practices run their own show, but we get together with them in a number of different venues regularly. So there are still meetings that occur between those practices to look at results and discuss how one practice changed care delivery. And we do a lot of promotional-type activity, both nationally and locally, with these practices.

For example, Crozer-Keystone Health System has 32 practices that are recognized as medical homes and are all connected by the same electronic medical record. So we meet with the health system to try to continue and improve the exchange of health information between us and them so that providers have more real-time access to clinical data at the point of care. Those meetings are quarterly.

FHP: Have the medical homes achieved any concrete success yet?

Snyder: There is a statistically significant difference between the cost of care in medical homes and non-medical homes. In the original 32 medical homes that are now five years old, 33 percent of all the members (220,000 total patients, including many children) had poorly controlled diabetes, as defined by the HEDIS measure. That decreased to only 18 percent in 2012. That's the power of transformation here.

If you look at cholesterol management, the percentage of patients who had very tight control of their lipids as measured by LDL of less than 100, 25 percent had tight control of their cholesterol in 2008, which increased to 56 percent in 2012. Those are dramatic improvement in controls. Blood pressure control of less than 140 over 90 started at 57 percent of patients in 2008, increasing to 83 percent in 2012.

And those 32 medical homes had a combined cancer screening rate of about 65 percent of all patients in 2008. But in 2011, the most recent year IBC analyzed, that increased to 75 percent. During that same period of time, the practices that aren't medical homes but were matched and risk-adjusted for the populations, had screening rates of about 63 percent in 2008 and 68 percent in 2011. The gap widened from 3 percentage to 7 percentage points between medical and non-medical homes. So medical homes did better on both chronic illness management and preventive screenings.

- Dina (@HealthPayer)

Editor's note: This interview has been condensed and edited for clarity.