Medica's clinic-based chronic care management program delivers promising results

Dec 19 2009

Medica’s clinic-based chronic care management program with six clinic partners shows that focusing on care coordination is beginning to deliver promising results. A recent program evaluation reported that members participating in the clinical pilots had 1 percent more doctor visits and 3 percent more prescription fills than members with similar conditions seen in traditional clinic settings. This is a positive finding and supports the program design that a greater number of provider visits and higher prescription drug use correlate to optimal care for people with chronic conditions.

The evaluation also found that even with increased utilization in these two areas, overall healthcare costs for Medica members in the program did not increase, while inpatient stays decreased.

“We were excited to learn that through this chronic care model, providers were able to have more meaningful interactions with these members, without increasing the total cost of care,” said Dr. Jim Guyn, Medica medical director for provider relations. “These findings highlight the importance of the healthcare home concept and the delivery of comprehensive care in the primary clinic setting.”

Developed in 2007, the clinic-based chronic care management program focuses on many related issues affecting a person who has or is at risk for a chronic disease, taking into account such things as lifestyle, prevention and physical and behavioral health. Proven behavior change methods are used and each person’s level of engagement is determined by their desire to work on changes in behavior that will improve their health or lower their risk of disease. Participating clinics included Apple Valley Medical Center, Fairview Clinics, North Clinic, North Memorial Clinic, St. Mary’s Duluth Clinics and Stillwater Medical Group.

Medica created the program as a precursor to the healthcare home concept, which is designed to deliver comprehensive care for patients at the point of service with the goal of reducing fragmentation in the delivery of health care.

“All of us in the healthcare system believe in working toward improved health outcomes and the most efficient delivery of care,” Guyn said. “Medica can bring value to those efforts through unique ways of supporting providers who deliver the best and most efficient care. It’s a path we will continue to explore.”

Many of the clinic-based programs focus on diabetes. According to the Minnesota Department of Health, one in five Minnesotans has diabetes or is at high risk of developing it. Every year, 15,000 Minnesotans are newly diagnosed with diabetes. The annual cost of diabetes in Minnesota in terms of medical costs, disability, lost work, and premature death is estimated at over $2.3 billion.

Diabetes is an optimal condition for a healthcare home setting because there are a number of modifiable risk factors associated with diabetes. These include: Being overweight or obese; having a sedentary lifestyle; using tobacco; having high blood cholesterol; having high blood pressure.

One of the clinic systems in the program, Apple Valley Medical Center, demonstrates how a systematic focus on comprehensive management can improve care. Two years ago they developed a registry of its patients with diabetes to allow the clinic to track them better. The registry provides staff with daily reminders on patient-status so that any issues are addressed promptly. Based on the issue, the provider involved may be a nurse, nurse practitioner, physician or other provider. As a result of this approach, Apple Valley Medical Center was able to improve its community standing on this measure by 110 percent in the first year of the program. Its patients with diabetes “at goal” for optimal diabetes care, as reported to Minnesota Community Measurement, moved up 23 percentage points in one year.

“Our pilot project with Medica has allowed us to better coordinate patient care in order to improve the health outcomes of those with chronic or complex health conditions,” said Dr. Peter Frederixon, medical director of quality at Apple Valley Medical Center. “Our efforts are helping to prove that better coordination of care will increase a patient’s compliance and improve outcomes while decreasing cost. Since most health care spending goes to treat a small percentage of chronic conditions, addressing these aggressively is likely to save money. This effort has been truly beneficial for patients, Medica and Apple Valley Medical Clinic.”

The clinic-based chronic care management program also changed the way providers get paid by Medica. The participating clinics earn performance-based payments tied to improvements in clinical quality and to managing the total cost of patient care. While the healthcare home is one way to structure primary care practices to be more efficient and provide a higher quality of care, other care model designs and payment strategies will be explored.