Centers for Medicare & Medicaid Selects Hudson to Join a Groundbreaking Multi-Payer Initiative; Primary Care Practices Will Earn Higher Fees for Coordinating Care for Patients

TARRYTOWN, N.Y., June 19, 2012 /PRNewswire-iReach/ -- Think about what irks patients about doctor visits: hurried exams and no time to talk. Then think about what irks physicians: no reimbursement for practicing preventive medicine or for taking the time to coordinate patients' care with specialists. Finally, think about what irks everybody: spiraling costs and inconsistent, fragmented care. Now, Hudson Health Plan is participating in a new Comprehensive Primary Care (CPC) initiative that will address those problems in New York's Capital District-Hudson Valley Region. Hudson expects the initiative will create a win-win-win situation for patients, providers, and payers, alike.

"The current system of primary care isn't working, particularly for people with chronic illness. Someone has to coordinate their care, and their primary care physicians are the ideal people to do that," explains Georganne Chapin, President & CEO of Hudson, a community-based not-for-profit managed health care organization.  "But there is something dreadfully wrong in expecting primary care physician groups to assume this responsibility without reimbursement. Paying primary care physicians a care management fee will give them the means to keep patients in better health at a lower overall cost."

The CPC initiative is a multi-payer project organized by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. On June 6^th, CMS announced that it had finalized a memorandum of understanding with Hudson Health Plan and five other insurers in New York's Capital District-Hudson Valley Region in which the insurers and CMS agreed to provide incentives to primary care practices that coordinate care for patients. For example, CMS, which pays for Medicare services, will pay physicians an average of $20 monthly for each Medicare patient.

In addition to financial incentives, Hudson and the other private insurers willcollaborate closely with providers to leverage shared data. Insurers have agreed to work together to develop standardized reports, with the ultimate goal of aggregating all payer patient data into one report.

CMS, which also plans to share any cost savings with providers as a further incentive, anticipates that enhanced payments will allow doctors to spend more time with their patients and – most importantly – coordinate their care. With nearly half of all Americans living with at least one chronic health condition, according to the Commonwealth Fund, there is an urgent need to coordinate their care over multiple settings. A Commonwealth Fund survey found that 23% of respondents with chronic conditions saw four or more doctors during the last 12 months. Doctors struggle to collaborate in caring for a mutual patient, and primary care physicians, often the least compensated in the system of care, are not reimbursed for this task. "If more primary care physicians were able to effectively coordinate the care of chronically ill patients, there would be less chance of the patients falling through the cracks," Ms. Chapin notes.

Strength in Numbers

Hudson has been a leader in working with providers to improve health care quality since 1999, when it became the first health plan in the region to offer pay-for-performances bonuses to practices that met or exceeded quality standards. But Hudson's incentives compensated providers for only its members, not the entire practice. While there was some spillover effect that improved the quality of care for other patients, the incentives weren't sufficient to transform practices. "An incentive program really needs to cover a large percentage of a provider's practice to support real changes in the way care is delivered. This initiative will cover about 60% of all patients in each practice to encourage providers to change," points out Janet Sullivan, MD, Chief Medical Officer at Hudson.

Now the CPC initiative care coordination fees and the quality reports, collected from multiple payers, will cover the majority of patients. Primary care providers will be able to invest in health care technology and connect to networks of specialists and hospitals so they can collaborate on patient care. "Practices will have the means to share and analyze data which is the backbone of effective care coordination," says Catherine Clancy, Senior Vice President and Chief Strategy Officer at Hudson.

Provider Deadline Is July 20^th

Hudson has begun to talk about the initiative to primary care providers in its service area of Dutchess, Orange, Rockland, Sullivan, Ulster and Westchester counties. To qualify, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients' other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases. Primary care providers are invited to check their eligibility using an online pre-screening tool. Applications will be accepted until July 20, 2012.

Ms. Chapin believes the initiative will allow primary care physicians to spend more time doing what they do best: talking to patients face to face and engaging them in caring for their own health. "Physicians want to help people live healthier lives and take better care of their health," she says. "We are finally giving them a chance to do it."

About Hudson Health Plan

Hudson Health Plan is a community-based not-for-profit health care organization that provides state-sponsored Medicaid Managed Care, Child Health Plus, and Family Health Plus insurance coverage to over 115,000 members in New York's Hudson Valley. Hudson uses every government dollar it receives to fulfill its mission, which is "to promote and provide access to excellent health services for all people." Hudson improves the health of its members and the communities in which they live through its innovations in care coordination, and by supporting over 5,000 local health providers. In both 2009 and 2010, Hudson achieved the highest quality incentive scores of any Medicaid plan in New York State, and in 2010, it received the highest overall performance rating of any Medicaid plan in the Hudson Valley. It also has earned the highest ratings in overall satisfaction among Medicaid Managed Care members in the Hudson Valley region every year since 2003.

Media Contact: Jeannie Mandelker, Harrison Edwards PR & Marketing, 1-901-907-0448, jeannie@harrison-edwardspr.com

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SOURCE Hudson Health Plan

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