Sunday, April 27, 2008

Boeing Assembles the Ambulatory Intensive Care Unit - aka Medical Home

The Disease Management Care Blog has one more noteworthy plateful from last week’s World Health Care Conference Buffet Table. A representative from Boeing Corporation brought us up to date on one way to address a yearly $1.9 billion health care bill. Dissatisfied with the pace of incremental change, this company decided to pilot an “Ambulatory Intensive Care Unit.” Boeing was content with its disease management programs, but it decided more action was necessary. It targeted its sickest and costliest patients with a version of the medical home. Mercer was involved, but it was Renaissance Health’s predictive modeling program that found the approximately 700 patients that were destined to remain or become high cost. Three large clinics in the Seattle area agreed to participate in the program with 120 ‘opt-in’ patients. The clinics had to pass muster by developing the team-based support infrastructure and agreeing to develop a ‘Shared Care Plan’ for each of the participating patients.

It’s only just started, so stay tuned on the clinical and financial outcomes. The comparator group will be drawn from the non-participating patients.

But there were some interesting highlights:

  • The patient encounters continue to be paid using the established fee schedule, but there is an additional monthly adjusted case rate that ranges from $25 to $100.
  • The clinics have salaried physicians and there is no guarantee that the docs will personally share in the case-rate revenue. Boeing had some anecdotes suggesting the participating physicians were still very supportive.
  • Multiple enrollee incentives were necessary and even then, only 20% of the eligible patients opted-in, even with a waiver of the co-pay for the medical home - AICU intake exam. What seemed to work best was a recruitment letter signed by the patients’ existing physicians.
  • This is another example of the co-existence of the medical home and disease management in the same network.

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