Tuesday, April 22, 2008

What is Minnesota BCBS Up To?

The Disease Management Care Blog attended a session describing what Minnesota Blue Cross Blue Shield has been up to in the ‘medical home’ arena. As regular readers will recall, this particular Blue was one of the reasons why Healthway’s stock experienced a recent price decline following the announcement that it may withdraw from its contract.

It appears that Minnesota BCBS was petitioned by a number of provider organizations to support a ‘medical home’ in lieu of traditional disease management. The experience with one 400 physician medical group was very telling. This particular group had an electronic health record with registry support as well as physician-led teams staffed with non-physician practitioners. Minnesota BCBS agreed to give it a try and turned off the disease management for the patients assigned to this clinic. Over time, there was a meaningful improvement in clinical outcomes. Minnesota BCBS took the next step and compared the medical home-enabled clinic’s outcomes data to another similar clinic that still had live disease management. They found that the improvement in outcomes not only appeared to be significantly better compared to the convenience control clinic, but that there was also a meaningful difference in per member per month cost favoring the medical home.

Based on what the DMCB heard, this doesn’t mean Minnesota BCBS is prepared to cover all versions of the medical home throughout its network starting tomorrow. For example, the pilot above did not include any changes in reimbursement. However, other clinics have expressed an interest offering this and there are efforts underway to develop a payment mechanism. “It’s worth our time to work with clinics that have medical homes.”

Without being prompted to do so, the speaker pointed out that he believes the “call center” function works better in a central location that is supervised by the insurer. The intrepid DMCB asked about this, and the reply was interesting but unsurprising: a “distributed” call center function spread out among multiple clinics is destined to be higher cost: ‘we found one nurse can cover a thousand patients with CAD.’ The speaker suggested one way to approach this would be to allow the medical homes to individually or collectively “outsource” its telephonic remote support. To further support this, BCBS has had some positive experience in which remote disease management nurses were able to enter, interact with and document in the electronic health record for review by the care team.

Interesting stuff. The DMCB doesn't know if what is true in Minnesota is necessarily transferable to the rest of the United States, especially smaller clinics. However, it can't blame Minnesota BCBS for thinking about using its network for population based care while integrating the more scalable support functions from a central location.

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