Never Mind Massachusetts' Reform Efforts, Check Out What's Happening in the Keystone State

While all eyes are on Massachusetts, the Disease Management Care Blog’s home state of Pennsylvania has been busily involved in its own home health care reform efforts. Our larger-than-life Governor, who is not known for small ideas, has launched an ambitious package of proposals aimed at expanding the availability of health insurance to the under and uninsured, increasing access and reforming health care delivery. Part of the reform effort was the creation of the ‘Chronic Care Management, Reimbursement and Cost Reduction Commission,’ which was charged with developing recommendations for the ’78% of health care costs…traced to about 20% of patients…’

In February of 2008, the Commission released its ‘Strategic Plan,’ which included the ‘dissemination of the Chronic Care Model to primary care practices across Pennsylvania.’ To make this happen, the Commission sponsored a series of regional ‘learning collaboratives’ that focused on diabetes mellitus The first region was south eastern Pennsylvania, in which teams from 33 independent primary care sites involving more than 150 physicians serving more than 200,000 patients were invited to a series of ‘education and support’ sessions in May of 2008. The next will be south central Pennsylvania.

The American Board of Medical Specialties, thanks to funding from the Robert Wood Johnson Foundation is lending support to these sessions. The Pennsylvania Academy of Family Practice was successful in securing ‘Improving Performance in Practice (IPIP) grant support from ABMS, which is being used to coach the participating practices and help them ‘stay on track and implement the changes.’

According to the Philadelphia Inquirer report linked above, the south east learning collaborative has garnered the financial support of Philadelphia’s dominant health insurer, Independence Blue Cross as well as Aetna, CIGNA and others – all to the tune of $13 million. The money will be used to reimburse physicians for attending the training sessions, meeting certain standards involved in establishing the chronic care model, such as implementing supporting information technology (such as registries and decisions support and adding the necessary staff. According to another news report:

‘A typical four-doctor family practice that achieves all standards levels within two years, could potentially earn an additional $275,000 to $480,000 a year.’

That’s some serious coin.

A host of other Pennsylvania entities are lending their support also, including the PA Dept of Health, the University of Pittsburgh, Penn State’s School of Medicine, the Pennsylvania Medical Society, the Hospital Association of Pennsylvania, Lehigh Valley Hospital, Temple, Jefferson, Geisinger and the Jewish Health Care Foundation.

That's some serious support.

Now that we’re into July of 2008, the DMCB sought an update on how things were going from the Executive Director of Pennsylvania Chapter of the American College of Physicians. Here is his report. In a nutshell, the project has the support of the physicians, who believe the prognosis for success is very high:

Physicians in Philadelphia, Pennsylvania recently launched an innovative Pilot to improve the care offered to patients with diabetes. It is a chronic disease that is the subject of the Southeast PA roll-out of the Patient-Centered Medical Home Project.

This Pilot is part of Governor Ed Rendell’s RX for PA. It was designed by the Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission. Ralph Schmeltz, MD, FACP, FACE and Eric Gartner, MD, FACP, two leaders in the Pennsylvania Chapter of the American College of Physicians (PA ACP), have been active Commission members and are helping to spearhead the initiative.

PA ACP, in conjunction with PAFP and PAAAP, obtained a $150K grant for IPIP from the Robert Woods Johnson Foundation, thus making Pennsylvania only the third state enrolled in the IPIP program. IPIP, or Improving Performance in Practice, will support practices by focusing on improving diabetes care.