Nebraska's largest health insurer kicks off a six-month experiment Friday, betting costs will fall and people will get healthier if doctors walk into exam rooms with better patient information.
The program will start with about 1,200 diabetic patients in nine Nebraska cities, including Lincoln.
Blue Cross and Blue Shield of Nebraska hopes to expand the approach quickly, moving toward a system that rewards doctors for making patients healthier rather than paying per procedure.
"This model is looking at quality and outcomes," said Dr. Bill Minier, the company's medical director and vice president of policy.
The pilot program dovetails with the patient-centered medical home concept, an idea championed by national health care reform that enjoys broad political support. Its key tenet: Quality care depends on creating a meaningful relationship between patients and physicians.
Blue Cross will invest as much as $1.5 million in support, rewards and clinic tools over the duration of the pilot.
The program will rely heavily, at least initially, on an Internet program created by MDdatacor that turns disparate medical records into tailored patient checklists: a red flag might alert doctors to a missed flu shot.
Minier recalled that at a Lincoln practice where he worked in the 1980s: "Physicians almost to a person were caring for their patients as well as they knew how."
What they needed was more and better patient information.
In an industry that allots a physician 15 minutes to prepare for and address a patient's multiple chronic diseases, assess whether he or she is current on tests and has taken prescribed medications, and check for drug interactions, things fall through the cracks.
"Physicians have long struggled to have all of that information together," Minier said.
In 2006, Wellmark, the Blue Cross plan for Iowa and South Dakota, turned to the MDdatacor tool for that assistance.
It gives a physician in an exam room easy access, Minier said, "to exactly where the person stands on chronic care, immunizations, preventive care, including a Pap smear, colorectomy, mammogram."
The tool automatically grabs information from a variety of electronic records systems, or clinics can manually enter data.
Blue Cross expects administrative costs to climb initially but overall costs to eventually fall.
For diabetic patients in Iowa and South Dakota, the tool helped decrease emergency room visits and hospitalizations. Long term, Minier said, it should lessen the risk for blindness, heart disease and stroke.
The Blue Cross pilot will focus on diabetes, but practices can use the tool for all patients. In Iowa, more than 70 percent of physician practices were using the tool by the end of the third year.
Better patient information will be essential for clinics to transform into medical homes, said Lee Handke, Blue Cross vice president of health network services.
The medical home, a concept backed by a variety of family practice groups, would rebuild the care delivery system. Physicians would become players in a team that arranges and coordinates all patient care. Patients get greater support and better access to care and information.
For the pilot, Blue Cross will pay its 80 participating clinicians an administrative fee per patient for providing coordinated support. The fee varies based on illness severity.
In addition to Lincoln, participating clinics are in Auburn, Geneva, Grand Island, Kearney, Lexington, Nebraska City, Omaha and West Point.
At the end of the pilot, clinicians will be rewarded based on performance, such as their rate of scheduling recommended tests for vision, blood sugar and cholesterol, as well as on patient hospital admission rates.
Blue Cross created the incentives and will pay the licensing fee for the Internet tool, but it will be up to individual practices to adapt their systems.
At the end of six months, Blue Cross will evaluate the results and consult participants for help in tweaking the program.
"We're looking for their input long term," Handke said.
From diabetes, the program might move to include coronary artery disease or chronic obstructive pulmonary disease.
"Ultimately, we want to get to a point that we're not looking at specific diseases," he said.
"The question," Minier said, "is how does Blue Cross Blue Shield go from a single disease to raising the bar across the population. We're uncertain how to do that."
Reach Mark Andersen at 402-473-7238 or firstname.lastname@example.org.