Pilot provides incentives to physicians for managing patients
with complex and chronic conditions, keeping patients healthy
WALLINGFORD, CT, October 27, 2014 – HealthyCT, Connecticut’s non-profit health insurance CO-OP, has begun rolling out an innovative payment program to a pilot group of primary-care practices across the state. The practices can earn additional reimbursement by providing a level of quality care that not only helps keep their patients healthy, but also delivers comprehensive care coordination for those patients with chronic conditions.
As an insurance company founded by physicians, HealthyCT partnered with more than a dozen physician practices across the state and Qualidigm, a quality improvement organization, to develop the Advanced Practice Medical Payment Model (A-PMPM). The program offers incentives to physicians for the enhanced care provided through the patient-centered medical home, a form of patient care that involves a deep level of coordination among a HealthyCT member’s physicians and other health care providers.
“The first step in creating the model was engaging primary-care physicians. We’ve worked closely with a variety of primary-care practices – from solo practitioners to multi-specialty groups – and Qualidigm over the past year to define program requirements and appropriate incentives,” said HealthyCT CEO Ken Lalime. “The result is a model we all believe will be sustainable over time and reward those practices that improve quality and the health of their patients while lowering healthcare costs.”
Under the patient-centered medical home model of care, a medical practice is expected to make additional contact with a patient to ensure he or she is taking medication, obtaining routine tests or getting the follow-up care that is needed with other clinicians who are important to his or her health. This additional coordination requires staff time and resources that do not fall under the current fee-for-service billing model that is standard throughout most of the medical profession. The A-PMPM helps practices recover the costs of providing expanded access and a higher level of care for the patients most in need. Such patients might suffer from diabetes, heart disease or other chronic conditions that could become life threatening if left unchecked and uncoordinated.
“We built this in a way that provides payment for value to primary-care physician practices that have demonstrated transformation of their practices and provide a high level of quality care to our members,” said Dr. Russ Munson, HealthyCT’s Chief Medical Officer, whose career began as a primary-care physician practicing in Connecticut.
The practices participating in the program include the physicians who helped HealthyCT create the new payment model. They are located in Bristol, Farmington, Hamden, New Milford, North Haven, Norwalk, Norwich, Portland, Putnam, Vernon, West Haven and Willimantic. More practices are joining the pilot and will continue to do so throughout the year.
“Aligning incentives to create behavioral change is critical in transforming healthcare. HealthyCT continues to impress us as a mission-driven organization committed to making a difference in patient-centered care. Qualidigm is proud to partner with HealthyCT to promote the delivery of affordable, high-quality, coordinated healthcare,” said Qualidigm President and CEO Tim Elwell.
HealthyCT is an NCQA-accredited insurer offering a variety of health insurance plans to individuals and businesses in Connecticut. The non-profit company has one provider network for all products, with more than 15,000 unique individual providers and 30 hospitals statewide. It sells its individual and group products through private insurance exchanges, through insurance brokers and agents and through the state’s health insurance exchange.
Founded by physicians, HealthyCT opened for business in 2013 with a mission to provide Connecticut residents with comprehensive health insurance and easy access to quality healthcare. It is committed to developing an innovative, progressive health plan that ensures the delivery of patient-centered care for individuals, families and businesses of all sizes. Unlike traditional for-profit insurance companies, any profits generated by HealthyCT are to be used to stabilize or reduce premiums to consumers and businesses, and/or to enhance plan benefits and services. HealthyCT can be found at www.HealthyCT.org; across social media @HealthyCTPlan and at 35 Thorpe Avenue in Wallingford. HealthyCT’s toll-free phone number is 1-855-HLTHYCT (458-4928).