Research Reports & Market Briefs

Patient-Centered Medical Homes and ACOs: How Health Plans Are Transforming Provider Incentives and Improving Quality

Get the Inside Scoop on Health Plan Involvement
in Patient-Centered Medical Homes and Get the Jump on the Competition

Health plans are playing a key role in the development of patient-centered medical homes - pioneering new provider reimbursement structures, bonus pools, care management programs and other incentives and innovations to help change provider practices.

The goal is familiar: improved care at a lower cost. But the question is whether patient-centered medical homes - along with Accountable Care Organizations fostered by healthcare reform - are the answer? Or are they just another attempt - as one skeptic stated - "to change the landscape without changing the landscape," and as such are doomed to fail?

Either way, the PCMHs and ACOs are the latest fad - and health plans are funding a wide variety of pilot programs to test the concept.

Patient-Centered Medical Homes and ACOs: How Health Plans Are Transforming Provider Incentives and Improving Quality is a 100-page report that provides an overview of the concept and outlines various health plans initiatives.

In this report you'll learn about...

• A medical home initiative that has helped Blue Cross Blue Shield of Michigan reduce radiology, emergency room and inpatient utilization by up to 3%.
• WellPoint's multi-payer collaborations in 10 pilot projects, including the results of a Colorado initiative illustrating both the promises and challenges of attracting providers to the medical home model.
• How Excellus Blue Cross Blue Shield and MVP Health Plan have teamed up on a three-year medical home pilot to target patients with chronic conditions such as diabetes, asthma and hypertension.
• Lessons from integrated delivery systems such as Kaiser and Group Health that might be applicable to medical home or ACO models in a network setting.
• Efforts by CareFirst and the state of Maryland to roll out an extensive medical home program by Jan. 1, 2011 - involving 50 physician practices, 200 primary care providers and 200,000 Maryland residents.
• Learn about the Managed Medicaid experience at CareSource and how their alternate reimbursement model has catapulted provider uptake.
• Review deep case studies of Oklahoma's SoonerCare State Initiative and San Francisco's municipal project with delineated reimbursement tiers and outcomes three years after program launch.

About the Authors:

Alicia Chung, Senior Editorial Analyst, Corporate Research Group, manages the competitive market analysis consulting projects for CRG. She is the co-author of ROI and Outcomes of Wellness Initiatives, Best Practices of On-Site Employee Health Clinics, and The Consumer-Driven Healthcare Revolution: Myth or Reality?. Before joining the CRG team, Alicia served as a pharmacy contracting and compliance analyst for IMS Health. Her work includes research and consulting on rebate pricing methodologies related to Medicare and Medicaid, training and development of disease management programs, and various public health data management projects. She holds a Master's Degree in public health from Tufts University.

Carl Mercurio, President of Corporate Research Group, overseeing a broad-based franchise in healthcare information publishing. Thousands of healthcare industry executives rely on CRG's commentary, consulting, data and expertise for strategic planning, market research and new product development. CRG's various information products include the Managed Healthcare Market Report, Outlook for Managed Care, and various print and electronic databases and special reports. Mercurio has 20 years of experience in consulting, market analysis, and information publishing. Prior to joining CRG, Mercurio was editorial director of Simba Information, which publishes newsletters and research reports on the media industry. He is a graduate of the University of Connecticut.

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