By Josh Goldstein

May 13, 2008 (McClatchy-Tribune Regional News delivered by Newstex) --
Today, the region's largest health insurers will start paying more than 150 family doctors and other caregivers to more closely track their patients' care and conditions.

The effort seeks to make caregivers more accessible to their patients through e-mail and phone calls and to educate them to take better care of themselves.

Independence Blue Cross, Aetna (NYSE:AEF) (NYSE:AET) , and four other insurers plan to spend $13 million over three years to finance the first phase of the initiative at 32 local primary-care practices. All told, about 220,000 patients in Southeastern Pennsylvania will participate, making the program among the largest of its kind in the nation, according to those involved.

"Our whole premise is that if we implement a model that takes a proactive approach and changes the way primary care is practiced, we will improve patient care . . . and ultimately save money," said Phil Magistro of the Governor's Office of Healthcare Reform, which is leading the effort.

For some experts, the approach is strikingly similar to past failures.

"In many ways, it is a return to the idea of integrated delivery, which is the original concept behind HMOs," said Mark V. Pauly, professor of health-care management at the University of Pennsylvania's Wharton School. "I doubt it would save money. . . . The best we can hope is that it will improve the quality of care."

The proposal comes as health costs keep rising. Health insurance keeps getting more expensive. And employers are continuing to cut benefits by raising co-pays or eliminating coverage. One factor driving these costs is the expensive care of people with chronic conditions, such as diabetes and asthma.

The initiative starting today is the first phase of Gov. Rendell's chronic-care model for Pennsylvania, which is expected to go statewide this fall.

The effort is part of Rendell's ambitious Prescription for Pennsylvania proposal, which seeks to expand access to health coverage for the uninsured and reduce medical errors. While the health-insurance expansion has stalled in the legislature, the quality initiatives have moved ahead since they were first proposed in January 2007.

The goal in chronic care is now to transform the way all primary care is delivered and how it is paid for.

Instead of the traditional way -- paying by the procedure -- the program will reward caregivers for how well they dispense proven treatments and keep patients healthy.

Practices will also track patients by using special computer software. Doctors would set aside unscheduled time, allowing sick patients to get appointments within 48 hours.

At the same time, patients will be asked to take a greater role in maintaining their own care.

As the region's largest health insurer, Independence Blue Cross estimates it will spend from $5 million to $6 million to help the 32 participating practices build the necessary infrastructure, from computers to extra staff.

"There are a lot of reasons for that kind of investment," said Richard Snyder, senior vice president for health services at Independence.

"The first thing we hope to accomplish is to increase the use of evidence-based medicine and improve the quality of care," Snyder said. "And by keeping control of chronic illnesses that we know over time will deteriorate, we hope we will decrease costs."

Snyder and others say they will analyze results to see whether the program is working.

"One of Aetna's interests in this, and others nationally, is to see if by transforming the way primary care is delivered, can you demonstrate a positive impact on quality and cost?" said Don Liss, medical director of the insurer's Mid-Atlantic region.

Allan Crimm and the eight other doctors at Ninth Street Internal Medicine Associates in Center City are excited about the initiative because it fits with their approach to patient care and promises to give them the financial resources they need to build a more proactive practice.

"Honestly it has been sort of a lonely process to be doing this," Crimm said. "In order to be able to do these things -- to have a Web site, to have more patient education in the office -- we need more resources. And we also need more time to be able to step back and think about how to do things better."

Today, Crimm and three colleagues will join representatives of the 31 other participating groups at Temple University for the first regional "learning collaborative" that officially launches the initiative.

Other participating practices include the North Willow Grove Family Practice in Montgomery County, Jefferson Family Medicine Associates in Center City, and CHOP Primary Care of South Philadelphia. Among the nurse practitioner-run practices are the Rising Sun Health Center and PHMC Health Connection in Philadelphia.

"This whole concept of the medical home is a way of reengineering patient care for the 21st century," Crimm said. "This gives us additional resources to do things that we would love to be able to do that we can't afford."

Ultimately, the initiative's success may depend on whether patients buy into the new approach.

"That is the real challenge," said Wharton's Pauly. "Some people just aren't about to be educated about their own health. They have their own preferences."


Contact staff writer Josh Goldstein

at 215-854-4733 or jgoldstein@phillynews.com.

Newstex ID: KRTB-0160-25219555