September 11, 2012

Insurer and PCPs Try Something New

Independent Health (a large and well-established insurer in upstate New York) announced this week that it has entered into an agreement with 140 primary care physicians in the area to offer much more highly coordinated care to IH beneficiaries.    They indicate that this is in response to the Affordable Care Act.

Here’s the strange thing – their description of the goals of the effort, called “Primary Connection” echoes eerily of the description of services provided at an on-site clinic, and the job description of the PCPs employed there.  To quote the article:  “They [the primary care physicians] and the insurer have agreed to a compact that demands the physicians meet certain expectations.  Among other things, they intend to improve communication with specialists and hospitals; use nurses to help coordinate services; share nutritionists, social workers and other personnel; measure the cost and outcomes of care; base some pay on meeting quality targets; and reimburse primary care doctors for work that often goes uncompensated, such as responding to calls and e-mails.”   I think someone at Independent Health was reading from the policy manual of an on-site clinic when they developed their goals!

Read the whole article, you’ll be amazed.  I believe they think they are inventing something new and unique when the model they are developing already exists in many on-site clinics all around the U.S.   The closing statement of the article is a quote from Anne O’Malley of the Center for Studying Health System Change:  “It could mean less unnecessary care, improved access to doctors and more satisfied patients.”   Wow, who knew?

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