James Mahoney is one of thousands of Idahoans who are guinea pigs in a new model of health care. It's a model the state hopes will stabilize skyrocketing medical costs, give health care providers a better way of doing business and help Idahoans stay healthy.
Mahoney is among the 17,384 Saint Alphonsus patients enrolled in this new system. Many more Idahoans are enrolled through other primary care groups.
At 76, Mahoney has several health issues. He sees specialists for osteoarthritis, early Parkinson's disease and other problems. His core team is led by Dr. Carla Pharris at a Saint Alphonsus Medical Group clinic in Boise.
A physician assistant at the clinic calls every so often to check on Mahoney, and his health care worker at home sends weekly reports to Dr. Pharris.
"There's no lack of support when we've needed it," Mahoney said.
Idaho won $3 million in federal funds about two years ago to craft a plan that would reward health care providers for being efficient and keeping their patients healthy - instead of the status quo, which pays providers to do more procedures, essentially rewarding them if they do a worse job and have sicker patients.
A group of stakeholders that includes insurance companies, Idaho Medicaid, local doctors and others used the grant to craft a master plan to change Idaho's health care industry. That plan just won Idaho a $39.7 million grant from the Center for Medicare and Medicaid Innovation. The money will be doled out mostly in contracts from the Idaho Department of Health and Welfare for technology, administration, organization, training and other expenses.
Over the next four years, it will affect most people in Idaho who get medical care.
The initiative will save $89 million in costs over three years - in both private and public health care spending - according to the state's application for the grant.
PATIENT AT THE CORE
The crux of the plan is something called a "patient-centered medical home," which functions like a homeroom for health care. Instead of bouncing around from clinic to clinic to see providers and specialists who might never talk with each other, much less collaborate, patients in the new model have a "medical home" clinic with a team focused on keeping them healthy. The state expects these "homes" to expand to a medical "neighborhood" tied into other services.
Idaho is one of 11 states notified last week that they received a total of $622 million in federal seed money to test new health care models.
The project has a few goals:
Save money by cutting back on waste and miscommunication.
Save money by keeping people out of the hospital and emergency room.
Improve Idahoans' health by, for example, calling to remind patients to schedule mammograms, tracking a patient's blood pressure through an online system or monitoring cholesterol levels on a regular basis.
Make it so physicians and other health care providers don't take a financial hit when they succeed in keeping their patients healthy, by paying for outcomes instead of just appointments and procedures.
A NATIONAL SHIFT
These ideas aren't new. It's a direction that Medicare, private insurers and other states already have moved in. The Affordable Care Act created many programs and grants aimed at accomplishing those goals. St. Luke's Health System CEO David Pate has pushed for similar changes within the St. Luke's system, signing on with a Utah health insurer to make changes in how St. Luke's is paid for its work.
Local hospitals and medical groups have spent millions of dollars on electronic medical records, which are part of the state's plan and a tool to more efficiently coordinate care.
Insurers, including Medicaid, have agreed to pay the medical home groups a set fee per month, per patient - instead of paying by the hour or by the lab test. If a doctor has a lot of very sick patients, that fee may be higher.
The grant includes incentive payments ranging from $5,000 to $20,000 for practices that make the switch to the new model.
The project will roll out over several years and eventually aims for 165 patient-centered medical homes available to Idahoans - not just those on Medicaid, but on many types of insurance - including virtual medical homes.
About $7 million of the grant will link providers to the Idaho Health Data Exchange so they can access and share patients' medical records, and it will pay their first year's fee. The project will promote access in rural communities to the "home" model as well, through funding for telehealth so that patients in Cottonwood, say, can have a psychiatrist in Boise as part of their team.
"Our goal is to impact 80 percent of the population," said Denise Chuckovich, deputy director for the Department of Health and Welfare. "My hope is that we will really transform Idaho's health care system and move away from paying for volume and move toward paying for (quality). ... Our current system isn't sustainable. We want to change."
THE EARLY TRIALS
The department has done a test run, with a core group of 27 health care organizations. Saint Alphonsus Medical Group was among the pilot participants, as was the Family Medicine Residency of Idaho, which provides care to uninsured and underserved patients and helps train family doctors.
The results in that first pilot group of patients were promising, according to people involved in the project. The pilot focused on chronically ill patients, so the results might not be as striking as the program rolls out to everyone.
Year over year, there was an 18 percent reduction in prescriptions, a 27 percent reduction in emergency room visits, and a 33 percent reduction in hospitalizations and other benefits, said Boise physician Ted Epperly, who runs the Family Medicine Residency of Idaho and is chairman of the coalition driving the initiative.
Three clinics run by Saint Alphonsus joined the pilot, including Mahoney's clinic on McMillan and Cloverdale roads. The clinics ended up with more satisfied, healthier patients and shorter waits for appointments, said Dr. Steven Brown, a Saint Alphonsus executive who is leading the push for patient-centered medical homes at Saint Alphonsus.
"It works," Epperly said. "That's what we're trying to achieve when we talk about better health, better health care and lower costs."
Audrey Dutton: 377-6448, Twitter: @IDS_Audrey