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Capital District Physicians Health Plan

CDPHP AND TRANSFORMED IN THE NEWS The Road to PCMH "... Capital District Physicians' Health Plan, Inc., a physician-founded and guided nonprofit health plan in New York state has been experimenting with the PCMH model since late 2008. Concerned with 'the plight of primary care physicians,' the board embarked on a multiphase pilot to test PCMH. The primary objective was 'revising the payment model,' says Bruce Nash, MD, chief medical officer of CDPHP. 'Delivering the same or better care at a lower cost is the quality marker,' he explains ... " • Read the article at HealthLeaders Media » CDPHP pilot program shows good results "... Capital District Physicians' Health Plan is saving $32 per member, per month, at the three primary care practices that made up the first phase of its patient-centered medical home pilot. The Albany-based health insurer is working with 21 other area practices for the second phase, and is ready to recruit additional primary care providers for the third part of the initiative, which it is now calling the CDPHP Enhanced Primary Care program. “The program’s initial results have thus far exceeded anyone’s projections,” said Dr. Bruce Nash, chief medical officer for CDPHP ... " • Read the article at The Business Review » • Read more about CDPHP's pilot program and TransforMED's role »

Capital District Physicians Health Plan (CDPHP), a physician-founded and physician-governed health plan based in Albany, New York, selected TransforMED to facilitate a 30-month pilot project to fully transform three primary care practices to patient-centered medical homes.

CDPHP works in tandem with approximately 10,000 physician partners and over 7000 employers throughout the New York and Vermont service areas. Rather than stand on the sideline, CDPHP forged an alliance with TransforMED and three practices — Schodack Internal Medicine and Pediatrics, Latham Family Medicine and Clifton Park Family Medicine — to create a medical home pilot program designed to transform primary care practices and payment models in the Capital District.

TransforMED Practice Enhancement Facilitators are currently working with the three participating practices and CDPHP to help transform the payment models within the Capital District and to improve patients' ability to access care when needed; coordinate patient care so it is seamless between practices, hospitals and specialists; and improve the patient, staff and physician experience.

The payment model being used in the pilot is called the risk-adjusted comprehensive payment model for comprehensive care. The payment model was created by Allan Groll, M.D., an internist and professor of medicine at Harvard Medical School and Massachusetts General Hospital in Boston, the model calls for risk-adjusted, outcomes-based bonuses that could constitute up to 25 percent of a physician's base pay. The risk adjustment element provides an incentive to physicians to take on even the sickest of patients, which physicians sometimes were reluctant to do under the current payment system.

"Data gathered from this project could ultimately save primary care," said Brian Morrissey, VP of strategy and development for the CDPHP. "The health plan's board of directors were convinced that fee-for-service and resource-based relative-value scale reimbursement are at the core of the demise of primary care. It's important for us to find a way to reimburse primary care physicians the right amount for the right level of care," added Morrissey.

"There are no productivity issues under this payment model because physicians are not paid based on how many patients they see a day, said Terry McGeeney, CEO of TransforMED. "We're honored to have been selected and to be working in this practice transformation initiative and look forward to supporting these practices and CDPHP in the future," said McGeeney.

The pilot program will serve as a model of quality and efficiency for the wider community and is designed to address some of the economic concerns of primary care physicians within the state. It is also based on a well-documented theory that access to comprehensive, coordinated, continuous and personalized care improves health status, facilitates disease management, lowers cost, and permits a more equitable distribution of care.

Another unique component of the pilot program is CDPHP's willingness to make the project an all patient demonstration, implementing the patient-centered medical home model for all patients within the three participating practices rather than just the patients who are currently covered by CDPHP. The pilot program will also include patients covered by Medicare and Medicaid.

"Rising health care costs, lack of care coordination, and declining patient and physician satisfaction have contributed to a crisis in primary care," said James Leyhane, Internist from Schodack Internal Medicine and Pediatrics, a participating practice in the pilot. "The medical home ensures personalized care of patients and access to the right care, when and where it is needed."