Game changing idea: Specialty intensive medical home

For more than 30 years, many Blue Cross and Blue Shield of Illinois (BCBSIL) members have benefited from value-based care initiatives, such as accountable care organizations, episode-based payments, health maintenance organizations, pay-for-performance, population-based payment, and medical homes or intensive medical homes (IMHs).

IMHs focus on improving patient access, care coordination and illness management, especially among those individuals needing treatment for chronic illnesses. The aim of an IMH is to move away from fee-for-service to providing incentives for quality outcomes and improved population health in physician practices.

The concept: Specialty IMHs

Back in September 2014, BCBSIL announced the first specialty IMH in the state, with the Illinois Gastroenterology Group (IGG), the state’s largest independent gastroenterology practice. Participating patients have Crohn's disease, a high-risk chronic inflammatory bowel disease that causes a high incidence of complications.

Today, nearly 350 patients are in the specialty IMH, according to Donna Levigne, divisional senior vice president, Illinois Health Care Delivery, BCBSIL.

“Recent results show that for Crohn’s specific costs and utilization-the IGG population is out-performing in all areas: hospital admissions, emergency room [ER], outpatient visits and office visits,” says Levigne. “We will be adding three more gastro IMHs this year.”

In the specialty IMH, a nurse care manager conducts initial outreach to patients identified as the most critically ill. The patients receive a call, letter or email inviting them to enroll in the program at no cost. At an initial intake visit with the patient, the nurse does an assessment of medical and psychosocial needs and develops an action plan. The nurse monitors the patient’s progress against the action plan, assists with care coordination and offers resources.

Illinois Gastroenterology Group uses a care management tool developed by SonarMD to enhance communications with its IMH patients. Once enrolled in the platform, patients receive monthly secure communications, which include questions designed to tell staff how the patients are doing. The answers to the questions produce a “Sonar Score,” a numerical value that correlates with symptom intensity. The slope of this score is then plotted over time to reveal trends. This monitoring can lead to intervention by a physician earlier than a patient would have initiated it.

The result: a decrease in emergency room visits, hospitalization rates and their associated complications, according to BCBSIL.

BCBSIL recently went live with another group to form a specialty IMH: Rockford Gastroenterology Associates.

In March 2016, it announced the first oncology IMH pilot program in Illinois with Illinois Cancer Specialists. To qualify, patients must be receiving chemotherapy or hormone therapy, with a cancer diagnosis of breast, colon, lung, pancreatic, prostate and any non-Hodgkin’s lymphoma. The program intends to enroll 150 to 200 patients per year.

Some of the key aspects of the BCBSIL/ICS Oncology IMH model are:

• Access to cancer care that is coordinated with the central focus on patients and their entire medical condition;

• Cancer care that is optimized based on evidence-based medicine to produce quality outcomes;

• Cancer care that is efficient, with treatment provided in a high-quality, low-cost setting for the patient;

• Cancer care that is delivered in a patient-centric, caring environment that optimizes patient satisfaction; and

• Cancer care that is continuously improved by measuring and benchmarking results against other facilities providing care, so that best practices “raise the bar” in delivering care.

“The goal is to improve their quality of life, while reducing avoidable complications and associated treatment costs,” says Levigne. “It supports our goals of improved outcomes and better health for our members, while moving reimbursement away from fee-for-service payments to those that are payments for value.”

Next: A Q&A with Levigne

Managed Healthcare Executive (MHE): What is the goal of the intensive medical home (IMH)?

Levigne: Intensive medical homes and specialty intensive medical homes are part of our suite of value-based care (VBC) models. VBC is the payment structure that rewards physicians and hospitals for achieving the best possible outcomes for patients at the lowest possible cost. BCBSIL introduced VBC in the late 1970s with the launch of HMO Illinois. Specialty medical homes are one of the ways we are evolving and customizing these programs-there isn’t a one-size-fits all solution to meet the needs of patients, payers and providers.

For many with chronic illnesses, their specialist serves essentially as their primary care physician. So, by developing IMH programs with specialty groups we are helping patients who can benefit the most from the enhanced access, care coordination and illness management that VBC provides.

MHE: How are IMHs different from traditional medical homes? What are the benefits?

Levigne: When we started our initial specialty IMH with Illinois Gastroenterology Group in 2014, it was the first specialty IMH in the state of Illinois. It uses a tool developed by SonarMD, which utilizes smartphones to help physicians monitor a patient’s status. BCBSIL has now contracted to expand that IMH program to other gastroenterology groups.

The BCBSIL intensive medical home programs initially focused on large primary care physician groups and have expanded to include hospitals, small primary care practices and specialists. BCBSIL’s specialty IMH’s use evidence-based clinical guidelines and clinical data to help drive medical decision making and improve quality of care for our members.

MHE: Can you tell us more about the technology used in the IMHs?

Levigne: Project Sonar uses smartphone technology to enhance physicians’ communications with their IMH patients with Crohn’s disease. We’ve signed an exclusive contract with Sonar and plan to use it to expand and add more IMH’s this year.

MHE: What specific results can you share as far as the Crohn’s disease program goes?

Levigne: Enrollees get texts with information/reminders and those who respond or acknowledge receipt are considered “pingers.” We’ve found $6,000 in savings for each “pinger” versus “non-pinger.” There were 81 pingers-resulting in almost half a million dollar savings.

MHE: What are some of the challenges of IMHs?

Levigne: It’s tough work to come up with solutions to help patients manage complex diseases. We believe the specialty IMH model, aimed at improving patient care while reducing costs, has enormous potential for making the healthcare system work in a sustainable way. We’re interested in targeting diabetes, multiple sclerosis and other disease states.

MHE: What have you learned in this implementation process? What advice do you have for executives?

Levigne: The SonarMD platform works because it is built by physicians, utilizes existing practice resources and is incredibly targeted. The platform is currently appropriate for Crohn’s and ulcerative colitis patients and since it’s not trying to be all things to all people with all chronic illnesses but rather built by a physician who understands this small population with a very specific chronic illness it is built for success.

Tracey Walker is content manager for Managed Healthcare Executive.