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.”