Keene hospital joins new program

Jul 21, 2010 — The Keene Sentinel

Dave Eisenstadter

Jul. 21, 2010 (McClatchy-Tribune Regional News delivered by Newstex) -- Should hospitals be paid for keeping patients healthy enough to reduce visits?

A new national program of "accountable health organizations," which Cheshire Medical Center/Dartmouth-Hitchcock Keene has been selected to join, is intended to do just that.

The program is a good fit, continuing work started through the merger between the clinic and hospital in 1998 to offer more coordinated care, and the organization's mission of Vision 2020, an effort to make Cheshire County the healthiest county in America by the year 2020, according to Chief Administrative Officer Arthur W. Nichols and Chief Medical Officer Dr. John G. Schlegelmilch.

The new system will provide incentives for hospitals to stop potential problems before they result in costly hospital visits, they said .

Currently, for a hospital to be reimbursed by an insurance company, the hospital must provide a service -- "medical widget" is the industry term -- which involves a patient coming into the hospital.

Preventative care that keeps patients out of the hospitals is not reimbursable.

"In the current fee-for-service model, patients come in to be seen, but that might not be necessary," Schlegelmilch said.

Under the accountable care organization model, hospitals will share in savings from keeping patients healthy, savings currently realized by insurance companies.

This will be accomplished through sitting down with New Hampshire's primary insurance providers -- Anthem, Harvard Pilgrim, MVP and Cigna (NYSE:CI) -- to work out a new reimbursement model.

With a funding model taking prevention into account, the idea is that health care providers will take a more active role in patient health, rather than leaving it up to the patient to come in when he or she is sick, according to Nichols and Schlegelmilch.

The program will provide incentives to coordinate efforts among different health care organizations and to engage in evidence-based protocols, the practices that the medical community agrees are the most effective. Cheshire Medical Center/Dartmouth-Hitchcock Keene does this already, according to Nichols and Schlegelmilch, but loses money while doing so.

"We've been following evidence-based protocols for a while; this is not going to be a major change on our part," said Nichols. "One of the advantages of group practice is we can get together and agree on what makes sense."

One expected change is that care coordinators -- "health coaches," according to Nichols -- will work with patients and their primary care physicians on issues such as healthy diets and quitting smoking. Currently, no one at the hospital serves that role.

Primary care, historically an unpopular choice for medical students, will have a brighter future under this model, Nichols said. By heading a team of care coordinators, the primary care physicians will be able to help more patients through fewer visits.

Additional hires and spending will result from this program, but the financial health of the hospital will improve because of the incentive system, according to Nichols and Schlegelmilch.

The effectiveness of the program will be measured through electronic medical records, which Cheshire Medical Center/Dartmouth-Hitchcock Keene has used for 10 years.

"There will be more management of statistics than you can shake a stick at," Schlegelmilch said. "That's the purpose of the pilot program. We will have cost data and quality data, because we don't want one without the other."

Using electronic medical records, health care providers are able to identify who is in the high-risk population for certain diseases, which patients have which conditions, and are also able to notify patients when they are due for certain shots and their regular checkups.

If patients do not show up for those appointments, the accountable health organization model encourages doctors to get in touch with those patients and reschedule, Nichols and Schlegelmilch said.

In the long run, the hope is to reduce chronic illness, obesity and unhealthy behavior, which will result in a healthier population and less need for hospital visits, Nichols and Schlegelmilch said.

Other program participants include Central New Hampshire Health Partnership, Exeter Health Resources, Southern New Hampshire Health System in Nashua and a North Country initiative that incorporates Ammonoosuc Community Health Services, Cottage Hospital, Littleton Regional Hospital and North Country Home Health and Hospice.

The program will run for five years, the first of which will be spent designing how it is going to work. Major changes to medical care are unlikely to take place before 2012.

Whether the program works is yet to be seen, but Nichols and Schlegelmilch expect an improvement in the health care provided.

"The previous system was a very reactive system, not a proactive system," Schlegelmilch said. "That's not the best way to deliver health care."

Dave Eisenstadter can be reached at 352-1234, extension 1432, or deisenstadter@keenesentinel.com

Newstex ID: KRTB-1475-47164055