Thursday, October 18, 2018
Health

Behind the scenes at the doctor's office, a new business model aims to keep you out of the hospital

TAMPA — Dr. Christopher Pittman's vein care practice looks like a typical doctor's office. Patients read magazines in a nicely appointed waiting area. Physicians scan medical charts and prepare for procedures.

Under the hood, however, it is a unique operation.

The practice, Vein911, is a member of the Tampa Bay Integrated Healthcare Network, a group of 150 local doctors working together to contain costs.

The physicians have a novel arrangement with the insurance companies Florida Blue and Cigna: If they can keep their 9,000 patients healthy — and out of the hospital, where costs are likely to accumulate — they get paid more.

Most other physicians are paid only by the office visit, test or procedure, a system some critics say rewards quantity of services over quality of care.

The network is among the first of its kind in the Tampa Bay region, Pittman said. But the concept, designed to encourage efficiencies in medicine, is becoming more popular nationwide.

"It's where things are going," said Gary Claxton, a vice president at the nonprofit Kaiser Family Foundation.

In some ways, such networks are an outgrowth of the Affordable Care Act. The federal health law encouraged the formation of so-called Accountable Care Organizations, or groups of doctors and other health care providers that are paid to serve a set group of Medicare beneficiaries.

The idea is now being applied to commercial health insurance. Florida Blue, the state's dominant health insurer, has nearly two dozen "accountable care arrangements" with physician groups and hospitals around the state, said Susan Scheetz, senior director of network programs.

Cigna inked five such agreements with Florida medical groups in January.

Most work like this:

The insurance company estimates how much it should cost to deliver care to a group of patients. If the physicians in the network can do it for less, they get to share the savings like a bonus.

Patients don't always know the arrangement exists. But they may reap the benefits. Their doctors may offer extended hours on nights and weekends, or hire a coordinator to provide followup care over the phone — measures that actually save the network money by preventing costly hospital visits.

"An office visit costs $75," Pittman said. "But a hospital visit could cost $75,000."

Physicians in the network can't just skimp on care. As part of their agreements, they must prove they are keeping their patients healthy. They use measures such as weight, body mass index and blood pressure.

Local physicians formed the Tampa Bay Integrated Healthcare Network four years ago. The group signed agreements with Florida Blue in 2015 and Cigna in 2016.

It is made up of 51 primary-care providers and 99 specialists, ranging from neurologists to podiatrists. It does not include a hospital.

"We are the first and only physician-led clinically integrated network in the Tampa Bay area," said Dr. Mona Boghdadi, the network's president and a family care physician at Our Family Doctor Clinic in Wesley Chapel.

Boghdadi said doctors in the network share health data and collaborate on how to treat patients with chronic illnesses. They connect with those patients on a regular basis.

"We stress preventive medicine and early detection," she said.

The group has other ground rules for keeping costs down. Physicians don't prescribe brand-name drugs that are advertised on TV, which tend to be more expensive than other medications. And they make sure they aren't ordering duplicative CT scans, X-rays and MRIs.

Neither Florida Blue nor the network would say how much savings the arrangement had generated in its first year. But Boghdadi said the network had nearly doubled its target.

"We are doing very well," she said.

A Florida Blue spokeswoman said similar arrangements had so far shown a 14 percent reduction in hospital visits, a 5 percent reduction in emergency-room visits and savings of $7 per patient per month.

Claxton, of the Kaiser Family Foundation, is skeptical the model can lower costs on a national scale. He said high-profile hospitals and physicians will remain in high demand — and will continue charging sky-high prices.

"The way to ultimately reduce costs is move (doctors) to practice care more efficiently and move (patients) away from the highest-price providers," he said.

But Pittman, the vein care specialist, is enthusiastic about the idea. He believes accountable care agreements could even help practices like his remain independent, rather than having to join large hospital groups to negotiate better rates with insurance companies.

"I see a pathway to do what's best for patients, maintain your integrity as a doctor and move the needle on health costs," he said.

Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

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