By Lauren Wanko
Senate President Steve Sweeney this afternoon announced a pilot program he says will improve health care and reduce cost.
“I know that’s hard to believe, but it is doable, it is very possible to get done,” he said.
The Senate president’s calling for the creation of a patient-centered health care pilot program made up of as many as 60,000 public employees and their families who voluntarily choose to join in.
“What we’re talking about here is primary care centric where you go to a doctor like you used to when I was a young man and spend the time that’s necessary to get an established relationship with the doctor, where they get to know you and they manage your care, where you have access 24/7 to that doctor,” Sweeney said.
In the program, a physician would be limited to no more than 1,000 patients, they’d be paid a set monthly amount with bonuses based on patient satisfaction and clinical outcomes.
And who would pay that fee?
“That would be the physician’s groups that they participate in,” explained Mark Blum, executive director of America’s Agenda. “The physicians are being paid on a per member, per month basis and we would ask the practices to actually bid in a competitive way to say we will meet the quality standards the state has set and actually compete on what that per member, per month fee would be, so the state is actually going to use the marketplace to drive the most efficient providers of high quality care to attract them.”
Program participants would be guaranteed same-day or next-day appointments for urgent care with no out of pocket co-pays or deductibles when they visit their primary care doctor.
“If right now firefighters or teachers are paying a percentage of their current health premiums, that is not impacted by this proposal, expect that as we deliver better care at lower cost, as the premium prices fall, they’re paying a current percent of a smaller premium price. That saves money immediately for the firefighter, the teacher,” Blum said.
The program would be overseen by the administration and union representatives to the Design Committees of the two state employee health benefits plans.
“We’re gonna need management to buy in, at least one management vote because they’re joint boards with equal numbers. It makes all the sense in the world for them to do this,” Sweeney said.
Blum says the pilot program, which has already been implemented in other states and the private sector, will eliminate a primary care doctor’s “fee for service” in which doctors are paid based on the number of patients they see daily.
“My patient panel is about 2,500 or 3,000 patients, something like that. I can’t tell you how exciting that is to me as a physician to hear about a patient panel of 1,000. To me, that’s VIP medicine, that’s concierge medicine,” said Dr. Jim Holton, primary care internist.
There would be five pilot regions in state for the program — areas where there’s a high concentration of the public employees in the program.
“There would be many clinical locations in each of those regions,” Blum said.
The pilot program would last three years — time, Sweeney says, to collect data needed to potentially move toward a new type of health care for all public sector employees.