Powered by The Atlanta Journal-Constitution

Web Search by YAHOO!
 

Updated: 9:22 a.m. Sunday, Oct. 6, 2013 | Posted: 9:22 a.m. Sunday, Oct. 6, 2013

Health reform measures pushing Conn. to innovate

By SUSAN HAIGH

The Associated Press

WALLINGFORD, Conn. —

While Connecticut embraced setting up a health insurance exchange and expanding Medicaid eligibility faster than many other places, the state has lagged behind when it comes to modernizing how health care is delivered to patients.

But with the new health care overhaul law and a growing push in the state to cut costs while improving patient care, Connecticut is now moving toward a streamlined and better-coordinated, patient-centered system of medical treatment.

"Connecticut has been a little bit slow to adopt many of these things, but I see it happening very quickly over the next five years," said Ken Lalime, CEO of the new nonprofit health insurance company HealthyCT.

The Wallingford-based HealthyCT offers small group and individual plans in the state's new online insurance exchange, known as Access Health CT, as well as outside the exchange.

Using money from a loan from the federal government, HealthyCT is providing hundreds of thousands of dollars to 75 medical practices across Connecticut, representing a total of 440 clinicians. The grants will enable them to become certified as a patient-centered practice. They're also referred to as patient-centered medical homes, a concept that's been embraced in neighboring Rhode Island and Massachusetts.

Once certified, these medical practices will take a new and more holistic team approach to treating their patients and anticipating their individual needs. For example, a primary care practice would plan ahead and have other practitioners, such as a diabetic nurse clinician or nutritionist, on hand for a patient's appointment.

"So when the patient comes through the door, we manage that event differently than we managed it before," Lalime said. "You are getting the right care at the right time, at the right place — for the first time, more often."

Once these 75 practices are trained and certified — a process that takes about eight months — Lalime estimates that about 40 percent of the state's primary care doctors will operate using a patient-centered approach in Connecticut.

"I think 10 years from now, there will be much more integration of care, and care coordination will be the standard," Lalime said. "And consumers should be looking for practices that actually function that way."

Such an approach, Lalime said, should eventually reduce the amount of times a patient might visit a hospital emergency room or inappropriately go to a specialist, both costly scenarios. Lalime estimates that the price of one emergency room visit, about $2,000, would cover the cost of 20 coordinated office visits, while the cost of a typical hospital visit, about $30,000, would cover 300 coordinated office visits.

Unlike managed health care, where insurance companies tend to be the gatekeepers that decide which procedures to cover, this new concept "puts the patient at the hub" while the practitioners and the patient's primary care doctor are the spokes, Lalime said. The state of Connecticut has received a $2.8 million grant from the U.S. Department of Health and Human Services to develop an application for a $45 million grant to design a new health payment system in the state that will support coordinated patient-centered care.

In Fairfield County, a new group is trying to make it easier for solo practitioners to provide patient-centered care. St. Vincent's Health Partners Inc. is a new physician-hospital organization created in 2011 by St. Vincent's Medical Center in Bridgeport and a group of doctors trying to determine how best to respond to federal health care reform efforts.

The concept allows the member doctors to remain independent but have access to resources available for large medical groups, such as electronic health records, patient management tools, group purchasing discounts and data sharing and quality management. Tracking systems will make sure people don't get duplicative tests or procedures they don't need and will remind them of upcoming appointments and tests.

Thomas Raskauskas, the organization's president and CEO, said a lot of independent practitioners are busy and find it overwhelming to understand all the complexities of health care reform, and they don't have the money to handle patient population management.

"This allows them to stay in solo practice without having to join a group," he said.

Copyright The Associated Press

More News

 

Today on MyAJC.com

Hotoberfest kicks off another season of beer festivals

Hotoberfest kicks off season of beer festivals

Looking for something to do this weekend? If you are a beer lover, you might want to check out Hotoberfest 2013 at Historic Fourth Ward Park on North Avenue.

APS superintendent: Close 13 schools

Image hurts, helps in search for new superintendent

The hunt for a new leader of Atlanta Public Schools has picked up steam, with superintendent candidates being targeted from across the country to replace Erroll Davis, who will retire next year.

myajc logo 300x225

New 24-hour Digital Pass: Sample all of MyAJC.com for 99 cents

With a 24-hour digital pass, you can enjoy full versions of premium articles, news updates and access to the AJC online archives.

Irresistible news

Governor compares gay marriage to incest

Pennsylvania Republican Gov. Tom Corbett is in hot water after he compared same-sex marriage to incest in a TV interview.

Comments  (31)  

Tiger mauls employee at animal sanctuary

An Oklahoma woman is recovering after a tiger attacked her at a zoo in Wynnewood about an hour south of Oklahoma City.

Comments  (6)  

AP IMPACT: Families hoard cash 5 yrs after crisis

Families hoard cash 5 yrs after crisis

They speak different languages, live in countries rich and poor, face horrible job markets and healthy ones.

5 achievements that haven't won a Nobel Prize

5 achievements that haven't won a Nobel Prize

The announcements of this year's Nobel Prize winners will start Monday with the medicine award and continue with physics, chemistry, literature, peace and economics.

Latest in news

SAT scores align with family wealth in Georgia.

AJC special report: SAT scores rise with family wealth. A notable exception in state: Norcross High

The AJC education team looked at recently released 2013 SAT scores for metro Atlanta high schools and found something that critics have long said: Scores are closely tied to a factor beyond any student's aptitude: the amount of money their parents have.