One central question the pilot program is expected to answer is whether it is feasible to do away with fee-for-service provider reimbursements, which Ms. McAnallen said are, in her opinion, at the crux of the current national health care crisis.
“You go to your physician, they do something, they submit a claim, they get a check. We haven’t put in a system that makes providers, whether hospitals or physicians, step back and say, ‘Let’s do this differently. I’m on a treadmill of fee for service. The more I produce, the more I get paid.’ This IBD pilot program is to really help us transform that payment structure.”
Intangible factors such as how much of a specialty medical home’s success is predicated on the verve of its leadership will also be evaluated. “If you don’t have a physician who will be the [medical home’s] champion, it will be very hard to replicate,” Ms. McAnallen said. Attracting ambitious specialists with the opportunity to create such an integrated care model could become a recruitment tool for UPMC, she added.
If the concept of a one-stop-doc-shop sounds slightly “what was old is new again,” harkening back to the days when physicians were called doctors, never “providers,” and largely were thought of as family friends who made house calls, said Dr. Szigethy, it’s because it is that model, amplified by modern means.
“We can’t go to patients’ homes because they’re even more widespread than they were back in the day of the village, but what we can do is provide care through the ancillary team members who are extraordinarily well trained, and can provide education on nutrition and medication. Whether it’s by telemedicine or face to face, patients are getting treated in an integrated way, and we’re doing it as efficaciously as possible. That is brand new.”
Dr. Regueiro said in an interview at least one other insurance company has expressed interest in learning more about the IBD center’s integrated approach, causing him to reassess the payer’s role in health care’s revolution. “There is more common ground between us than I once thought. Insurers are not the devil. They are central to improving value.”
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