When it comes to healthcare dollars, treating the chronically or seriously ill accounts for an estimated 84 percent of all U.S. healthcare spending
. Knowing this, CareFirst BlueCross BlueShield decided that to impact costs, it needed to focus on this category of patients as well as those at risk of becoming chronically or seriously ill. CareFirst determined that the fragmented nature of patient care and poor insight into costs were key factors. Improving the quality of care and, simultaneously, reducing the cost would require innovative and highly scalable ways to coordinate cost-effective care.
Primary care physicians (PCPs) are critical to accomplishing these goals, because of the influential role they play in patients’ medical lives and because of the day-to-day referrals they make to specialists, hospitals, and outpatient facilities. Primary care physicians are the hub of patient care, deciding when patients need to be referred and, ideally, coordinating their care with the preferred providers. As such, they are a branch point that drives the cost and quality of patient care. When individuals become chronically or seriously ill, the primary care physician’s impact on the patient’s treatment and cost of treatment is dramatic.
So, CareFirst BlueCross BlueShield CEO Chet Burrell initiated a pilot to test ways of improving treatment while lowering treatment costs, with primary care physicians as the focus. For the pilot, CareFirst asked participants to create medical panels of 10–15 primary care physicians from different practices to operate as virtual patient-centered medical homes. Using Microsoft technology, CareFirst then gave these physicians the tools to stratify seriously ill and at-risk patients in their practice.
CareFirst started by giving the physicians insight into cost and quality performance relative to their peers. For the first time, these PCPs could see detailed information about the care they were providing patients and how it compared with that provided by other physicians. Panel members could see many different quality-of-care measures and a complete analysis of the cost of care for each patient. Using Microsoft SQL Server and Microsoft SQL Server Reporting Services, they were able to see aggregated data to get a better picture of care and costs across their practices and to compare that data with one another. Physicians leveraged the insights they gained to improve care and reduce costs.
To equip physicians to collaboratively
manage the care of these high-risk patients and to coordinate that care across the provider community, CareFirst provided them with tools like Microsoft Lync and Microsoft SharePoint Server. Lync allowed local care coordinators, nurses, and physicians to continuously communicate with each other and to collaborate around a common care plan focused on each patient. SharePoint technology enabled them to gather information from across the network and to continuously update the care plans for each patient. As Burrell describes in this video
, the primary care physicians and their staff were then able to have complete and accurate information on each patient’s treatment and medical status when meeting with that patient.
The powerful combination of Lync and SharePoint technology enabled multi-disciplinary teams in each community to easily and instantly find and communicate with each other, arrange calls and meetings, work together, and coordinate care virtually―as if they were in the same location. Moreover, teams were able to exercise control over the medical care of each patient to drive better outcomes at a lower cost.
Because these primary care physicians played a central role in referring patients to potentially more costly specialists, CareFirst gave them cost information for the specialist network. The primary care physicians could factor the cost of different specialists―in addition to the quality of the specialists’ care―into their referral decisions. By giving PCPs access to information about the downstream costs of their referrals, CareFirst found that the information had a definite impact on PCP decision-making.
Based on the early success of the pilot, CareFirst immediately moved to a full implementation in its larger physician network. The program has grown rapidly. As of February 2012, CareFirst has assembled close to 300 panels involving some 3,100 primary care doctors
, with more than 20,000 patients participating. Full results are pending, but initial indicators are that physicians are happier, patient satisfaction is high, and seriously ill and at-risk patients are being seen more often. Based on the pilot, CareFirst is confident that significant savings will result from physicians’ greater access to patient and cost data, provided through Microsoft technology.