Premier Medical Associates begins tracking results of proactive care with pilot programs

Doctors at the Pittsburgh region's biggest independent medical practice say they've been providing a better value for the consumer's health care dollar than other groups for years. And they have the word of two big insurers to prove it.

Now, Premier Medical Associates has begun documenting the advantages of the care they provide, positioning the practice as a high-value provider at a time when the reimbursement paradigm is shifting to how well the patient does after treatment overall rather than the number of procedures performed.

"High-quality health care is less expensive and less expensive in a significant way," said internist Dr. James Costlow. "If you increase quality, you become efficient, and, in turn, you decrease costs."

Monroeville-based Premier has some 60 doctors, 16 offices, a medical imaging center, sleep disorder clinic and blood lab. Premier has remained stubbornly independent as the region's two big health systems have been on a medical practice buying binge, allowing Premier's doctors to admit patients to both West Penn Allegheny Health System and University of Pittsburgh Medical Center hospitals.

Separating Premier from competing physician practices is a focus on proactive care, which helps patients avoid unnecessary hospitalizations and trips to the emergency department, Costlow said.

At the heart of the approach is a computerized patient registry. The registry allows Premier's doctors to track patients with chronic health problems such as asthma and congestive heart failure, making sure prescriptions are getting filled and doctor's appointments are kept.

Use of the registry dovetails nicely with Premier's participation in two patient-centered medical home pilots, which are sponsored by UPMC and health insurer Highmark Inc. Medical homes are souped-up HMOs, where the totality of a patient's wellbeing is the focus of care, rather than providing specific procedures.

In both experiments at Premier, doctors are paid for services rendered in addition to receiving bonuses for meeting certain quality care benchmarks. Pay for performance is a forerunner of bundled payments for services, which Medicare has been trying out in several parts of the country.

On Aug. 23, Medicare opened a new round of applications for hospitals that want to participate in a bundled payment program, which pays hospitals for providing a range of services related to, say, heart bypass or hip replacement. One such project saved Medicare $42.3 million and saved patients $7.9 million in coinsurance while improving care and reducing mortality.

And Premier has a history of making the proactive approach work. Jerry Dioguardi, vice president at Harrisburg-based health insurer HealthAmerica, said Premier is shifting the discussion about health care to patient outcomes rather than fee for services.

"They provide a tremendous amount of value in managing care in such a way that it's preventative of more services down the line," he said. "Not all providers do that."

Within Highmark's network, Premier has been a "low-cost provider of primary care services among comparable practices," according to spokesman Michael Weinstein. Premier's strength is coordinating care for patients, avoiding duplicate and unnecessary testing, said Harold Miller, executive director of Center for Healthcare Quality and Payment Reform.

"They have been very focused and very successful in reducing hospitalizations and lengths of stay in hospitals," he said.

Although HealthAmerica and Highmark officials say Premier has a better approach to providing care, the practice has not fully developed its own metrics to measure results, said Premier CEO Mark DeRubeis. Participating in the medical home pilots is giving the practice the opportunity to begin tracking results.

"We're really just establishing the infrastructure for the pilots, identifying measures and identifying gaps in care," he said. "The medical care home is all about care coordination, something we've been engaged in for a long time. Our mission is to educate people on the value of it."