Premier takes team approach

Affiliating with the biggest independent medical practice in western Pennsylvania looks like a smart move in health insurer Highmark’s effort to build a health system to compete with the colossus University of Pittsburgh Medical Center.

But Premier Medical Associates’ affiliation promises patients much more than size and reach. A team approach and culture of prevention are among the features that distinguish Premier’s brand of care from other medical practices, elements that also anticipate the big changes in store for how people receive medical care.

Overnight, the affiliation positioned Highmark for pending changes in how doctors will be paid, which will focus on coordinated care and how well the patient does after treatment. The deal also created a template for the cost-effective approach to primary care that Highmark and its partner, West Penn Allegheny Health System, want to provide in the future.

Dr. Robert CrosseyMost doctors rely on personal experience and what they’ve learned in making treatment decisions. At Premier, decisions about chronic health problems are more often made by a consensus among doctors, said Dr. Robert Crossey.

“Premier has created the platform to collaborate,” he said. “That’s the key.”

The difference is not readily apparent to patients, but commercial insurers have taken notice: Highmark and HealthAmerica have praised Premier for its cost-effective approach, which saves money by keeping patients healthy and out of the hospital.

Take diabetes, one of the most frustrating diseases for doctors to treat because patients often ignore the symptoms until it’s too late. Blindness, kidney failure and amputation are among the consequences, which are as unfortunate as they are costly to treat.

Municipal police officer Scott Kucic is fit and focused — and he was diagnosed with Type 2 diabetes about a year ago.

“When I was first diagnosed with it, I was in denial,” he said. “I couldn’t accept it. I felt like I did something wrong.”

He consulted with a chiropractor, who assured Kucic his disease could be controlled with supplements and vitamins, which the chiropractor sold to him. They did little.

A friend recommended Crossey, who dismissed the pills. Crossey made Kucic an offer: “Give me six months to try to help you,” he said. “If I can’t get you better, you can do whatever you want.”

Kucic, in fact, did get better and gained control over his blood sugar and cholesterol levels. “It has been a great experience with him,” Kucic said.

Each Premier doctor has between 500 and 800 patients with diabetes — up to one-third of their patient load — and Premier’s approach is standardized, regardless of which doctor a patient sees or office the patient visits. The protocols are based on clinical research and collective experience.

The result: The hospital admission rate for Premier patients who have diabetes is 48 percent lower than the national rate, according to an internal study. Crossey said he can’t remember the last patient who had to have a diabetes-related amputation.

Now, Premier is developing treatment protocols for common breathing problems, grouped under chronic obstructive lung disease. At Premier, doctors focus on managing chronic diseases such as asthma and congestive heart failure while nurse practitioners and other so-called physician extenders address the most acute medical problems.

“It’s a culture change,” Crossey said about Premier. “You have to buy into this. I think we have a model that works.”

Kris Mamula covers health care and employee benefits for the Pittsburgh Business Times. Contact him at or (412) 208-3825.