WASHINGTON — A focus on specific diseases and patient needs can improve care and reduce costs to Medicaid by keeping patients healthier and out of hospitals, John Sory said at a meeting sponsored by the Center for Health Transformation.
Pfizer Health Solutions, a care management subsidiary of Pfizer Inc., has applied such an approach to Florida's Medicaid program, the fourth largest program in the country, said Mr. Sory, the company's vice president.
The company partners with health care and community organizations to implement patient-centered programs that focus on prevention, disease management, and care coordination. Through an agreement with Florida Medicaid, “we took responsibility for improving the health of a significant part of the Medicaid population, through creation of a program that connects 10 hospital systems around the state, trains nurse care managers employed by those hospitals, provides clinical technologies to support the nurses, distributes medical equipment to patients' homes, and guarantees that the better patient health will reduce overall cost of care for this population,” Mr. Sory said.
The state's Medicaid program has more than 2 million beneficiaries and takes up 24% of the state's budget. Nearly 50% of expenditures are spent on institutional services such as hospitals and nursing homes.
Access to care is a significant issue for Medicaid beneficiaries in Florida. Although the number of health care providers in Florida has increased in recent years, there has also been a notable decrease in the number of providers willing to see Medicaid patients, he said.
Prevalence of chronic disease and unhealthy behaviors has been rising in the Medicaid population in Florida. There is low treatment compliance because patients “don't necessarily know what steps they can take to be healthier,” Mr. Sory said. In addition, there are few tests and services for those who need monitoring, coordination, and continual follow-up.
Pfizer Health Solutions began in 2001 with a goal of looking at specific populations—patients with asthma, heart failure, hypertension, and diabetes—with an eye to decreasing Medicaid costs for them, he said.
Working with the state's government, Pfizer Health Solutions identified diagnoses and comorbidities then “built a network around those patients, to find new care managers who could work with them, and match the intensity of the intervention with the patients' diseases.”
For example, high-risk patients that tend to visit the emergency department would receive more intensive intervention from care managers.
“Patient-centered care” means instructing patients on when and how to call their physician, he explained. Some patients don't interact with the health care system except in the emergency department, so they're not ready to handle hour-long phone conversations with a nurse.
Coordination of care with local providers is important to make sure that patients get appropriate referrals and that data tracking takes place for each patient, he said. Ten health systems and 50 care managers have been integrated into the program.
No program will work unless you measure the outcomes and promote results, Mr. Sory said. This involves measuring clinical changes such as asthma severity or blood pressure scores, as well as tracking the satisfaction of physicians and patients. “Are patients using the emergency room less, and is this lowering the overall health system costs?” These are the outcomes a successful program has to track, he said.
Among the improvements in patient behavior, 39% of patients have increased their compliance with medication regimens prescribed, 19% of patients have reported following a special diet, and 52% improved physical health scores, he said.
There has been a 99% increase in patients who monitor their peak airflow at home and a 72% reduction in diabetes patients who fail to check their feet. Mr. Sory said more than 240,000 lancets have been distributed to monitor blood glucose at home. In addition, thousands of blood pressure monitors have been distributed to patients with hypertension, as well as 3,700 peak flow meters to asthma patients.
Mr. Sory gave the example of one patient, a recent immigrant, who was legally blind, had asthma, and was taking multiple medications. Under the program, a caregiver drives out to visit him and instructs him on using his medications and ways to ensure he takes each at the right time.
In addition, the caregiver told him what environmental triggers for his asthma might send him to the emergency department, and found a physician for him. Such changes have an impact on the number of hospital visits and also reduce costs, Mr. Sory said.
Pfizer sponsored the interactive Webcast for the meeting.