|It Can Be
Done: CDPHP Found To Prove Quality Goes Up As Costs Go Down
Medicare Advantage plans score better than
traditional Medicare fee-for-service plans in key quality criteria,
according to a study by Johns Hopkins University. The study was
commissioned by the Alliance of Community Health Plans (ACHP).
The report supports the assertion that it is
possible to improve quality and lower costs in the Medicare program if
the delivery system is structured differently.
ACHP is a Washington D.C.-based membership
organization of 19 nonprofit, community-based, regional health plans
and provider organizations from across the country.
It commissioned the Johns Hopkins study in
response to "a broadly shared concern that hospitalization rates are
too high and that a lack of coordination is the cause," said Patricia
Smith, president and CEO of ACHP.
Based on 2007 data Capital District
Physicians’ Health Plan (CDPHP) said its Medicare Choices
plan reported significantly lower rates of avoidable hospital
readmissions, preventable admissions, and emergency department visits
than traditional Medicare. Based on that same data, CDPHP Medicare
Choices’ hospital readmission rate (13.9 percent) was nearly
five percentage points lower than traditional Medicare’s
national average (18.6 percent). Hospital readmissions cost Medicare
$17.4 billion in 2004.
CDPHP said it is able to put the brakes on
readmissions because it invests in delivering the kind of integrated,
coordinated, patient-centered medical care that traditional
fee-for-service Medicare – in its current state –
cannot consistently provide.
In addition to a comprehensive care coordination
and case management program, CDPHP believes in the patient-centered
medical home (PCMH) model of care and is in the midst of a 30-month
PCMH initiative with three of its largest Capital Region practices.
"CDPHP Medicare Choices’ high degree of
coordination and integration of care can serve as a blueprint for
achieving better delivery, improved outcomes, and lower costs in the
Medicare program," said John D. Bennett, president and CEO of CDPHP.
"Our members who face the daily challenges of living with a chronic
condition would prefer to receive good preventive care that keeps them
healthy and out of the hospital."
CDPHP is a physician-founded and guided health
plan. It and its affiliates currently serve members in 29 counties
throughout New York state and seven counties in Vermont.
Addresses: Capital District Physicians’
Health Plan, 500 Patroon Creek Blvd., Albany, NY 12206; (518) 641-3000,
Alliance of Community Health Plans, 1729 H Street NW, Suite 400,
Washington DC 20006; (202) 785-2247, www.achp.org.