Published: Tuesday, September 7, 2010
Group Health to lead study on gaps in medical care
Nearly every patient has experienced the problem: bad "handoffs" in health care.
A family practice doctor refers you to a specialist who might then recommend outpatient surgery.
Sometimes test results don't get passed on in a timely manner or tests are conducted again.
Sometimes follow-up appointments aren't made or patients don't feel they're getting all the information they need.
Part of the problem is that medical providers typically get paid for tests, procedures and surgeries, and don't get paid for "quarterbacking," or overseeing and coordinating care.
Group Health has been chosen to help lead pilot projects in Washington to figure out where gaps in care occur and how to close them.
It's part of the efforts by Washington state to find ways to provide better health care for patients while reducing costs.
The goal is to link primary care providers with specialists and hospitals and then pay them to treat patients in a way "so that they all have a stake in seeing that the patient is fully cared for throughout the system," said Richard Onizuka, director of health policy for the Washington State Health Care Authority.
The health care authority provides health care for about 400,000 state residents, including public employees and some low-income residents on the state's Basic Health Plan.
Although similar efforts are under way as part of the federal health care reform legislation, "the exciting part is our state has fast forwarded that and wants to do pilot (programs) here in the state," said Dr. Brenda Bruns, executive medical director of Group Health's Health Plan. "We were selected to push it forward."
Communication is easier in a health system such as Group Health, where general practice and specialty physicians have access to a patient's medical records.
But, for example, if an Everett Group Health member goes to a non-Group Health specialist for a consultation on hip surgery and then has the procedure at a hospital, communication among the three groups can become a problem, she said.
"Right now, we don't have a good clinical information system that connect all those parts of the system," Bruns said.
And payments typically don't include reimbursement for a surgeon spending 45 minutes reviewing the procedure and carefully going over its benefits and risks.
Under the current payment system, "there's not much time to go through those conversations," Bruns said, because doctors get paid to operate.
In the same way, hospitals typically are paid to provide care while patients are hospitalized. But they aren't necessarily paid for taking steps to that would shorten patient stays or to prevent patients from being readmitted to the hospital for problems that occur once they get home, she said.
"As we do these pilots, we'll look at what would … bring down costs and ramp up quality," Bruns said.
"We believe that if you give the right quality, you'll actually decrease the costs of health care."
Sharon Salyer: 425-339-3486; salyer@heraldnet.com.
A family practice doctor refers you to a specialist who might then recommend outpatient surgery.
Sometimes test results don't get passed on in a timely manner or tests are conducted again.
Sometimes follow-up appointments aren't made or patients don't feel they're getting all the information they need.
Part of the problem is that medical providers typically get paid for tests, procedures and surgeries, and don't get paid for "quarterbacking," or overseeing and coordinating care.
Group Health has been chosen to help lead pilot projects in Washington to figure out where gaps in care occur and how to close them.
It's part of the efforts by Washington state to find ways to provide better health care for patients while reducing costs.
The goal is to link primary care providers with specialists and hospitals and then pay them to treat patients in a way "so that they all have a stake in seeing that the patient is fully cared for throughout the system," said Richard Onizuka, director of health policy for the Washington State Health Care Authority.
The health care authority provides health care for about 400,000 state residents, including public employees and some low-income residents on the state's Basic Health Plan.
Although similar efforts are under way as part of the federal health care reform legislation, "the exciting part is our state has fast forwarded that and wants to do pilot (programs) here in the state," said Dr. Brenda Bruns, executive medical director of Group Health's Health Plan. "We were selected to push it forward."
Communication is easier in a health system such as Group Health, where general practice and specialty physicians have access to a patient's medical records.
But, for example, if an Everett Group Health member goes to a non-Group Health specialist for a consultation on hip surgery and then has the procedure at a hospital, communication among the three groups can become a problem, she said.
"Right now, we don't have a good clinical information system that connect all those parts of the system," Bruns said.
And payments typically don't include reimbursement for a surgeon spending 45 minutes reviewing the procedure and carefully going over its benefits and risks.
Under the current payment system, "there's not much time to go through those conversations," Bruns said, because doctors get paid to operate.
In the same way, hospitals typically are paid to provide care while patients are hospitalized. But they aren't necessarily paid for taking steps to that would shorten patient stays or to prevent patients from being readmitted to the hospital for problems that occur once they get home, she said.
"As we do these pilots, we'll look at what would … bring down costs and ramp up quality," Bruns said.
"We believe that if you give the right quality, you'll actually decrease the costs of health care."
Sharon Salyer: 425-339-3486; salyer@heraldnet.com.
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