While health systems all across the country are scrambling to keep pace with sweeping changes prompted by the Affordable Care Act, an Idaho-based medical group is outpacing its larger peers in embracing the shift from fee-for-service to value-based care. Piggybacking on transformations they set in motion even before the passage of Obamacare, Primary Health Medical Group (PHMG) is now turning to a predictive analytics platform developed by Proskriptive to aggregate and make sense of mounds of disparate data, providing the key to obtaining even better patient outcomes with greater efficiency for its 14 clinics.
“We’ve long sought to prove that we can measure the value of our care by measuring outcomes, but to really maximize value across the continuum of care, we have to integrate the claims data [from the insurers] with our clinical data,” notes David Peterman, M.D., PHMG’s President and a practicing pediatrician. “We’ve done a great job in using the outcome data we have to improve care, better manage certain populations, and remain nimble. But we’ve largely been flying blind when it comes to the cost side. Merging the claims, outcomes, and demographics data is Proskriptive’s ‘secret sauce,’ and it will be very powerful in driving further efficiency and quality care.”
Peterman and his partners have been retooling and refining their primary and urgent care operations for over 8 years, and have enjoyed notable growth, even during the great recession. At a time when many providers are being absorbed into the region’s two big health systems, Peterman points to positive signals from patients and payers: “Blue Cross of Idaho, Regence BlueShield, and United Healthcare are telling us that we are very efficient compared to our local peers. And we’re receiving customer validation in the growing demand for our services.” PHMG sees more than 300,000 patients annually and has added 3 new clinics in the last two years, with two more slated for fall 2015.
Peterman cites numerous data-driven practices the group has implemented in recent years. “We have over 2000 diabetics whom we’ve been following for over three years. We use seven nationally recognized parameters and we can show you the data and how and where we’ve improved by responding to what the data tells us.” For patients with diabetes, lab testing has improved by 13%, eye exams have increased nearly 37%, and foot exams have increased 29%.
Peterman also touts the group’s integration of Electronic Health Records (EHR) in 2007, small and efficient clinic sites, an emphasis on customer service orientation and training, and the availability of family practice and urgent care under one roof.
Perhaps what’s most exciting to Peterman is that PHMG is doing what so many in the industry have said can only be done on a large-scale (read: massive, highly consolidated health systems). “We have a homegrown network of clinics that deliver integrated, efficient and effective care, with impressive outcome data and insurers telling us it’s working. Now, we’re going to have a powerful software platform (Proskriptive) that will allow us to better examine and manage populations and measure how we’re doing every step of the way.”
Peterman is embracing Proskriptive because it will allow PHMG to take its evidence-based medicine to the next level. “A tool like Proskriptive allows us to dialogue and coordinate with the other elements of the healthcare community, rather than just handing off a patient to a hospital or other care setting and hoping for the best, with no input until that patient returns to our office,” said Peterman. PHMG’s Pediatric clinic has met the Level 3 scoring criteria for Patient-Centered Medical Home, as recognized by the National Committee for Quality Assurance (NCQA.)
“We’ve already moved our organization toward greater accountability. And now as the federal government continues to aggressively push for value-based care by restructuring Medicare reimbursement, we, the primary care provider, become responsible for the entire continuum of care, including hospital care. We need to continue to reach quality parameters. We need to measure patient satisfaction and outcomes. And then, as we’ve already seen, insurance companies will reward us for being efficient and meeting those parameters and goals.”
About Primary Health Medical Group
Boise-based Primary Health Medical Group is a predominately primary care medical group with 14 clinics and 62 providers seeing more than 300,000 patient visits a year. Most clinics offer walk-in urgent care and appointment-based family medicine, so unlike the traditional model, providers can work together to address episodic and chronic care needs. The group also has physicians in pediatrics, obstetrics and gynecology, dermatology, occupational medicine, and ear, nose, and throat. Learn more at www.primaryhealth.com.
About Proskriptive
Proskriptive is a Boise-based company offering providers and payers better population care, improved patient outcomes and more efficient management of healthcare resources through a dynamic analytics platform, expert services, and flexible tools to guide data-driven decision making. Learn more at www.proskriptive.com.
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