Three new health care centers will open their doors in Wake County, North Carolina, to some Medicare patients in January as part of an effort by UNC Health Care to keep seniors healthier and to lower health care costs. The centers are envisioned as hubs for care coordination, where doctors and nurses can monitor or even head off patients' health problems.
The new centers – in Wake Forest, Garner and Raleigh – are the core of a partnership between UNC and Alignment Healthcare, a California-based health care management company. The goal is to offer better quality care and save money by carefully tracking patients' needs at the centers run by Alignment. If patients are healthier, they're less likely to need an expensive hospitalization or emergency care.
"It's not rocket science. If you can eliminate barriers to care, you can make your patients healthier, you can keep them at home." — Dr. Adam Wolk, regional medical officer, Alignment Healthcare
The center in Wake Forest, for example, has an education room where newly diagnosed diabetes patients can learn how to manage their care. Or, the center's staff can send a patient with high blood pressure home with a wireless monitor that takes readings daily and transmits the information to a nurse who regularly reviews the data for signs of trouble. If one of the center's patients does end up in the hospital, an electronic medical record will flag the hospitalization for the center, so the staff can quickly put a plan in place to get the patient healthy and avoid another admission.
The centers' smaller details also are designed for the needs of seniors. The carpet is static-free so that it won't disturb a patient's hearing aid, and the exam chairs can be raised and extended into a table with the push of a button.
How it works
The centers' services are only for patients enrolled in a particular Medicare Advantage HMO plan offered in Wake County by the private insurer Humana, called the Gold Plus plan.
In the traditional Medicare program, the insurance plan primarily for those ages 65 years and older, doctors bill the federal government directly for services they provide. In Medicare Advantage, the federal government pays a private insurer a monthly fee to take care of each Medicare patient its signs up.
Under the UNC-Alignment partnership, Humana will contract with Alignment to provide care to the Gold Plus participants. If Alignment can provide quality care for less than Humana pays out, it reaps the rewards. Those profits are then shared with UNC. UNC comes into the day-to-day picture by offering the network of primary physicians, specialists and hospitals that are available to the Humana members. Some non-UNC providers also will be included in the network.
Across the country, health care officials are looking for ways to change the health care system from one that rewards the volume of services doctors and hospitals provide to one that rewards quality and value.
Allen Daugird, UNC's chief value officer and president of the UNC Physicians Network, said the partnership grew out of UNC's recognition of the ways the system is changing.
"We wanted to go ahead and prepare for that," he said. "And we also came to the conclusion that it's the best thing for our country, for our patients and for our economy."
Alignment offered the care coordination expertise UNC sought. Daugird said the system hopes to learn from Alignment during the initial phase of the partnership and then expand its effort.
"We see this not just as dabbling in Wake County," he said.
Not an ACO
One way the federal Affordable Care Act looks to promote value over volume is through the creation of Accountable Care Organizations. Those are networks of hospitals, doctors and other health care providers that are eligible for Medicare bonuses when they provide quality, cost-effective care. WakeMed and Duke late last year each won approval from the federal government to pursue the model.
Daugird said UNC opted to do something different than an ACO because it would require less of an upfront investment. By working through a private insurer with a defined provider network, the partners also would have more control over where patients seek care. In an ACO, they are not required to remain in network.
"In my mind this really is a way to be able to improve the health of seniors in a way that is sustainable financially," Daugird said.
Of the 113,000 Medicare-eligible seniors in Wake County, about 30 percent are enrolled in a Medicare Advantage plan. Medicare open enrollment started Wednesday and ends Dec. 7. Medicare participants can tour the centers now. Services begin in January 2015.