Tulsa, Okla., is a shining example of a city that has committed itself to turning around its second-to-last in the nation health status. It is doing so by taking advantage of federal grants focused on healthcare innovation. These include a $12 million grant that made Tulsa a Beacon Community to support the creation of a health information exchange for patient data sharing between hospitals and physicians. MyHealth Access Network is operating and has more than 1,400 physicians signed up even those in rural areas, where the state suffers from a major physician shortage as well as all hospitals. Such expansive exchanges are uncommon nationally.
MyHealth brought all three rival health systems and health insurers in Tulsa to the table to collaborate on how to make care better. It was around that table that the group decided to apply for another federal grant: the Comprehensive Primary Care Initiative, which involves private and public insurers who make up more than 60 percent of the local market share agreeing on standards and quality metrics for reimbursement of physicians in a medical home. Getting competing insurers to collaborate is one thing; getting them to agree on quality standards along with government payers is quite another.
Blue Cross and Blue Shield of Oklahoma, Tulsa-based CommunityCare, and the Oklahoma Health Care Authority (which runs the state's Medicaid program, SoonerCare) applied for the grant and received it in April 2012, making Tulsa one of seven markets chosen. Medicare will reimburse physicians in practices that agree to the quality standards and transform themselves into a medical home, paying a per-member, per-month coordination fee on top of fee-for-service payments. Physicians will share in any savings in years two through four of the pilot. The two private insurers will do the same, although they will set their own reimbursement rates (but will be reimbursing on the same quality standards). SoonerCare already operates a medical home that rewards physicians for quality care.
Up to 75 primary-care practices in the Tulsa region, including rural physicians, can participate and organizers hope that rural physicians sign on. The Centers for Medicare and Medicaid Innovation program is expected to have a profound impact on the market as a whole because it has few active medical homes beyond physicians that participate in the Medicaid medical home program. That means more practices have the opportunity to start one and be reimbursed for it from four payers instead of one.
The results should be significant. By incentivizing physicians to transform their practices to a medical home rather quickly (contracts must be signed by September), the CPC will shift the region to offering proactive care for patients that's focused on care management and stabilizing chronic conditions by the end of the year. Such transformation in the way care is delivered, which is largely possible thanks to the MyHealth Access Network, is sure to result in better health outcomes in the long term. The community's collaboration and innovation have put it on the right path to changing its overall health status.