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February 24, 2005

U-M Health System physician group tapped for Medicare demonstration project

UMHS only site in Michigan to participate in the CMS disease management project

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ANN ARBOR, MI - The University of Michigan Health System announced recently that its Faculty Group Practice has been named by the Centers for Medicare and Medicaid Services as one of 10 physician groups – and the only one in Michigan – to demonstrate that improving care in a proactive and coordinated manner also reduces costs.

Dr. BlaumThe CMS Physician Group Practice Demonstration seeks to align incentives for physician groups to manage the overall care of their patients, especially beneficiaries with chronic illness who account for a significant portion of Medicare expenditures.

The U-M program, a collaboration of its hospitals, health centers and Faculty Group Practice, will phase in quality measures that focus on common chronic illnesses and preventive care measures during the three-year demonstration. The new care model will include:

  • Care coordination for high-risk and complex patients;
  • Availability of disease management programs for some patients with heart failure, coronary artery disease, diabetes, depression and chronic obstructive pulmonary disease;
  • Coordinated transitional care among acute, ambulatory and long-term care providers;
  • Increased access to geriatric clinics and programs for identification and treatment of high risk conditions in the elderly.

“We've been working on these basic principles of better managing chronic illnesses for almost a decade. Participation in the demonstration project allows us to put our experience and resources to work for the Medicare population we serve,” says Robert Kelch, M.D., U-M executive vice president for medical affairs and U-M Health System CEO. “The project will also allow us to train the next generation of health care providers in new models of care.”

“Many Medicare patients at the University of Michigan have multiple chronic disease and complex problems. This project will help us to provide higher quality care for those patients through better care coordination. The project does not require patients to change their insurance coverage,” says Caroline Blaum, M.D., the U-M geriatrician who is leading the project.

“The University of Michigan's Faculty Group Practice is one of the largest group practices in the country, and our health system is the largest academic medical center in the demonstration project. Together, we have the potential to make a tremendous difference in the delivery of clinical care to older adults with complex medical conditions,” says David Spahlinger, M.D., FGP executive medical director.

Currently, Medicare reimburses physicians based on the number and complexity of the services provided to patients. There is good evidence that by anticipating patient needs, especially in patients with chronic diseases, health care teams that partner with patients can intervene before expensive procedures and hospitalizations are required. Under the three-year demonstration, physician groups will be paid on a fee-for-service basis and may earn rewards from savings derived from improvements in patient management. Data that CMS collects during the demonstration will be shared with physicians to help deliver more comprehensive care.

“This demonstration project helps us focus on what's best for our Medicare patients. We can offer care coordination services to our most complicated patients to provide the care they need in the best setting possible. We hope this will benefit our patients and the Medicare program, using evidence based medicine, health navigators and disease management programs to improve outcomes, prevent admissions and save costs for the patients and the government,” says Jack Billi, M.D., U-M associate vice president for medical affairs.

The U-M Faculty Group Practice was selected through a competitive process. Groups were chosen based on their demonstrated success in chronic care management, organizational structure, operational feasibility and implementation plan. The multidisciplinary groups were required to have at least 200 physicians and include freestanding group practices, integrated delivery systems, faculty group practices or independent practice associations.

Faculty Group Practice is the unit within the Medical School through which the faculty provide clinical services to patients in the U-M Health System. There are more than 1,200 physicians within Faculty Group Practice.

Related links:

U-M Geriatrics Center :
http://www.med.umich.edu/geriatrics/

Merger of U-M Geriatrics Center and Institute of Gerontology (press release):
www.med.umich.edu/opm/newspage/2004/geriatrics.htm

CMS Medicare Physician Group Practice Demonstration:
www.cms.hhs.gov/researchers/demos/pgp.asp

 

Written by Mary Beth Reilly


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