at the level of specialists: http://www.businessinsurance.com/cgi-bin/article.pl?article_id=24742 Crisis looming on primary care front GLORIA GONZALEZ Insurers urged to pay physicians more to prevent pending shortage NEW YORKEmployers can provide financial incentives to primary care physicians to expand their patient services and offer concrete feedback they can use to improve their performance, employers say. A pending shortage of physicians is problematic and employers need to help attract doctors to primary care, said George Chedraoui, health care leader for IBM Corp. in Research Triangle Park, N.C. One way to do that, he said, is to compensate primary care doctors at levels comparable to specialists, which some countries do. In his home state, for example, there are about 7,500 primary care physicians, but more than half are older than 55, which means they will retire in the next five to 10 years, with an inadequate number of physicians to replace them, he said. Advertisement Related Stories from Business Insurance "I think it's naive to think we can fix the health care crisis in this country without fixing primary care," Mr. Chedraoui told attendees of the New York Business Group on Health's April 15 conference Consumerism in Healthcare: Reality or Wishful Thinking. IBM provides health care bene-fits to about 550,000 people in the United States at a cost of about $2 billion per year. "Even for a company like IBM, this is not an insignificant investment for us," he said. The company implemented disease management programs about five years ago that reduced hospitalizations and emergency room visits and saved $61 million over its first two years. Even so, only about 40% of those needing chronic care management participated in the programs targeting asthma, coronary artery disease, congestive heart failure and diabetes, due primarily to employee reluctance to discuss private health care issues with a third party rather than their personal physicians, he said. "The problem is we're not getting the value that we want to get," Mr. Chedraoui said. "This is not the type of disease management that we as an employer want to go buy in the future. The type of disease management we want to buy in the future really resides in a personal patient-physician relationship centered around the medical homes concept." The medical homes approach redesigns primary care to facilitate patient-centered care that personal physicians coordinate in partnership with patients, he said. The system is designed to hold physicians and other medical professionals accountable for the care they provide while also improving the reimbursement structure, Mr. Chedraoui said. The traditional fee-for-service model pays physicians solely on the volume of visits or procedures and does not recognize the time physicians spend coordinating with other health care professionals and family caregivers and engaging the patient in his or her own care, he said. "We are more than willing to pay extra money for our patients to get better primary care," Mr. Chedraoui said. In New Jersey, a pilot program jointly conducted by physician group Partners in Care; the state's largest health insurer, Horizon Blue Cross Blue Shield of New Jersey; and the state's largest employer, the State of New Jersey, demonstrated patient-centered care could improve health care outcomes, said James Barr, medical director for Partners in East Brunswick, N.J. The program used data to show physicians where gaps in care existed, such as patients not receiving recommended tests or treatments, and providing resources for the doctors to address them, including paying physicians and their staff to remind patients of the importance of these medical services and facilitate the patient receiving the test or treatment. The program resulted in health care quality improvements by engaging physicians, he said. For example, the number of patients with diabetes participating in the program who were in control of their conditionthose who received necessary tests and treatmentsincreased from 10% at the beginning of last year to 42% at the end of the year. Employers need to demonstrate for physicians where they see areas for improvement in their performance, said Laurel Pickering, executive director of the New York Business Group on Health. The organization's New York Metro Health Data Project aggregates data from the Health Plan Employer Data and Information Set measures from major health plans in New York and New Jersey and provides reports to individual physicians on their performance in treating diabetes, heart disease, asthma and depression and in providing preventive care. About 3,500 physicians in New York and New Jersey receive the reports, she said. The reaction from physicians has been "mostly negative," primarily because the program uses claims data, she said. Primary care physicians also object because they do not perform tests such as mammograms and pap smears in their offices and are not reimbursed for screening for conditions such as depression, Ms. Pickering said. She said NYBGH plans more outreach to physicians to explain why the performance-improvement effort is important. "If we don't change the experience for physicians of how they're paid, giving them tools like electronic medical records, our hope of making any changes in the health care system or changing it the way we want to is drastically reduced," Ms. Pickering said. Employers can improve provider quality when developing their employee benefit plans, said Dr. Edward Anselm, vp and chief medical officer for HIP Health Plan of New York in New York. Escalating health care costs and demand for consumer choice have led to a migration to preferred provider organization or consumer-driven health plans, but data has shown that improvements in the quality of care are achieved in health maintenance organization plans, he said. While CDHPs keep more employers in the health insurance market, data on employee health outcomes is mixed, he said. "Certainly, the barriers of paying out of your pocket for health care really would ultimately be daunting," Dr. Anselm said. Meanwhile, shifting costs to employees for doctor visits and prescription drugs by increasing copayments results in employees avoiding necessary care because of higher out-of-pocket expenses, he said. For example, placing injectable drugs in a category where employees are responsible for a substantial portion, if not most, of the costs, is a cost-shifting mechanism that is completely contrary to the concept of health insurance, Dr. Anselm said. "It doesn't sound like health insurance to me." Employers can help their health plans improve provider quality by not demanding the broadest provider networks possible, recognizing that better quality health care can be provided by a smaller network of doctors, he said.