New Medicare Advantage Integrated Payment and Delivery Model Leverages Physician Expertise, Technology to Offer High Quality, Affordable Healthcare
AUSTIN, Texas, Oct. 15, 2018 /PRNewswire/ -- Medicare beneficiaries considering 2019 Medicare Advantage plans now have a new reason to take a closer look: an innovative, Central-Texas based population health model that features trusted local medical groups providing services designed to improve the quality, value, efficiency, patient experience and outcomes of Medicare Advantage patients.
Two Central Texas medical groups — Austin Regional Clinic (ARC) and Premier Physicians are teaming up to offer a new Medicare Advantage population health model, Connected Senior Care Advantage (CSCA). CSCA will be offered to beneficiaries enrolling in the Humana and WellCare Medicare Advantage plans listed below. Medicare beneficiaries can explore the benefits offered by these plans during the Medicare Annual Election Period from Oct. 15 through Dec. 7. Additional CSCA health plan partnerships are still being evaluated for 2019 and 2020.
ARC and Premier Physicians are significantly expanding the number of physicians who will focus on care for Medicare beneficiaries as a result of the CSCA model. Humana and WellCare Medicare Advantage members will have access to more than 145 primary care physicians at 32 locations. The CSCA population health model and provider network is currently being offered via two major Medicare Advantage organizations with a like-minded approach toward improving Medicare patient outcomes:
- Humana: Humana Gold Plus HMO and HumanaChoice PPO Medicare Advantage plans
- WellCare: WellCare TexanPlus Classic
The four-county area is populated by 248,936 Medicare beneficiaries, according to 2017 demographic figures. About 31 percent were enrolled in Medicare Advantage plans.
The goal is to offer high quality care by providing the right care at the right times in the right locations, with a focus on preventing illnesses from occurring or worsening, explained Kevin Spencer, MD, Medical Director of CSCA. "If patients stay healthier, they are less likely to require costly emergency care or hospitalizations. Better coordination will be safer for patients and lead to less duplication of testing, such as unnecessary MRIs, X-rays, or overprescribing medications that can conflict with each other."
Better Access Means 'Real-Time' Data
By entering into this partnership, ARC and Premier Physicians' providers will have at their fingertips considerably more patient health information that wasn't available before. In essence, the CSCA population health model will improve doctor-patient and doctor-doctor communications and offer patient and family counseling and support, thus eliminating the 'blind spots' that exist in the healthcare system.
"Today, if a patient goes to a hospital or gets care from a doctor outside of our group it often takes weeks or months before we see the detailed account of that visit, similar to the days when we were mailed monthly or quarterly records of our finances," described Anas Daghestani, MD, CEO of Austin Regional Clinic. "What if, like our online bank accounts, doctors could access real-time information about their patient. Imagine the difference we could make with our patients' care."
A 2017 J.D. Power study found that Medicare Advantage patients believe "coordination of care among doctors is extremely important" and many are seeking "assistance navigating the myriad healthcare providers and managing associated costs that matter most."
ARC and Premier have proven experience in care navigation and coordination. For example, for more than a decade, ARC has developed and enhanced a proven 'medical home' model, providing seamless, coordinated care to optimally serve patients with chronic conditions.
"By combining ARC and Premier's expertise, CSCA is uniquely poised to provide Medicare Advantage patients with locally managed, high quality and more affordable care," said Spencer.
As part of a patient's annual wellness visit, CSCA will provide a comprehensive, individualized assessment, guided by new technology, to maintain patients' best level of health and enjoyment of life. This may include:
- Comprehensive review of medications;
- Scheduled preventive care visits;
- Patient outreach about upcoming appointments;
- Chronic care and disease management programs;
- Cancer screenings and other preventive health measures;
- Coordinated care and collaboration with other health professionals and services; and
- Personalized service for patients who are hospitalized or admitted to skilled nursing facilities – and need guidance and planning for a safe, smooth transition back home.
'Opting-in' to Improve Access
Every year, thousands of physicians "opt out" of Medicare, leaving patients across the U.S. in a lurch because federal payments have not kept up with doctors' actual costs. In Central Texas, an overall doctor shortage contributes further to the problem.
"We have learned from our medical home model how to make this new partnership succeed. This type of coordination makes sense and is what Medicare patients deserve. So, we're 'opting in' — it's a necessary step to improve access to care," said Daghestani.
For more information about CSCA, visit www.connectedseniorcareadvantage.com.
About Austin Regional Clinic
Austin Regional Clinic is a multispecialty medical group committed to providing comprehensive healthcare services throughout Central Texas. Founded by three physicians in 1980, it now provides health care to over 475,000 area residents in 25 locations in 10 cities, including both primary and specialty care. For more information, visit www.austinregionalclinic.com.
About Premier Physicians
Premier Physicians is an independent, physician-owned practice that has been serving primary care need of Austin, Texas' families for more than 25 years. For more information visit www.pfpdocs.com.
Additional Information
Humana is a Medicare Advantage HMO and PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. Other providers are available in our network. Call 1-877-877-0714 (TTY: 711) 8 a.m. to 8 p.m. local time seven days a week.
SOURCE Austin Regional Clinic
Share this article