Congressman Roy Blunt was present at a news conference Feb. 14 to announce that St. John's is one of only 10 organizations in the country chosen to participate in a physician group practice demonstration project.  If successful, the project could have long-term impact on the delivery of health care to Medicare beneficiaries. The project gives physician groups an opportunity to demonstrate that improving care in a proactive and coordinated manner also reduces costs.

St. John’s Health System has already seen success with patient-centered care that better manages conditions between physician’s office and hospital visits.

“Health care has always been focused on events of care, whether it’s a hospitalization where someone comes in for pneumonia, or whether it’s going to a doctor’s office for advice on how to care for themselves or to get a prescription,” says Walter Gaska, M.D., St. John’s Clinic president. “Payment systems have been designed around this focus. We have demonstrated that by focusing on chronic conditions, we can keep people healthier and avoid more expensive treatments down the road.”

Currently, Medicare pays physicians based on the number and complexity of the services provided to patients. Evidence is growing to support the theory that by anticipating patient needs, especially for patients with chronic diseases, health care teams can partner with patients and intervene before expensive procedures and hospitalizations are required.

“At St. John’s, we’ve literally designed a health system: hospitals, physician clinic and health plans to link health care events in a patient’s life,” says Ronnie Brownsworth, St. John’s Health Plans senior vice president. “By linking events of care and enabling patients to better care for themselves between episodes, we encourage the relationship between the physician and the patient to help them improve their health.”

Janet Pursley, RN, is St. John’s vice president of medical management services. Her team uses strategies such as case, disease, utilization and data management to identify and coordinate care at a very customized level.

“What we’ve been able to do is take clinic, hospital, and health plan resources and combine them in studying the most common chronic diseases affecting our patients and, in many instances, improve their outcomes,” Pursley says. “Integration is what makes this possible.”
As part of the project, St. John’s will expand this already successful approach to the Medicare fee-for-service population and be rewarded when certain performance targets are met.

St. John’s will provide Medicare patients with management and coordination of both inpatient and outpatient services including case management, 24/7 access to nurse triage, care transition by a social worker, outpatient preventive and disease management programs and palliative care.
St. Johns’ disease management programs for diabetes, congestive heart failure, asthma, chronic obstructive pulmonary disease and depression will be expanded to the Medicare fee-for-service population. An arthritis disease management program currently under development will also be part of the project.