Pa. health-care innovation shows results

After a year, the first 32 medical practices to sign up for the Rendell administration's chronic-care initiative reported that their diabetic patients were doing better.

Forty-four percent of the 15,000 diabetic patients in the program gained ideal control of their blood sugar, up from 33 percent a year ago.

Participants say the program works because it gives incentives for caregivers to track patients better and to hire more staff. Over time, proponents hope to see broad health improvements and big savings from fewer hospitalizations and ER visits.

"You can see the trend lines going the right way," said Ann S. Torregrossa, the director of the Governor's Office of Health Care Reform.

The effort is one part of Gov. Rendell's so-called Prescription for Pennsylvania, the health effort he launched in January 2007 to reduce health-care costs and extend insurance coverage to the state's one million uninsured residents.

While the insurance expansion has stalled in the state Senate, smaller pieces of Rendell's proposal, such as allowing parents to cover children under their insurance through age 29, are moving ahead in Harrisburg.

And the chronic-care program will extend to all parts of the state next month with the addition of primary-care practices in Northeastern Pennsylvania.

Once that happens, it will involve 400 primary-care providers covering 750,000 patients.

"This has been an effort to revitalize primary care," Torregrossa said. "This will be an important legacy of 'Rx for Pa.' . . . It will have transformed how health care is provided and paid for at the primary-care level."

Doctors and other clinicians at the 32 practices in Southeastern Pennsylvania got financial support to redesign their practices into a more team-oriented system aimed at changing patient behaviors, in part by providing basic education, tracking patients' progress by computer and calling people who miss appointments.

Independence Blue Cross, Aetna, and four other insurers committed to pay the practices up to $13 million over three years as they meet certain goals.

Practices make slots available so patients can get same-day appointments, and they added staff to help educate patients in self-management of chronic conditions.

The practices also added patient registries to alert them to test results and needed treatments.

"It has been fun to create a system where there is a real strong interdisciplinary approach to managing diabetes," said Donna L. Torrisi, executive director of the Family Practice and Counseling Network, which has three nurse-run health centers in the program here.

"The outcomes have been tremendous," she said. "And patients like it."

That is true for Elaine Coles, 65, who for nearly 20 years has lived with the ups and downs of diabetes. Now, the North Philadelphia woman is learning to manage her condition.

"Things started getting out of control," Coles said. "I had to buckle down and be more serious and dedicated to my life."

She is trying to do so with the aid of a team of nurse practitioners and other staff at the Abbottsford Falls Family Practice in the city's Tioga-Nicetown neighborhoods.

Ellen Peluso, a diabetic educator at Abbottsford, said simple things, such as replacing hard-to-read syringes with "insulin pens," help patients - particularly older ones like Coles - take their correct doses.

On Wednesday, not far from the Abbottsford clinic, nearly 200 people from the 32 local practices met to review their results for the first year. They shared experiences about what worked and what didn't as they prepared to cover other conditions besides diabetes.

"I can't say we are having a lot of fun," said Daniel G. Orr, a doctor in solo practice in Chester Springs. "I have been out here 21 years . . . and we have always, I feel, taken good care of our patients."

Still, Orr said he believed the changes he was making were necessary for his practice to survive, and he's starting to see benefits, especially of tracking patients' care and test results electronically.

"The registry shows us where we have been deficient" such as when patients' blood sugars rise, he said. "It has provided us information which can make us manage patients better."

Susan Day said her larger, 13-doctor primary-care practice has had similar growing pains. Her practice, owned by the University of Pennsylvania Health System, has 10,000 patients, including 1,585 diabetics.

"It has been a huge amount of work," Day said. "I think the positive thing is it has catalyzed getting us all together to work better and more effectively as a team."

But she said the challenge was whether her practice - which includes about 50 Penn residents regularly rotating in and out - can get its entire staff "to help people lead healthier lives."

The health insurers, which are footing the bill for this experiment in care delivery, are also waiting to see if the good initial results can be sustained over time.

"I am optimistic that the patient-centered medical home will deliver higher-quality and better-coordinated care that will result in improved outcomes," said Richard L. Snyder, senior vice president for health services at Independence, the region's largest insurer.

Still, whether improvements in short-term measures such as cholesterol, blood pressure, and blood sugar will result in better long-term outcomes will take years to learn.

"If diabetics are under control, that is good in and of itself," said Don Liss, a medical director for Aetna, another funder. "But will it result in beneficial effects in terms of cost containment? The jury is still out on that."

Nationally, many regional groups, states, and even the federal Medicare program are undertaking similar efforts, but Pennsylvania is actually implementing a program that delivers care differently to patients, Liss said.

No one really knows if it will work.

Said Liss: "This is faith-based for now."