Doctors, MWHC Team Up To Tame Expenses By Enhancing Efficiency Of Services Rendered

Mary Washington Healthcare and area doctors have joined together in a new program to improve healthcare and lower costs.

The Mary Washington Health Alliance, as it’s called, is helping MWHC and about 400 independent doctors coordinate patient care, share best practices and provide follow-up for high-risk patients.

“Its goal is to respond to changes in the health care industry,” said Travis Turner, the alliance’s vice president of clinical integration. “How better to do that than partner the health care system and local physicians?”

Begun on a limited basis last year, the alliance is already having an impact. The total cost of care for the 50,000 people that it serves—employees in its self-insured plan and Medicare patients—has decreased 3 to 4 percent so far this year compared with 2014, when it was first implemented, Turner said.

Meanwhile, total health care spending nationwide has increased 4.4 percent this year, according to the Peterson–Kaiser Health System Tracker.

Mary Washington Health Alliance is what’s known as an Accountable Care Organization, a concept that’s springing up nationwide. So far, it is the only one in the Fredericksburg area.

“Physicians want to do one thing primarily, and that’s to take the best care of their patient as they can,” said Dr. Thomas O. Janus, who chairs the alliance’s board and is the founder of Rappahannock Family Physicians.

Their dilemma, he said, has been that doctors treating the same patient haven’t had an easy way to share information about the medications, labs and other tests that they’ve ordered. That can help improve treatment and avoid the additional cost of duplicate tests.

“We need a way to get real information to people,” Janus said. “This allows us to have a true health information exchange. If I see a patient today, by the time he leaves, all the information is available to his other doctors. That would never happen without an ACO.”

To accomplish this, the alliance is asking physicians to use the same electronic health information system. While the majority already use electronic records, the programs aren’t always compatible.

This year, 15 doctors groups switched to a system owned by a subsidiary of MWHC. Another 15 will have changed over by the end of 2016.

“Hopefully, by the end of the third year the entire alliance will be up and running,” Janus said.

The alliance also provides members with access to a library of best-care practices, because technology and health care are evolving so rapidly that it’s difficult to keep up, Janus said.

Locally, an allergist and immunologist have teamed up to develop a protocol for dealing with asthma, which can help prevent a patient’s condition from getting serious enough to see a specialist, said Dr. Jeffrey Frazier, a radiologist who serves on the board of Pinnacle Health, a local physician’s health organization similar to the alliance.

“We’re trying to get the right level of care to the right physicians at the right time so they can treat things more appropriately,” he said.

In addition, there is now a business roundtable where people who manage practices can share information about such things as the latest federal health care regulations, Frazier said.

Care provided by alliance participants doesn’t end when a high-risk patient leaves a doctor’s office or the hospital. Coordinators check to make sure they follow their doctor’s orders. If a patient can’t afford a medication, for example, the coordinator might be able to get them samples, a discount or have their prescription switched to a generic, he said.

Steps such as these can help prevent the patient from being readmitted to the hospital—and racking up more medical bills.

Board members from Mary Washington Healthcare and Pinnacle began organizing the alliance about three years ago. It now includes Mary Washington Hospital’s locations in Fredericksburg and Stafford County, related centers such as those providing imaging and about 400 area physicians in 37 specialties.

“I think anybody who has to deal with the crisis of health care costs realizes that something has to be done,” Janus said. “The system as it stands right now is unsustainable. Employers can’t afford double-digit raises in health care.”

The alliance started with MWHC’s employees and their families, and was expanded to include area residents who are eligible for Medicare. It isn’t an insurance plan, but there are plans to expand the alliance to include more people in the area and enter into similar agreements with insurance companies.

“In the past, employers worked through commercial insurers and that’s the pricing mechanism for the community,” Turner said. “Now the employer, insurance company and delivery system can sit down and have those conversations, which we’re doing with lots of self-insured companies.”