The Centered Care Initiative seeks to improve health care coordination and quality while reducing costs. Primary Care Providers play a critical role in helping their patients get the right care at the right place with the right provider. The central idea is to coordinate health care services around the needs of you, the patient. Because health care is so expensive, Centered Care also seeks to engage providers and health plans in managing these dollars more efficiently.
These efforts to manage spending benefit both you and Commonwealth taxpayers. Not only have we avoided cutting benefits, we were able to add federal-mandated benefits and some modest benefit enhancements, while also achieving an overall 0.8% premium increase for all employee and Medicare plans for the Fiscal Year 2015, the lowest increase in over 10 years. These rates are lower than national employer trends, which according to Mercer’s National Survey of Employer-Sponsored Health Plans will increase 2.1% in 2014 and another 5.2% in 2015. Other employers are controlling costs through enrollment restrictions and benefit cuts. The GIC’s Centered Care program holds our health plans to lower costs and improved health care over a five-year period.
In addition to helping to keep premiums in check, how does this affect you?
There are 10 key elements of Centered Care:
- Primary Care Provider (PCP) designation – your health plan keeps track of who your PCP is and lets the provider know that you are their patient and you have selected him or her to coordinate your care.
- PCP engagement – your PCP helps coordinate your care.
- Data sharing – electronic medical records provide secure access to your health history, prescriptions, lab results and appointments to help your PCP and other providers keep track of your medical needs and make sure they are met.
- Low cost providers are encouraged - you will continue to have incentives for choosing low cost, high quality specialists and hospitals.
- Expanded hours and urgent care access – the GIC and our health plans are working to expand providers’ hours to include some evenings and weekend appointments making it more convenient for members with off hour urgent care needs.
- High level of care for chronically ill - if you have a chronic condition, yourPCP will monitor and advise you all year long.
- Disease management - members’ health plans will identify patients at risk for complications and will help those members and their PCP navigate their care and find out about best practices.
- Group visits - patients with similar conditions sometimes meet together with providers for education, group interaction, support, self-management assistance, and direct patient-practitioner encounters. These types of visits include wellness programs for patients with weight-related issues, diabetes, or low back pain.
- Transitional care management - when you are released from the hospital to rehab or home, your treatment plan accompanies you.
- Essential reporting package - our health plans will help providers to help you by giving them timely reports on patients, their fellow physicians, and best practices.
Plan benefits help support this initiative:
- All GIC health plans will be reaching out to members to acquire PCP information.
- One plan will offer a copay incentive for visiting a Centered Care PCP.
- Plans will continue to tier specialists based on quality and/or cost-efficiency scores. Millions of physician claims are analyzed for differences in how physicians perform on nationally recognized measures of quality and/or cost efficiency. You pay the lowest copay for the highest-performing doctors:
***Tier 1 (excellent)
**Tier 2 (good)
*Tier 1 (standard)
Physicians for whom there is not enough data and non-tiered specialists are assigned a plan’s Tier 2 copay.
During annual enrollment, check your doctors’ and hospitals’ tier, as they can change each July 1 with new data.
This information provided by the Group Insurance Commission .