Community Health Solutions of America's South Carolina Solutions Program Highlighted in the March Issue of the South Carolina Medical Association Medical Journal
The following article, authored by Dr. Boyce Tollison, was recently published in the South Carolina Medical Association Medical Journal. Dr. Tollison is a well respected member of the South Carolina medical community and has been deeply involved in the development and support of the Medical Homes Network program.
South Carolina Solutions has strong partnerships with the South Carolina Medical Association as well as the University of South Carolina’s School of Medicine and the Medical University of South Carolina. These partnerships, as well as relationships with many of South Carolina’s community based health care organizations, have proved invaluable to the success of the Medical Homes Network model.
A Medical Home Experience - South Carolina’s Medicaid Medical Home Model Improves Patient Care and Saves The State Money
The concept of delivering managed medical care through a medical home (MHN) model, as an alternative to an HMO approach has been talked about for a number of years. Now, MHN’s are even being modeled on a national basis by Medicaid and a number of private insurers. Here in South Carolina, we can be proud that we have been successfully operating a MHN – South Carolina Solutions since 2004.
There have been a number of principles established explaining a medical home and its function. The Patient-Centered Medical Home is a means of providing comprehensive primary care for children, youth, and adults.
The basic principles are:
- Personal physician – each patient has ongoing relationship with a personal physician
- Physician directed medical practice – personal physician leads a team who take responsibility for care of patients.
- Care is coordinated and /or integrated across all elements of healthcare system (sub-specialty, hospitals, home health, etc.).
- Quality and safety are hallmarks.
- Enhanced access to care is readily available
In 2004 the Department of Health and Human Services asked SCMA to pilot a Medicaid Medical Home network in the upstate involving the counties of Pickens, Anderson, and Oconee. Our MHN program was begun with a group of local primary care physicians, working with the South Carolina Medical Association’s Physician Management Department as our staff source. As the program grew in numbers and needs, it became necessary to partner with a known and philosophically aligned medical home program to accomplish our goals. We researched many options and decided to merge with Community Health Solutions. Together, our program - South Carolina Solutions has grown to be a state wide network serving over 78,000 South Carolina Medicaid patients.
South Carolina Solutions has been a tremendous success for patients, physicians, as well as DHHS. Under the program, the patients have a physician they recognize, are able to find care on a regular basis without over utilization of urgent care/emergency room care and have access to high quality disease management programs. The disease management programs have a positive effect on the quality of care for the targeted diseases of Asthma, Diabetes, Hypertension, Chronic Obstructive Pulmonary Disease, Coronary Artery Disease and Congestive Heart Failure.
Earlier this year the University of South Carolina Institute for Families in Society completed an evaluation of South Carolina Solutions on a number of industry-standard quality indicators. Their findings indicate that South Carolina Solutions scores higher than traditional fee-for-service or HMOs for the following measures:
Clinical Quality
- Use of Appropriate Medications for People with Asthma (all ages)
- Comprehensive Diabetes Care (HbA1c Testing and LDL-C Testing)
- Breast Cancer Screening
- Well Child Visits in the First 15 Months of LifeMedical
- Adolescent Well Care
Customer Satisfaction
The South Carolina Solutions program also demonstrates high customer satisfaction. The University’s Institute for Families in Society also surveyed Medicaid beneficiaries and found that South Carolina Solutions ranked above all managed care plans for the following measures:
- Getting Needed Care
- Getting Care Quickly
- Doctors’ Communication
Also, physicians have had similar experiences of a positive nature. The monthly management fee is a positive cash flow benefit and the shared saving with Community Health Solutions has made Medicaid a positive benefit as one of the better payers of care.
A unique feature of the Medical Homes Network program is that program cost savings are shared with network medical home providers. To date, South Carolina Solutions has distributed savings sharing checks to its providers totaling over $1.4 million. These savings disbursements are in addition to the per member per month payments paid to providers.
Through December of 2007, South Carolina Solutions has saved the state over $9.7 million. Reasonable projections have that number growing to over $17.0 million as of December of 2008. Participating providers will continue to receive shared savings as long as the program continues to produce superior results. It’s important to note that these savings have not been achieved by restricting access to care. The program does not require utilization review, but rather produces savings through a case management partnership between South Carolina Solutions’ medical management and the medical homes providers.
Another positive attribute of the MHN model is that consultant subspecialist physicians also have experienced positive outcomes as a result of accepting referrals from MHN participating providers. Under our program, there are no panels of specialist and any physician who sees Medicaid patients is eligible and they are directly reimbursed by Medicaid. Subspecialist physicians need only a referral number provided at the time the appointment is made.
Our Medical Home program – South Carolina Solutions, is a strong reinforcement of a traditional medical principle, the right of selection of a personal medical home and receiving quality medical care.
Boyce G Tollison MD