LINCOLN — High-needs patients are more likely to get improved care under a voluntary agreement that two Nebraska state senators reached with doctors and several major insurance companies.
The senators say that increased use of “care managers” for the elderly and people with chronic illnesses will result in better care at a lower cost.
It's an approach to primary care called “patient-centered medical home” — a model that aims to meet most of a patient's physical and mental health care needs, including prevention and wellness, acute care and chronic care. The care manager helps patients learn how to take better care for themselves, thus reducing the need for repeat trips to a doctor's office or even costly hospitalization.
State Sen. Mike Gloor of Grand Island, a former hospital administrator, said the goal is to provide health care that is “more efficient and better coordinated, more holistic care.”
Gloor and State Sen. John Wightman of Lexington announced the agreement Tuesday and scheduled a press conference for Wednesday morning. They have been advocates for the approach, which often uses registered nurses as “care managers” to coordinate care for patients.
“Doing so is proving to save money in program after program across the United States,” Gloor said.
Wightman introduced a bill in 2012 that would have required insurance companies to reimburse doctors who use care managers, but he has since sought a voluntary agreement with the companies.
It took 18 months of talks to hammer out the agreement, which will serve as sort of a pilot project. It expires in two years.
“This type of reform is best accomplished with a private and public collaboration,” Wightman said.
Medicaid and Medicare, he said, are already adopting the patient-centered medical home model. Medicare, which is government-paid health care for the elderly, already reimburses for care manager services. Medicaid, which is subsidized care for low-income people, provides reimbursement for some pilot projects in Nebraska.
Wightman said private health care funding needs to be involved, too.
Signers of this agreement include Blue Cross Blue Shield of Nebraska, Coventry Health Care of Nebraska, the Nebraska Medical Association and Nebraska Academy of Family Physicians.