Employer, Medical Group Partnership Could Reap Long-Term Rewards

Thinking outside the box when it comes to making the business of health care better has generated a flurry of patient appointments, a little extra revenue and a good deal of excitement about what the future may hold at Bowdoin Medical Practice in Brunswick, Maine.

Judith Chamberlain, M.D., a family physician at Bowdoin Medical Practice and a member of AAFP's Board of Directors, said her practice is partnering with one of Maine's largest employers, Bath Iron Works, on a project to get patients into the office for overdue health maintenance exams.

The best and most obvious reward is healthier patients, but Chamberlain said her practice's motivation runs much deeper.

"We realize that if we want to effect changes in both health care and reimbursement, we need to work directly with the employers, because the insurers are not the people on the cutting edge of these issues," said Chamberlain. The program is giving her and her colleagues at the Brunswick medical practice a way to start talking directly to Bath Iron Works about the care of its employees, she added. It may not be a huge moneymaker, but "it's a foot in the door."

Jeff Bland, CEO of Bowdoin Medical Group -- which includes Bowdoin Medical Practice and four other clinical practice sites -- agreed, saying he welcomed the opportunity to partner with Bath Iron Works. "The real kicker for us is to do something in collaboration with the employer and to start building that relationship." If the project is successful in terms of healthier employees and cost savings to the employer, that success may, in turn, push other large companies in the state to invest money in creative solutions for improving health care, said Bland. And those solutions could mean new revenue streams for physicians.

Bath Iron Works has about 5,600 employees, but in 2004, only about 36 percent of men and about 56 percent of women who were enrolled in the company's health plan saw a physician for a health maintenance exam.

Those low percentages spurred the company to action.

"When you think about a workforce whose average age is 48 -- and you think about it from a health care perspective -- you realize this is a population that is probably tripping a number of chronic condition thresholds," said Maureen Kenney, manager of integrated health services at Bath Iron Works.

In September, the company invited seven of the largest primary care practices and physician hospital organizations that had contracts with CIGNA HealthCare, the company's insurance provider, to the shipyard for a brainstorming session. The result was a one-year project that commenced in January and that focuses on Bath Iron Work's employees and their spouses who are insured by the company's health plan but who have not had a medical checkup for at least a year.

Around 1,100 letters were mailed to Bowdoin Medical Practice patients in late January, and the response has been tremendous, said Chamberlain. Her practice has been inundated with phone calls, and, at press time, she'd seen 10 patients, three of whom "haven't been to a doctor in over five years," she said. Chamberlain guessed that as many as 800 people may respond to the letters and schedule appointments.

Bath Iron Works made the venture worthwhile for physicians by offering a small financial incentive, about $20, to pay for the administrative costs upfront and an after-the-fact bonus for each patient seen.

For their part, physicians agreed to include a health risk assessment as part of each patient's preventive visit. For example, said Kenney, a patient diagnosed with hypertension might brainstorm with the physician to identify some measurable and achievable goals to improve his or her health status. The patient's action plan might include such things as smoking cessation, increased exercise or better nutrition. A nurse follows up on the patient's progress by phone.

Bowdoin Medical Group's electronic health record system helps the process run smoothly, said Bland. The patients' health risk assessment information and action plan are incorporated into the EHR.

Bath Iron Works anticipates that the project will reap a number of positive outcomes for the company, including

"Ultimately we wanted to realize better long-term cost outcomes for Bath Iron Works and for its health plan participants," said Kenney. She stressed the involvement of the company's health plan, CIGNA, especially in matching patients to primary care physicians. "They've been with us every step of the way," she said. However, she also made it clear that Bath Iron Works receives no patient-specific information from the project.

When data from the project start streaming in, Bowdoin Medical Group's Bland suspects that Bath Iron Works may see other opportunities for health care partnerships. "One of the beauties of having our own EHR is that we can put initiatives together and draw baseline data together fairly quickly," he said.

For instance, the company may find a high percentage of its workers already have, or are at risk for, chronic conditions such as coronary heart disease or diabetes, said Bland. As the company identifies its outliers from an expenditure perspective, "we'll look at how we can dovetail that information with an initiative to help them improve in that area," he said.