Physician Strategy (managed fee-for-service)

Goal: Similar to that of Healthy San Diego Plus (HSD+): quality, consumer-centered health and social services through improved chronic care management, but without the capitation risk.

The Planning Phase targeted specific stakeholders--physicians, community-based social service providers, consumers and caregivers--to help identify strategies and incentives for improving health promotion, care coordination, and chronic care management within the fee-for-service system. The California Endowment provided $142,000 to George Mason University’s Center for Healthy Policy, Research and Ethics, under the direction of Dr. Mark Meiners, to support the planning of this strategy in conjunction with Aging & Independence Services and San Diego LTCIP stakeholders. The deliverable is an Implementation Plan that will be brought to the County Board of Supervisors in mid-2006.
The Physician Strategy was originally initiated to address concerns of a number of physicians in the community who had self-identified as being opposed to growth in managed care, including the integrated care model envisioned and developed by local LTCIP stakeholders over the last seven years. That LTCIP vision is a single health and social service system of care management, with “no wrong door” entry into the system, a plan of care shared by all providers, and funding that is pooled to allow for flexibility and creativity in providing “seamless,” consumer-centered care. The Physician Strategy has been a part of this larger grass-roots effort over the last four years.

The LTCIP Physician Strategy planning phase effort identified major obstacles to local physician and community capacity to provide a holistic approach to comprehensive chronic care management to underserved elderly and disabled individuals in need of considerable support with managing their acute and long-term care needs. An abbreviated summary of key findings include:
· physicians are dissatisfied with current healthcare drivers, such as managed care, inadequate levels of funding for publicly subsidized care and chaotic Medicare changes;
· physician interaction with “after office” support service providers is vital to successful care as well as to physician satisfaction with their practice;
· physicians describe patient barriers to after office services, gaps in support services and transitions that are poorly orchestrated and result in revolving door hospitalizations or emergency room (ER) use;
· physicians in neighborhoods with high cultural diversity and/or high poverty rates need support in getting patients to office visits, pharmacies, ancillary services, and social support services;
· no insurance/funder reimburses for the physician or office staff doing referrals or care coordination activities for patients.

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Physician Strategy Meetings