A five-year ongoing study involving 10 large physician practices across the country has so far shown improved quality of care for chronic disease patients from the use of health information technology.

The study, named the Medicare Physician Group Practice Demonstration, was launched by the Center for Medicare and Medicaid Services to enable physician practices to demonstrate that proactive and coordinated care has the potential for larger revenue savings. It is the first Pay-for-Performance project to work directly with physician practices.

The clinics that are taking part in this study include Billings Clinic, Billings, Mont; Dartmouth-Hitchcock Clinic, Bedford, N.H; The Everett Clinic, Everett, Wash.; Forsyth Medical Group, Winston-Salem, N.C; Geisinger Clinic, Danville, Pa.; Marshfield Clinic, Marshfield, Wis.; Middlesex Health System, Middletown, Conn.; Park Nicollet Health Services, St. Louis Park, Minn.; St. John's Health System, Springfield, Mo.: and the University of Michigan Family Group practice in Ann Arbor, Mich..

Of these 10 physician practices, the Geisinger Clinic and the University of Michigan Family Practice Group were two that showed improvements in a least 29 of the 32 quality measures tracked in the third year of the project.

"We focused on hardwiring reminders and alerts into the electronic health record to enhance care consistency and reliability particularly related to diabetes and coronary care as well as ensuring adults receive preventative health screenings," said Frederick Bloom, MD, assistant chief qualify officer, Geisinger Health System.

The Geisinger Health System, which encompasses 40 community practices in central and northeast Pennsylvania, has experienced improved quality of care while lowering the cost to patient from participation in the project. Through the use of their EHR system, the clinic was able to improve care on all 32 categories that include continuing programs for diabetes and coronary artery disease, adult preventative care, and hypertension.
 
"By participating in this project, we're able to develop more effective ways of consistently bringing quality and value to all our patients, not just the Medicare beneficiaries who are the focus of the demonstration project," continued Bloom.

Results were similar with the University of Michigan Family practice group. Of the 32 measured categories, the UM Family practice group improved care on 29 fronts. Care improvements were made in areas that included diabetes, congestive heart failure, coronary artery disease, hypertension, and breast and colorectal cancer screenings.

"The UM Faculty Group Practice invested significant time and resources in this project because it provided the opportunity to develop and test potential interventions that could improve clinical outcomes and reduce costs for patients with chronic disease," says David Spahlinger, M.D., senior associate dean for clinical affairs. "Our investments have enabled better coordination of care."

The UM Family Practice group expressed a total in Medicare savings of $2.9 million surpassing the target put down by the CMS. This will be the third year that UM has savings as well as improving care.

The project began by focusing on the quality of care of patients with diabetes. In its second year it was expanded to include congestive heart failure and coronary artery disease. Both chronic heart conditions carry a very high risk of emergency hospitalization and other higher-cost care if not carefully managed. The program was further expanded in its third year to include hypertension, which was another high-risk and costly condition, and breast and colorectal cancer screenings.

"There are plenty of opportunities to squeeze costs out of the system while also improving quality of care. For example, focusing on how patients transition between care settings and proactively reaching out to ensure they understand the information provided and the next steps can make a substantial impact," said Caroline Blaum, associate professor of internal medicine, associate chief of geriatric medicine and a research scientist at the VA Ann Arbor Healthcare System.

Both Geisinger Clinic and the Unversiy of Michigan Family Practice Group have seen improvements in cost savings and care through the project. UM Family Practice Group has implemented new care coordination programs designed to reduce unnecessary treatment and readmissions, while the Geisinger Clinic has so far met all of the goals of the areas focused on for improved care.

We successfully met 100 percent of the quality measures in part through effective use of our sophisticated EHR," said Ronald Paulus, MD, MBA. "Above all, it was the focused commitment of all Geisinger physicians and staff to delivering quality care and integrating the EHR into all that we do that contributed to our success."

"Geisinger's EHR helps our healthcare providers deliver the best and most efficient care since all lab results, notes and studies completed at Geisinger sites are available through the EHR to any provider. This helps decrease repeat testing and improve coordination of care between healthcare providers, no matter where in the system the patient is located."