By Martin Kidston

The Centers for Medicare and Medicaid has selected Montana as one of several states to launch a five-year pilot program aimed at lowering health care costs by reforming how primary care is delivered and paid for, Gov. Steve Bullock announced on Monday.

Surrounded by doctors, nurses and several state legislators at the Western Montana Clinic in Missoula, Bullock said the program, known as Comprehensive Primary Care Plus, will advance the state's efforts to ensure that all Montanans have access to affordable health care.

“Comprehensive Primary Care Plus really is a promising primary-care innovation that aims to improve the health outcomes for patients,” said Bullock, who created the Montana Council on Healthcare Innovation last year. “It aims to provide flexibility and incentives to doctors, and it aims to reduce the overall cost of care.”

Dr. Pam Cutler, president of the Western Montana Clinic, described the program as a home model of delivering primary care. It gives doctors more freedom to decide what types of care will result in the best outcome for their patients. Those doctors are then rewarded for achieving results.

“It really means doing what's best for the patient at all times, keeping their needs and comfort as the focus of our work,” said Cutler. “We've learned that putting the patient at the center of our work will make health care more efficient and more effective.”

Advocacy groups have described Comprehensive Primary Care Plus as the “largest ever” push to transform the way primary care is delivered and paid for in the U.S. Among other things, it calls upon insurers to work more closely with providers to achieve better patient care while making smarter spending choices when treating those patients.

Dr. John Griffin, the medical director at Blue Cross and Blue Shield, said the program aims to reward quality care over quantity. That's a step away from the current “fee for service” model, where the more a doctor does, the more he or she is paid, Griffin said.

“That's what exists currently,” he added. “We're now shifting to incentivize direct and improved health care outcomes. This is a way of changing how payments are made to physicians in the health care system.”

Those present Monday described the program as a three-pronged effort that looks to improve the delivery of care and the way patients experience that care. It also looks to cut costs for both patients and providers by realigning the billing system.

To achieve the intended results in Montana, the program must pass several critical tests, including closer collaboration between providers and insurers.

Those who participate in the program will also be required to track the value and cost savings of their work, according to Jessica Rhoades, the policy director for the Montana Department of Health and Human Services.

“This is an opportunity for Medicare, Medicaid, Blue Cross and Pacific Source to all come together and agree to align how health care is incentivized to reduce the administrative burden on providers, which can also drive down health care costs,” said Rhoades. “Some of the outcome measures include reducing emergency room visits and unnecessary hospitalizations.”

Montana was selected as one of 14 states to participate in the program. Participating clinics and hospitals have not yet been selected, though the Western Montana Clinic and Providence St. Patrick Hospital are expected to apply.

“We have to redesign the delivery system itself to be more hourly focused and not just doing the best job we can taking care of you when you show up, but doing a better job reaching out and actually keeping you healthy and out of the hospital,” said Jeff Fee, CEO of St. Patrick Hospital.

“Primary Care Plus really represents a very tangible and significant step toward changing the incentives for the front-line caregivers,” he added. “It's changing the way primary care physicians work with the community.”

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