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BETTER CARE FOR MEDICARE
Questions & Answers about St. John’s partnership with CMS
What is the CMS Physician Group Practice Demonstration Project?
Currently Medicare reimburses physicians based on the number and complexity of
the services provided to patients. During a three-year demonstration project,
CMS will reward participating physician groups that improve patient outcomes by
coordinating care for chronically ill and high-cost beneficiaries in an
efficient manner.
Why does St. John’s wish to participate in the CMS Physician Group Practice
Demonstration Project?
St. John’s Health System believes in the importance of prevention and medical
management, particularly for those patients with chronic diseases. By linking
the events of care and enabling patients to care for themselves better between
the events, we facilitate the relationship between the physician and the patient
to help them improve health care outcomes. This CMS Physician Group Practice
Demonstration Project will allow us to be rewarded for the same care management
approach we currently provide to Employer Partners and managed care clients.
Why was St. John’s chosen for the CMS Physician Group Practice Demonstration
Project?
1. St. John’s Clinic, as part of the St. John’s Health System that also includes
hospitals and health plans, already has the infrastructure in place and have a
demonstrated ability to effectively improve health outcomes while keeping cost
trends down.
2. St. John’s data management infrastructure uses healthcare information
technology to allow us to document our progress toward specific quality measures
that improve patient outcomes.
3. St. John’s has a unique setting that allows the project to test in both rural
and urban settings. (300 Springfield area physicians, 100 in the region and 50
in the Rolla area)
4. St. John’s is already rewarding physicians for more comprehensive management
of patients because we believe care management of patients in between medical
episodes is crucial to improving outcomes and decreasing costs.
What’s important about being an integrated health system?
St. John’s uses its strengths as an integrated delivery system to affect the
multiple care processes that it takes to take care of patients today. It’s
appropriate use of care delivery in whatever form to limit fragmentation. It’s
about getting the right care at the right time, in the right place, from the
right person and that almost always creates the best outcomes.
St. John’s has learned that an answer to improving health while addressing
costs, lies in anticipating patient needs, especially in those patient with
chronic diseases and using medical management teams to partner with patients and
their physicians in the care of their conditions . This fills in the gaps of
care that often allow conditions to progress, often to the point where patients
need expensive procedures and hospitalizations.
How will this project benefit Medicare beneficiaries?
This allows St. John's Health System to expand its medical
management model developed for its managed care operations to the
Medicare fee-for-service population. The model provides for management
and coordination of both inpatient and outpatient services including
full continuum case management, 24/7 telephonic nurse triage, social
worker facilitated care transition, outpatient preventive and disease
management programs, and palliative care. Specific disease management
programs to be expanded to the Medicare fee-for-service population
include diabetes, CHF, asthma, COPD, and depression. An arthritis
disease management program currently under development will also be
implemented under the demonstration.
Frequently Asked Questions
1. I am a member of PremierPlus. Will my care be delivered any differently as a
result of this project?
No. St. John’s PremierPlus members already benefit from St. John’s medical
management model, with benefits covering many support services needed to create
quality outcomes.
2. I’m a Medicare patient. Will my relationship with my doctor be any different?
St. John’s recognizes that the physician-patient relationship is personal and
extremely important. Your relationship will not change based on your physician’s
involvement in this project. It may, however, open the doors for your physician
to provide access to a variety of support services and improved coordination of
your care between office visits.
3. What doctors are part of this project?
All of St. John’s Clinic physicians, approximately 420, are participating in the
CMS Physician Group Practice Demonstration Project.
4. Why do they call it a demonstration project?
It is designed to show or “demonstrate” how physician groups respond to
financial incentives for improving care coordination.
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