Brad Gaspard, M.D., is a family physician at Louisiana’s Baton Rouge General Medical Center. It’s a busy practice: Gaspard and his nurses see about 45 patients a day, most of whom have one or more chronic diseases, such as diabetes or high blood pressure.
Gaspard says the clinic used to operate like most primary care practices, seeing patients when they were scheduled, doing what they could during those appointments and keeping records on patient visits. Gaspard thought the practice was doing a good job of helping patients manage their conditions. But the first time he looked at the data on his patient population overall, he was surprised.
“The results came back underwhelming to me,” says Gaspard. “So even though we thought that we were highly focused on quality and chronic diseases, when I got the results of the initial evaluation, I thought, ‘This is not nearly as good as I think we can do.’”
Enter a new program from Blue Cross and Blue Shield of Louisiana (BCBSLA) called Quality Blue Primary Care (QBPC).
Putting the data puzzle together
One of the major challenges physicians face when caring for patients with chronic illnesses is a lack of data.
“They know everything that is discussed within the four walls of their exam rooms. Examples of things they don’t know about are that the patients visited an ER over the weekend,” says Selina Loupe, past director of Clinical Partnerships for BCBSLA and head of the QBPC program. Another example is whether a patient is taking medication as prescribed. Doctors know what prescriptions they write. But, says Loupe, “What they are not aware of is that the patient did not pick up the medicine. Or even, sometimes, due to some financial restraints, maybe they’re picking up the medicine, but they’re cutting it in half so it can last longer.”
Loupe says BCBSLA has had this kind of data for a while. “But we really needed to put that insightful information into the hands of the physicians,” she says.
Now, the insurer provides participating practices with a tool that blends their patients’ health information records and their appointment scheduling data with medical and pharmacy claims data, “so they have a holistic view of the patient,” says Loupe.
Navigating the next week’s patients
But Loupe says just dumping data on a physician’s doorstep wasn’t the answer. They had to make it easy for physicians to act on that data.
So BCBSLA assigned registered nurses to be “quality navigators” for each participating practice. The navigator’s job is to identify all of the BCBSLA patients scheduled for appointments in the next couple of weeks and dive into the data on those patients. Then the navigator can highlight any critical information about upcoming patients. For example, Loupe says the navigator might uncover that a patient hasn’t picked up her prescription in the past two months. At that patient’s appointment, the doctor can ask about the medication, troubleshoot any issues and encourage the patient to get back on track. The navigator can follow up.
Loupe says patients probably trust their primary care physicians more than they trust their insurance company to help manage their care. But, according to Loupe, “it’s very powerful when a physician says, ‘You know what? The nurse at Blue Cross is going to be following up after our visit. Because I’ve told her to keep up with you and help you manage your condition.’”
Boosting health, reducing spending
Although QBPC has been around just four years, the program has already improved patient health outcomes and kept costs in line. BCBSLA measures patient improvement on the four chronic conditions targeted in QBPC—diabetes, high blood pressure, heart disease and kidney disease—with quality measures that show how well physicians are helping their patients meet health goals.
For example, physicians are measured on how many of their patients have their blood sugar and blood pressure controlled, whether heart disease patients are on statins and taking them as directed, or on getting patients to quit smoking.
At-goal percentages for these quality measures have gone up every year since QBPC began, with the 2017 program year results ranging from 34% to 76% of patients at goal for the targeted chronic diseases.
The program is also saving money. Loupe says BCBSLA reviewed how much it spent on each patient in the program and discovered that, in the first year, “that subset of members had a $27 reduction in per-member-per-month overall cost.” That’s thanks to fewer inpatient hospital stays, better medication adherence and more.
While $27 may not sound like much, factor in the nearly 300,000 patients participating in the program as of 2017, and the dollars add up.
Gaspard says he’s all for saving the system money. But mostly, he says, the program frees him up to do what matters most: help his patients get well and stay well. And, he says, he sees the program’s results in his patients’ health every day.