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New program targets N.M.’s sickest

ALBUQUERQUE, N.M. — Goal is to keep patients well and to reduce costs

Copyright © 2013 Albuquerque Journal

Severely ill Medicaid patients often get lost in the health care system and end up being repeatedly admitted to a hospital, at an average cost of $10,000 per admission.

Such hospitalizations explain why just 5 percent of the state’s 500,000 Medicaid patients account for more than half of the $4 billion annual cost of the government-funded insurance program for the poor, said Dr. Sanjeev Arora, a University of New Mexico physician.

“These are expensive patients because they tend to be hospitalized repeatedly,” Arora said.

This fall, a UNM program plans to begin enrolling 2,500 of the state’s sickest and costliest Medicaid patients with the goal of keeping them well and out of the hospital.

The program, funded by an $8.5 million federal grant, will form 10 teams across the state, each with 24/7 responsibility for 250 patients.

Each team will consist of five primary-care clinicians under the supervision of UNM specialists.

“The reason it’s cost effective is because these 250 (patients) will cost a massive amount of money if not managed appropriately,” Arora said.

The program, called ECHO Care, will build on a model developed by a 9-year-old telemedicine program called Project ECHO, which allows primary care clinicians to treat patients with complex illnesses, such as hepatitis C and HIV/AIDS, under the guidance of UNM specialists.

Each five-person team will be headed by a nurse practitioner or a physician assistant who will oversee a registered nurse, a counselor and two community health workers.

Medicaid managed care organizations in New Mexico have agreed to pay salaries to team members.

“Their only responsibility is to take care of these 250 patients in the best way they can,” Arora said.

The model is intended to free primary care clinicians from the tyranny of the fee-for-service billing system.

“If I’m a clinic doc or a nurse practitioner, my salary depends on just cranking (patients) through,” said Dr. Miriam Komaromy, associate director of Project ECHO.

“It doesn’t have anything to do with how well those patients do, how healthy they are, or whether they get hospitalized. It’s just numbers, numbers, numbers.”

The program plans to form four care teams this fall and six more in early 2014. The teams will serve patients in Las Cruces, Farmington, Santa Fe, Albuquerque, Española, Las Vegas and other locations.

Project ECHO uses Web-based teleconferencing tools that will allow the teams to consult twice each week with 10 UNM specialists.

Support from specialists will be the key to treating patients with complex illnesses that often include mental illness and drug addiction, said Chris Ruge, a Las Vegas nurse practitioner who will lead one of the teams.

“Getting in to see specialists is very, very difficult, especially up here in northeast New Mexico,” Ruge said. The Project ECHO model improves communication between specialists and primary care clinicians “so we know what to do next,” he said.