Research Shows WellMed Seniors Living Longer Than 65+ Population In Texas

SAN ANTONIO, TX, anuary 13, 2011 (Press-News.org) Seniors enrolled in a Medicare Advantage plan and served by one of the region's largest primary care providers utilizing a patient-centered medical home model live longer than their peers statewide, according to federally funded research published in this month's The Journal of Ambulatory Care Management (JACM).

The adjusted mortality rate for WellMed Medical Group patients enrolled in a Medicare Advantage plan was consistently, and considerably, lower compared with the Texas senior population as a whole, according to the case study published in the most recent JACM.

The finding is significant since, "WellMed patients are older and more likely to be male (features typically associated with worse outcomes) than the Texas Medicare population," the study states. The mean age of WellMed patients examined during the study was between 75 and 76, versus 72 for Texas Medicare recipients.

In San Antonio, WellMed cares for an older, largely Hispanic population of patients. More than 13,700 of 27,000-plus patients at WellMed clinics have one or more chronic disease states, such as heart disease, diabetes or chronic emphysema. Yet their mortality rate was at least half the statewide death rate most years from 2001-07.

The 2007 age-adjusted death rate for WellMed patients aged 65-74, for example, was 9.7 per 1,000 patients, versus 20.8 per 1,000 statewide for the same age group that year. The WellMed mortality rate dropped to 7.8 in 2008. Statewide comparisons are not yet available for that year.

Mortality rates for patients age 75 or older are higher -- 40.7 per 1,000 in 2007 - but still well below the statewide death rate (77.3) for that age group.

The study did not cite mortality rates for U.S. seniors, but a National Vital Statistics Report issued in December 2010 by the Centers for Disease Control shows the age-adjusted death rate for the 65-74 age group in 2007 was 20.1 per 1,000 - higher than the mortality rate of WellMed patients.

"This study validates our understanding that aggressive management of chronic disease yields high quality outcomes," said Dr. Gary Piefer, Chief Medical Officer at WellMed Medical Management Inc., the medical group's parent.

"We were aware that our aggressive management of chronic disease had decreased hospitalizations and decreased overall morbidity, but we were unaware of the significant impact of the WellMed Care Model on mortality," he said. "We are delighted with that finding."

The case study was penned by a team from The Robert Graham Center: Policy Studies in Family Medicine and Primary Care, the research arm of the American Academy of Family Physicians. The Graham Center and Distributed Ambulatory Research & Therapeutics Network (DARTNet) received a $280,000 grant from the U.S. Agency for Healthcare Research and Quality to study WellMed's care model beginning in 2009. The research focused on 21 WellMed-owned clinics, which specialize in senior healthcare, in the San Antonio area. WellMed also owns and operates senior clinics in El Paso, Austin, Corpus Christi and the Rio Grande Valley, and in the Treasure Coast region of Florida.

Researchers targeted patients enrolled in Medicare Advantage - Medicare replacement insurance policies provided by an HMO - because they benefit from the full suite of WellMed's care coordination services. The vast majority of WellMed patients are enrolled in preferred Medicare Advantage plans.

The JACM article, titled "Case Study of a Primary Care-Based Accountable Care System Approach to Medical Home Transformation," is the first published paper from this research. The Graham Center is preparing more studies and evaluations based on its examination of WellMed for scholarly publication later this year.

"This case study confirms what we've known for a while -- that WellMed's mission to change the face of healthcare delivery for seniors is succeeding," said WellMed Chairman and CEO Dr. George M. Rapier III, a noted geriatrician and founder of the company. "We're looking forward to seeing further results from this research as more studies are released."

Lawmakers and health policy analysts recently have expressed great interest in the concepts of the Accountable Care Organization (ACO) - a network of healthcare providers who are held financially accountable for overall patient care, tasked with achieving measured health quality improvements for patients while reducing healthcare costs. Another concept closely linked to ACOs is the Patient-Centered Medical Home (PCMH), referring to the complete coordination of patient care involving a team of healthcare professionals under the direction of a primary care physician.

Both concepts are potential linchpins of the federal healthcare reform overhaul. Advocates see the promise of lowering escalating healthcare costs while providing better quality care for patients.

Discussions about ACOs to date have focused on hospitals and specialty groups. Graham Center researchers chose to examine WellMed, however, because the San Antonio-based company has spent two decades developing a medical home model (which the company now calls the WellMed Care Model) utilizing primary care providers at community-based, outpatient clinics to deliver preventive healthcare tailored to the unique needs of the Medicare-eligible population. In doing so, WellMed has achieved "unusually high quality measure rates," according to the JACM article.

"The robustness of its information management system and full access to all Medicare Advantage data allows WellMed to monitor patient and population outcomes and identify weaknesses in their system and patients at high risk," the study states near its conclusion. "These overarching features and culture speak to something larger than a medical home, approaching something akin to integrated service delivery networks but without owning hospitals or multispecialty groups."

"WellMed is the only example I know of a primary care-based ACO," said Graham Center Director Dr. Robert L. Phillips Jr., who led the eight-member research team. "Most people are trying to tie ACOs to hospitals, and WellMed has a great example of how it can be done otherwise."

Dr. Phillips said he hopes the case study will guide policy makers hoping to create systems with outcomes like the WellMed model.

"We said in the study that your patients tend to be older than other Medicare patients. One explanation is that they are simply living longer," said Dr. Phillips, Vice Chair of the U.S. Council on Graduate Medical Education, which advises Congress and the President on physician workforce policy. "You have a great model to learn from, but it takes time to build processes and culture. This is not a 2 to 3 year process, which is what many of the (federally funded) demonstration projects are set up for."

The case study cited several initiatives that have been introduced and developed over time into the WellMed Care Model, such as:

• An award-winning Disease Management program that utilizes "health coaches" who counsel patients with Diabetes, Congestive Heart Failure, Ischemic Heart Disease, Chronic Obstructive Pulmonary Heart Disease and Asthma.
• Improved rates for successfully achieving hemoglobin A1c and blood pressure control - critical in the management of diabetes and heart disease.
• A voucher program that provides no-cost prescription medications to Disease Management patients, and that prevents them from falling into the Medicare part D "donut hole"
• A social programs team that helps Medicare beneficiaries apply for reduction or elimination of Part B premiums, and possibly qualify for medication assistance.
• WellMed subsidiary Comfort Care Transportation, which provides no-cost transportation to and from non-emergency medical appointments. It was created to improve the rates of patients keeping scheduled medical appointments.
• Specialists on staff who provide in-demand services, including rheumatologists, dermatologists and podiatrists to address problems with timely referrals. Cardiologists were not on staff at the time of the study, but have since joined.
• Assigned staff who coordinate care with recommended specialists by making appointments, assisting with follow-up care and providing medical records.
• Inpatient case managers who coordinate patient interactions with specialists, hospital discharges and skilled nursing facilities or home healthcare.
• A proprietary electronic medical record (EMR) that can access a robust database with patient, physician and insurance information, most recent labs, immunizations, medications, allergies and more. Patients may receive a portable device such as a key chain or bracelet with a USB port that allows emergency responders to access this information.

Researchers said these initiatives taken separately would not necessarily yield better health outcomes for patients. Yet these patient-centered services "seem to have improved (patient healthcare) outcomes collectively," the case study abstract states.

WellMed Medical Management is a diversified healthcare company and health plan provider serving more than 100,000 patients and Medicare Advantage health plan members in Texas and Florida. WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services, and more.

WellMed is South Texas' largest physician-owned practice management company and medical group, specializing in senior health care since 1990. With more than 35 medical clinics in Texas and Florida, the vision of the healthcare company and insurance provider is to change the face of healthcare delivery for seniors.