Case Study in Physician Practice and Payment Transformation: The CDPHP Experience

Setting the dual intentions of improving the value of healthcare while enhancing compensation for its primary care physicians may seem like a formidable goal; nevertheless, CDPHP set out to do just that when it launched a two-phase pilot in 2008 to reform both the practice of primary care in its network and payment to these physicians.

Case Study in Physician Practice and Payment Transformation: The CDPHP Experience chronicles the clinical and financial journeys of this network model health plan, sharing practical strategies and lessons learned from this two part-process.

Case Study in Physician Practice and Payment Transformation: The CDPHP Experience

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Illuminating Phase I, Dr. Bruce Nash, MD, MBA, and CDPHP senior vice president, medical affairs, and chief medical officer, describes how CDPHP met the challenge of developing a novel risk adjustment methodology that would drive a global payment combined with a significant bonus structure. The approach was successful in both attracting physician participation and encouraging future growth by medical students to enter primary care.

In Phase Two, CDPHP built its clinical transformation to a patient-centered medical home around case managers embedded in physician practices. Lisa Sasko MA, MBA, director of clinical transformation and Charlene Schlude, director of case management, at CDPHP, describe how the transformation better facilitates medical, behavioral and pharmaceutical services for high risk patients.

They also share the business case for an embedded case management program to bring healthcare organizations to the new level of care required in today's healthcare delivery system, and describe the day-to-day interactions of embedded case managers with providers in a practice.

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