Are Higher-Value Care Models Replicable?

Boeing’s Pilot Project

Boeing’s just-completed, successful pilot – called the Intensive Outpatient Care Program (IOCP) – aimed to improve quality of care and substantially reduce total spending for the predicted highest-cost quintile of its Puget Sound employees and their adult dependents. The program enrolled employees and pre-Medicare retirees and their adult spouses, who participated in Boeing’s self-funded, non-HMO medical plans.  The project was designed by Mercer Health and Benefits and clinically managed by Renaissance Health, in partnership with Regence BlueShield of Washington, Healthways, ValueOptions, and leaders of three physician groups. Boeing incentivized the groups via a monthly per patient fee to test a new, judiciously intensified chronic care model, the “ambulatory intensive caring unit” (A-ICU).  Designed to both lower per capita spending and improve quality by a national team of clinicians and systems engineers familiar with high quality, low-cost care systems, A-ICU model development was coordinated by Mercer with support from the California HealthCare Foundation. The model was based on the experience of prior successful primary care innovators such as those described as “American Medical Home Runs” in the current (Sept-Oct 2009) issue of Health Affairs.  Each physician group tailored the model to fit their environment.

Patients were invited to enroll in the IOCP if they received primary care through one of the three physician groups and had a severe chronic illness likely to benefit from intensified primary care. The pilot enrolled 740 eligible non-Medicare Boeing patients being treated by physicians at the Everett Clinic, Valley Medical Center IPA, and Virginia Mason Medical Center clinics.  Patients who accepted were connected to a care team that included a dedicated RN care manager and an IOCP-participating MD, either their prior PCP (in one physician group) or a new IOCP-dedicated PCP (in two physician groups). Each IOCP-enrolled patient received a comprehensive intake interview, physical exam, and diagnostic testing. A care plan was developed in partnership with the patient. The plan was executed through intensive in-person, telephonic and email contacts – including frequent proactive outreach by an RN, education in self-management of chronic conditions, rapid access to and care coordination by the IOCP team, daily team planning huddles to plan patient interactions, and direct involvement of specialists in primary care contacts, including behavioral health when feasible.