N.Y. IPA progresses–slowly

The Greater Rochester (N.Y.) Independent Practice Association has just landed its first contract with a health plan—sort of.

GRIPA attracted attention in 2007 after its innovative use of health information technology and its quality-improvement infrastructure made it one of the first clinically integrated IPAs to get a favorable Federal Trade Commission advisory opinion.

Since then, however, the organization—which uses "Healthcare could look like this" as its slogan—has been shunned by local health plans. GRIPA has made up for this by contracting with large self-insured employers.

This summer, GRIPA began a collaborative effort with the 4,500 employees (plus dependents and pre-Medicare retirees) of Monroe County. The employees are already covered by Excellus, the local BlueCross BlueShield affiliate, through which GRIPA will receive $400,000.

Excellus spokesman Jim Redmond says the third-party payer was, in fact, only a third party to the deal. "This is the county's doing," he said.

Although Dr. Joseph Vasile, GRIPA's president and CEO, downplayed the insurance company's role, he didn't dismiss it.

"I don't know if it's a change of direction, but it certainly validates the work we've been doing with local employers," he said. "Excellus is not central to the agreement, but they are part of it, so it is a step forward."

Using its Accountable Care Medical Program measures, GRIPA offers doctors Patient Outreach Reports that identify high-risk patients for appointment scheduling in order to meet treatment goals and care guidelines.

"As a result of the partnership, Monroe County's current and retired workforce will have access to nurses, social workers, certified diabetes educators, clinical pharmacists and other experts who can answer their questions, provide education concerning specific medical issues and help save money on healthcare services, including prescription costs," a county news release (PDF) noted.

Apparently though, not everyone was informed of the arrangement beforehand.

"The general idea behind GRIPA is it's a 'Coordinator of Care' organization which works to save employers money by increasing preventative care, track maintenance care, and look for ways to reduce duplication of services, and look for lower-cost alternatives, and with no reduction in care and perhaps better care," wrote Chris Palozzi in the Monroe County Federation of Social Workers newsletter (PDF). "The union wants to be clear that we support all efforts at cost-cutting as long as it does not affect access to care as well as quality of care. The union also wants the membership to know that the union was not previously informed of this venture until after contracts were signed."

While it's stated the goal is to provide higher-quality, lower-cost care, some read "lower-cost" as code for fewer services. As a result, Vasile said meetings were held with some 50 employee and retiree groups.

"The unions had concerns about the new program and any potential change in their benefits," he said. "Initially, there was some skepticism, but at the end of the meeting, there was a better understanding of what we're trying to do.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks.