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Chronic Disease Management: Tying patient health and financial incentives

Dr. Christine Foanio

Dr. Christine Foanio

Through a clinical incentive program offered by its largest commercial HMO payer, UI Health in the Internal Medicine Center pursued upwards of $700,000 in bonus earnings for hitting clinical benchmarks in diabetes and asthma. After some years of solid performance, financial earnings began sliding in 2013. That prompted UI Health leadership to bring Christine Foanio, a clinical pharmacist in Ambulatory Pharmacy Services, into the mix.

“The thinking was that a more interdisciplinary approach and the involvement of a clinical pharmacist could be particularly advantageous in managing these chronic disease states,” Foanio says.

She crafted a pragmatic program focused on direct interaction with the most vulnerable patients, including hour-long face-to-face visits, telephone calls and regular communication through a secure portal system.

“It’s difficult for physicians to manage these conditions in a brief 20-minute office visit, so we initiated more direct intervention with patients to get them the care, feedback and direction they needed in a much more targeted visit,” Foanio says.

With Foanio’s involvement sparking a jump in performance incentives, UI Health added a second clinical pharmacist, Kelly Schmidt, and extended the program to include hypertension in 2016. Today, Foanio and Schmidt oversee a pool of some 1,200 patients with diabetes, 5,000 with hypertension and another 200 with asthma, providing hands-on care that has improved patient outcomes and helped UI Health meet its partner’s incentive benchmarks.

“This is really one of the only programs linking pharmacy intervention to dollars earned,” Foanio says, adding that UI Health has thus far devoted incentive earnings to various patient care initiatives.

And by regularly including pharmacy students and residents in their work–students, for example, attend managed care meetings, learn how to risk-stratify patients and execute protocols that close gaps in care–Foanio and Schmidt provide trainees a unique opportunity to understand the increasingly important linkages between clinical care and finances.

“With the healthcare model trending more and more toward value-based care, this is a prime example of how the involvement of pharmacists can add significant value to patients as well as to multidisciplinary healthcare teams,” Foanio says.

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