Jim Carraway Links to an external site., a 53-year-old retired state of Florida employee, suffers from Charcot-Marie-Tooth, a rare neurological disorder that causes progressive nerve and muscle degeneration. He also suffered a stroke, had six heart bypass operations, a defibrillator implanted, several surgeries on his feet, and has diabetes. He was exactly the kind of patient for whom the Capital Health Plan in Tallahassee designed theCenter for Chronic Care Links to an external site.. When the Center was created in 2003, Capital Health Plan identified their sickest patients, those with multiple chronic conditions who didn't fit into existing programs for patients with single diagnoses, and, after consulting their primary care physicians, invited them to the Center for Chronic Care. Here, using a comprehensive, planned approach to care with a focus on patient engagement and self-management, every aspect of a patient's care is coordinated. If a patient is admitted to Tallahassee Memorial Hospital, the largest hospital in the area which serves a significant percentage of the area's residents, or visits the hospital's ER, the hospital's electronic health record flags the patient so that the Center for Chronic Care's medical director can be closely involved in their care. Capital Health Plan has seen primary care physician visits and pharmacy costs increase for the Center's patients. Still, inpatient hospital days dropped by 40%, ER visits decreased by 37%, and overall claims costs dropped by 18%. The care model makes a difference for patients like Jim Carraway Links to an external site., who, according to his wife, Sarah, is "doing much better" than he was before becoming a patient of the Center. Jim says that at the end of each visit, his doctor sets "goals and expected outcomes for the next visit, like lose five pounds or keep your blood pressure at this level. He names them, and it is motivating because you know someone is paying attention."

The Center for Chronic Care is based on the patient-centered medical home model it is a new payment and delivery model. It showed success in improving care and cost containment.

A. What factors have led to the Practice's success?

B. Are present financial incentives strong or sufficient to change healthcare provider behavior? Why or why not?