Beltrami County Board: PrimeWest streamlines health care for indigent
A 2-year-old Beltrami County health care system is making a difference in controlling public health care costs, officials say.
"We are a managed care organization and we're owned by the counties," Jim Przybilla, CEO of PrimeWest Health, told Beltrami County commissioners last week. "We provide health care services for people in public assistance programs."
As a form of county-based purchasing, PrimeWest uses state and federal dollars to purchase services from local health care providers. Dealing with $180 million a year in reimbursements to providers, 40 percent comes from federal sources, he said.
"We serve 21,000 people in 13 counties," Przybilla said. "The number is rising, he adds. "When people lose their jobs, they lose their medical insurance and they come to us." PrimeWest serves 7,500 clients in Beltrami, Clearwater and Hubbard counties while competitor Blue Cross/Blue Shield serves 7,000.
Beltrami, Clearwater and Hubbard counties joined PrimeWest in 2007, but didn't begin channeling patients to it until 2008. Currently, PrimeWest serves 4,239 public assistance patients in Beltrami County, which includes MinnesotaCare, pre-paid Medical Assistance, Medicaid, Minnesota Senior Care Plus and Minnesota Senior Health Options. It also serves a small number of people on Special Needs Basic Care, for patients under age 65 and on Medicaid and Medicare.
PrimeWest serves 2,160 public assistance patients in Hubbard County and 1,106 in Clearwater County. It only serves 397 patients in Traverse County.
Results are being seen, Przybilla said. PrimeWest has been able to reduce hospital stays while increasing access to needed health care.
In a survey, PrimeWest patients for 2009 reduced ambulatory care for sensitive conditions preventable inpatient hospital stays to 2.38 days, compared to 2.44 for 2008 and 2.57 for 2007.
"Timely access to effective outpatient medical care can often prevent health conditions from escalating in severity and thus reduce lengths of stays if not preventing the hospitalization altogether," according to a report Przybilla gave the County Board. "PrimeWest Health Care Coordination program integrates several early identification and intervention approaches to minimize the need for costly health care services."
Of great benefit, Przybilla said, is that PrimeWest is local. It has 122 employees and six are stationed in Bemidji. "Turnaround of claims in payment to providers is seven days."
PrimeWest actively reinvests in the community, he said. The agency donated $200,000 to the Northern Access Dental Center in Bemidji, and is doing similar donations to other dental centers in its membership counties.
PrimeWest gave $5 million in grants in 2007 and 2008 for such services as access to transportation services for elderly and individuals with disabilities, prevention and wellness services and expanded chronic disease management capacity and services.
For the future, PrimeWest hopes to launch value-based health care coverage for uninsured individuals unable to afford private health insurance and ineligible for state or federally sponsored programs.
"Values Health utilizes proven wellness and prevention, care management, service delivery, health care financing, and cost containment approaches - many of which arew included in numerous health care reform proposals and plans," states the report.
PrimeWest is also beginning a new program for Medicare Advantage Special Needs Plan participants who are eligible for both Medicare and Medicaid. Already the program has "demonstrated greater health care delivery and administrative efficiencies by consolidating Medicare and Medicaid benefits and financing," said the report.
Przybilla said PrimeWest is also working on mental health coverage for public assistance patients.
Aside from the three local counties, other PrimeWest members include Big Stone, Douglas, Grant, McLeod, Meeker, Pipestone, Pope, Renville, Stevens and Traverse counties.
Health care services are delivered to member counties through the PrimeWest Health provider network. The network includes more than 4,000 providers in four states contracted with PrimeWest and comprises the entire continuum of health and human services providers, the report said.