Eight out of 10 pilot patients got flu shots, for instance, compared with four out of 10 PEIA patients statewide. Ninety-six percent of women over 40 were screened for breast cancer, compared with 65 percent statewide. And 92 percent of appropriate patients were screened for colorectal cancer, compared with 66 percent statewide.
Amber Crist, Cabin Creek education director, credited Cabin Creek's team approach. "Each patient sees a doctor, but also gets other services as needed," she said. Teams include staffers who can help with nutritional, behavior, medical, prenatal and dental issues, she said.
Between medical visits, case aides "stay in touch with patients in a friendly way, to encourage them to take care of themselves," she said. An aide might "call and say, 'How're you doing?' chat a bit, then ask 'Have you taken your blood pressure medicine?'"
Cheatham said PEIA usually pays for a nurse to check on its members between visits, but "since they do it, we don't have to."
"If a patient is called by a friendly person they know, you get a better outcome than if a stranger from an out-of-state managed care company called them," said Dave Sotak, CEO of New River Health Association in Fayette and Raleigh counties.
New River will run a PEIA pilot project, Sotak said. "To me, it seems like the way to go. The provider gets a steady stream of revenue with some chance of incentives.
"We also very much like the fact that PEIA lets us know when our PEIA patients go into the hospital," he said. "That helps us provide good follow-up care after they come home."
Cabin Creek and New River are also part of a health reform pilot project which involves 10,000 working people, run by the state Department of Health and Human Services. That pilot, which also pays a flat fee per person, has just begun.
"We all should be watching these pilots," said Don Perdue, Chair of the House Health and Human Resource Committee. "The savings could be immense, compared with what we've got now."
The PEIA statistics are not all positive. During the past year, Cabin Creek pilot project patients visited the emergency room about 300 times during the year, instead of an expected 192 times, according to PEIA records. An emergency room visit typically costs far more than a private doctor or community health center would.
"That's our goal for the upcoming year," Crist said. "Reducing unnecessary ER visits."
In 2011, Cabin Creek PEIA pilot patients will sign a written agreement, she said, spelling out patient responsibility not go to the ER for care they could get through the center. "We have to make that clearer."
In a third pilot last year, Cabin Creek, New River, and FamilyCare in Kanawha and Putnam counties have been testing a team care approach to care of 1,500 chronically ill patients on Supplemental Security Income.
It's not possible to compare the results with a statewide average, Crist said, because Medicaid does not collect statewide medical data on patients like PEIA does. "But we think we'd see similar results."
Earlier this year, Medicaid stirred controversy with a plan to hire three out-of-state companies to manage care of 55,000 SSI patients. The companies would in turn pay state providers. Nobody else was allowed to bid.
"We were disappointed by that," Robinson said. "We've proven we get good results."
Ted Cheatham at PEIA is convinced. "If we can get this model streamlined into what I call Primary Care Modular System -- easy to administer claims-wise -- I would love to see all primary care in West Virginia go to this model."
Reach Kate Long at katel...@wvgazette.com or 304-348-1798.