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Blue Cross Blue Shield of Michigan Taming the Healthcare Beast: A Plan for Michigan. Federal Reserve Bank. Presenter: Tom Simmer M.D. Chief Medical Officer. March 31, 2009. Overview. A few facts about health status, healthcare costs, and personal income in Michigan.

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Presenter tom simmer m d chief medical officer

Blue Cross Blue Shield of Michigan

Taming the Healthcare Beast:

A Plan for Michigan

Federal Reserve Bank

Presenter: Tom Simmer M.D.

Chief Medical Officer

March 31, 2009


Overview

Overview

  • A few facts about health status, healthcare costs, and personal income in Michigan.

  • The Goal: Improve the competitive position of the state of Michigan for business while supporting access to needed medical services.

  • Provider Partnership Programs improve healthcare delivery through population based, collaborative initiatives, often connected with performance-based payment.

  • A quick look at results.


Michigan personal income falling relative to u s

Michigan Personal Income Falling Relative to U.S.

Michigan per Capita Income as a Percent of U.S. Per Capita Income

122%

93%

89%

Source: Department of Treasury calculations from Bureau of Economic Analysis data


Presenter tom simmer m d chief medical officer

Source: “Michigan’s Health Care Safety Net: In Jeopardy,” A MHA Special Report


Older fatter smokier sicker

Older, fatter, smokier, sicker


2008 michigan health plan costs

Average Annual Cost to Employer Per Employee

State: $8,812

Regional: $7,557

National: $7,327

2008 Michigan Health Plan Costs*

Employer Share

Employee Share

State: $6,152

Regional: $4,904

National: $4,117

2008 health plan costs according to the annual United Benefit Advisors Health Plan Survey. The survey included 18,019 employers nationally, 5,283 in a four-state region and 828 in Michigan. United Benefits Advisors is a national alliance of independent insurance agencies that includes The Campbell Group in Grand Rapids, BenePro Inc. in Royal Oak, Pappas Financial in Farmington Hills, Saginaw Bay Underwriters in Saginaw and Employee Benefits Agency in Marquette.

State: $2,660

Regional: $2,653

National: $3,210


Why haven t we succeeded in healthcare

Why haven’t we succeeded in healthcare?

  • Lack of Population focus – fee for service / third party payment system drives increased delivery of services.

  • Cottage industry: Physician practices lack capacity to build information infrastructure and implement lean processes that are key to improving performance.

  • Health plan, rather than delivery system,focus introduces process variation and re-work, not clinical process improvement.

  • Weak primary care foundation misses opportunities for care coordination and lower cost approaches.

  • BCBSM programs are unique in rewarding population-based improvements in care, strengthening primary care, investing in infrastructure through large physician organizations, and reducing variation through lean process improvement across the delivery systems and across payers.


Presenter tom simmer m d chief medical officer

Care

Relationship

Effective Providers

  • Basics

  • Precertification

  • Utilization Review

BCBSM Members

Support

Wellness & Care Management

Michigan

BCBSM Clinical Programs


Presenter tom simmer m d chief medical officer

CQIs: Collaborative

Quality Initiatives

Michigan Surgical

Quality Collaborative

Michigan Bariatric Surgery

Collaborative

BMC2: BCBSM Cardiovascular Consortium

Angioplasty Collaborative Quality Initiative

Michigan Society of Thoracic Surgeons

Cardiac Surgery

Collaborative Quality Initiative

Etc.

Current Partnering for Value Programs

Physicians

Hospitals

Hospital

Incentive Program

(in Participating

Hospital

Agreement)

PGIP:

Physician Group

Incentive Program


Presenter tom simmer m d chief medical officer

  • PGIP Participants (June 2008)

  • 35 groups

  • 6,471 physicians

  • 1,700,000members

Keweenaw

Marquette County: Upper Peninsula Health Plan (176)

Houghton

Genesee County: Genesys Integrated Group Physicians(87), Hurley PHO (116), McLaren Medical Management (95)

Ontonagon

Baraga

Luce

Marquette

Gogebic

Chippewa

Oakland County: Medical Network One (303), Oakland Physician Network Services (144), Oakland Southfield Physicians (204), Oncology Physician Resource (64), Quality Partners of MI (34), St. John Medical Group (223), United Physicians (560)

Alger

Schoolcraft

Mackinac

Iron

Dickinson

Delta

Saginaw County: Primary Healthcare Partners (57)

Menominee

Emmet

Presque

Isle

St. Clair County: Mercy~ Physician Community PHO (38), Physician Healthcare Network (26)

Cheboygan

Kent County: Advantage Health Physicians (146), Michigan Medical, PC (MMPC) (90), Regional Delivery Network of West MI (136),West Michigan Physicians Network (227)

Charlevoix

Alpena

Otsego

Antrim

Montmorency

Leelanau

Macomb County: DMC Primary Care Physicians (115), St. John HealthPartners (417)

Grand

Traverse

Kalkaska

Oscoda

Benzie

Alcona

Crawford

Muskegon County: Hackley PHO (79)

Missaukee

Ogemaw

Wexford

Roscommon

Iosco

Manistee

Arenac

Wayne County: Henry Ford Medical Group (328), Olympia Medical Services (127), UOP, LLC (252)

Mason

Lake

Osceola

Clare

Gladwin

Ottawa County: Principal Health PHO (35)

Huron

Mecosta

Midland

Oceana

Newaygo

Isabella

Bay

Tuscola

Sanilac

Montcalm

Saginaw

Ingham County: Consortium of Independent Physician Associations (1,230), MSU Health Team (104), Sparrow Family Medical Services (45)

Muskegon

Gratiot

Washtenaw County: Huron Valley Physicians Association (245), Integrated Health Associates (109), U-M Health System Faculty Group Practice (387)

Genesee

Lapeer

St.Clair

Ottawa

Kent

Clinton

Shiawassee

Ionia

Macomb

Ingham

Oakland

Eaton

Calhoun County: Integrated Health Partners (69)

Allegan

Barry

Livingston

Wayne

Calhoun

Jackson

Kalamazoo County: Bronson Medical Group (50) and ProMed Healthcare (83)

Van Buren

Washtenaw

Kalamazoo

Jackson County:Jackson Physician Alliance (70)

Monroe

Cass

St. Joseph

Hillsdale

Branch

Lenawee

Berrien

10


Presenter tom simmer m d chief medical officer

  • Next-Generation PPO

  • Stronger role for primary care

  • (medical home, not gatekeeper)

  • Strong link between performance and payment

Partnering for Value

Foundation for Future

Short-

Term

Value

  • Build effective physician organizations.

  • Care commitment to a defined population

  • Facilitated practice improvement and technology dissemination.

  • Substantial improvement in healthcare delivery

Preparations

Incremental Savings and Improvement

ValuePartnerships: Leveraging Provider Relationships and Market Share to transform healthcare delivery.

Current

State


Programs to improve hospital care mha keystone hospital associated infection hai

Programs to Improve Hospital Care: MHA Keystone: Hospital-Associated Infection (HAI)

The Challenge:

  • 5-10% of hospital inpatients develop infections each year, resulting in 90,000 deaths nationally

  • $5 billion to $6 billion in national health care costs

    The Response:

  • Launched in 2007 to eliminate Hospital Associated Infections

  • Hand hygiene compliance nearly 80% (U.S. average is 40%)

  • Eliminating nonessential catheters

  • 112 participating hospitals in MHA Keystone: HAI


Keystone results in michigan

Keystone Results in Michigan

  • Lives Saved – 1,729*

  • Patient Days Saved – in excess of127,000*

  • Dollars Saved – 0ver $246 Million*

  • Culture of Safety improved 28%

  • Teamwork improved 15%

* Based on the Johns Hopkins Opportunity Calculator


Improving cardiac interventions participating centers 2009

Improving Cardiac Interventions – Participating Centers – 2009


Comparison of outcomes for 2002 2008

20

2002

2008

15

40%

Percent

10

22%

1.5%

5

18%

25%

26%

0

Death

Kidney

Failure

Transfusion

Vascular

All CABG

Revasc

Complications

Comparison of Outcomes for 2002-2008*


Improving performance to the population evidence based care measures

Improving Performance to the Population: Evidence Based Care Measures

2008 Measures (scored in 2008)

Diabetes

Comprehensive Diabetes Care - HbA1c Testing

Comprehensive Diabetes Care - LDL-C Screening

Comprehensive Diabetes Care - Monitoring Nephropathy

Lipid Lowering Drug Rate

Statin Therapy for Persons with Diabetes

ACE/ARB Use with Comorbidity CHF

ACE/ARB Use with Comorbidity Nephropathy

ACE/ARB Use with Comorbidity Hypertension

Asthma

Use of Appropriate Medications for People with Asthma – Combined

Congestive Heart Failure (CHF)

LDL-C Screening

Beta Blocker Prescription over Last 12 Months

Rate of ACE/ARB

Coronary Artery Disease (CAD)

Beta Blocker Treatment After a Heart Attack

Cholesterol Management for Patients with Cardiovascular Conditions - Screening

Lipid Lowering Drug Rate

Statin Use

Additional Measures

Appropriate Treatment for Children with an Upper Respiratory Infection

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

New Measures for 2008 (scored in 2009)

Adult Prevention

Breast Cancer Screening

Cervical Cancer Screening

Child/Adolescent Prevention/Treatment

Adolescent Well Care Visit

Adolescent Immunization Status – Combo 2

Childhood Immunization Status – Combo 3

Well Child Visits in First 15 Months of Life

Well Child Visits in 3, 4, 5, 6 Years of Life

Chronic Obstructive Pulmonary Disease (COPD)

Use of Spirometry in Assessment and Diagnosis

Congestive Heart Failure (CHF)

ACE/ARB Continuation/Persistence

Coronary Artery Disease (CAD)

Persistence of Beta Blocker Treatment After AMI

Low Back Pain

Imaging Studies for Low Back Pain

16


Ebcr performance trend

EBCR Performance Trend


1q 2008 ebcr performance

1Q 2008 EBCR Performance


Increasing generic use

Increasing Generic Use


Pmpm by year

PMPM by Year

Final

Difference=$21.08

Savings=$16.24 PMPM

Initial PMPM Difference=

$4.84


Improving primary care performance

Improving Primary Care Performance

  • Performance assessment is based on attributed population rates.

    • PC-MH practice characteristics, based on national criteria

    • Performance on Quality metrics – “Evidence-Based Care Report”

    • Resource management

      • Generic dispensing rate

      • High tech imaging

      • Low tech imaging

      • Rate of use of ER for non-emergent care


Building the primary care foundation patient centered medical home

Building the Primary Care Foundation: Patient Centered Medical Home

PGIP Phys Org B

PCP

PC-MH

PGIP Phys Org A

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PC-MH

Nominee

PCP

PCP

PC-MH

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PGIP Phys Org C

PCP

PC-MH

“Control

Group”

PCP

PC-MH

Nominee

PCP

PCP

PCP

PCP

PC-MH

Nominee

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP

PCP


Summary

Summary

  • Michigan has unfavorable health status and medical costs compared to regional and national benchmarks.

  • BCBSM is working to make Michigan a more competitive state to attract business and job growth, while improving medical care.

  • Health Plan-based Wellness and Care Management programs are cost-effective and act as a safety net for failure of the primary clinical process, but they do not change healthcare delivery and do not significantly affect health benefit costs.

  • Population-based collaborative programs improve key clinical processes and achieve substantial savings.

  • PCP’s are actively transforming their practices by implementing the Patient-Centered Medical Home model, creating a lower cost model of care.


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