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An Approach for Caring for Particular Types of Patients A Presentation by Chet Burrell

An Approach for Caring for Particular Types of Patients A Presentation by Chet Burrell President and CEO CareFirst BlueCross BlueShield December 16, 2010. PCMH: Designed to preserve and enhance PCPs ’ ability to practice medicine the way they want to practice medicine –

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An Approach for Caring for Particular Types of Patients A Presentation by Chet Burrell

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  1. An Approach for Caring for Particular Types of Patients A Presentation by Chet Burrell President and CEO CareFirst BlueCross BlueShield December 16, 2010

  2. PCMH: Designed to preserve and enhance PCPs’ ability to practice medicine the way they want to practice medicine – while improving quality and reducing costs Participation 12 percentage points upon enrollment Incentive 12% fee schedule increase upon enrolling Participation 12 percentage points upon enrollment Participation 12 percentage points upon enrollment Incentive Incentive Significant rewards* based on quality and efficiency New fees paid for Care Plan development and follow-up 2 * Incentives and reward increases apply to all medical services and exclude supplies and drugs.

  3. 10 Essential Elements • Medical Care Panels are the central building blocks • Patients ‘attributed’ to panels • Calculating the illness burden score • Establishing global expected care costs and tracking experience • Referrals to specialists: patient authorization and consent • Enhanced focus on patients with chronic illnesses – care plans / teams • An online member health record (MHR) • Measuring quality of care • Annual settlement and calculation of incentive awards • Signing on and complying with program rules 3

  4. Focusing on High-Risk Patients Targeted Group 4

  5. Wellness/Illness Burden Pyramid – PCMH & Employers Example PCMH Panel Experience Example Employer Experience 5

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