Baseline Demographic Variables - PowerPoint PPT Presentation

1 / 38
About This Presentation
Title:

Baseline Demographic Variables

Description:

Blue Cross Blue Shield of Michigan. BCBSM's Value Partnerships: ... Blue Cross Blue Shield of Michigan Cardiovascular Consortium ... – PowerPoint PPT presentation

Number of Views:114
Avg rating:3.0/5.0
Slides: 39
Provided by: mauromo
Category:

less

Transcript and Presenter's Notes

Title: Baseline Demographic Variables


1
Partnering for Value
David Share, MD, MPH Senior Associate Medical
Director, Health Care Quality Blue Cross Blue
Shield of Michigan
2
BCBSMs Value PartnershipsProvider-Plan
Collaboration to improve outcomes and efficiency
  • Current state
  • Fragmented acute care focused patients are
    passive recipients of care consistently poor
    value
  • Future state
  • Integrated system designed to assure proactive
    management of population wellbeing care
    customized to individuals needs patients are
    active participants in care consistently high
    value
  • Collaborating with physicians to modernize health
    care
  • Forge a common vision of a preferred health
    system
  • Energize physicians to lead change
  • Charge them to transform system in which they
    practice
  • Design an incentive program to achieve the vision

3
Now Future
  • More
  • Incremental change
  • Reactive
  • Defend status quo
  • My patients/my practice
  • Compete on quality
  • Better
  • Transformative
  • Systematic
  • Advocate for change
  • Our community of patients
  • Collaborate on quality

4
Now Future
  • Fragmented
  • Acute care focus
  • Problem oriented
  • Reactive
  • My records
  • Hard copy
  • dispersed
  • Integrated
  • Chronic care focus
  • Goal directed
  • Proactive
  • Patients information
  • Electronic
  • accessible

5
Now Future
  • Error prone
  • Spotty
  • Trees
  • Led
  • Caregiver
  • Error free
  • Consistent
  • Forest
  • Lead
  • Caregiver

6
Strategies for Improving Outcomes
  • Steerage Direct patients to high-performing
    narrow networks/COEs
  • Not effective on a population basis
  • P4P reward high performance
  • Addresses a narrow range of health care services
    due to limited ability to define and measure
    optimal care not subspecialty specific rewards
    past performance, doesnt catalyze fundamental
    change playing to the quiz focus on what is
    measurable, not necessarily what is important
  • Partnering for Value
  • Physician Group Incentives Multi-hospital,
    registry-based Collaborative Quality Initiatives
  • Emphasizes collaborative and continuous quality
    improvement and transforming systems of care

7
Partnering for Value overarching goals
  • Optimize wellbeing, maximize health care
    efficiency
  • Energize patients as partners in goal setting and
    self-management
  • Raise the bar of quality community-wide, dont
    just reward high performers
  • Transform systems of care assure proactive
    management of populations with chronic care needs

8
Partnering for Value underlying assumptions
  • System transformation is more likely if
  • physicians interests are aligned with payers
    and purchasers interests
  • physician groups own the responsibility
  • groups have structure and active leadership (at
    the group and clinic levels)

9
Partnering for Value underlying assumptions
  • Physicians practice in groups (actual or virtual)
  • Solo practice is unusual
  • Even solo practitioners dont practice in
    isolation
  • Cross coverage is standard, even for soloists
  • PCPs rely on specialists, hospitalists, the ER
  • Specialists sub-specialize

10
Partnering for Value underlying assumptions
  • Advantages of measuring group performance
  • Supports and stimulates system transformation
  • Less likely to reward past performance
  • The needle moves slowly when measuring individual
    physician performance
  • More valid than individual level measurement (low
    n, patient clustering, patient attribution)
  • Physicians creative energies are focused on
    improving systems not defending personal practice

11
Partnering for Value underlying assumptions
  • Cross-group/institution collaboration yields more
    than competition on quality
  • Improvement catalyzed by sharing best practices
  • More variation exists in practices across groups
    than within groups
  • Permits more robust analyses of link between
    processes and outcomes of care

12
Optimizing Value in Physicians Practices
  • Health plan can catalyze system transformation
  • encourage formation of physician groups
  • then high-functioning, integrated systems of care
  • Resources are needed for physician groups to
    achieve optimal systems
  • One size doesnt fit all Physician groups are in
    different stages of evolution ranging from
    vertically integrated, highly functioning systems
    to cottage industries

13
BCBSMs Physician Group Incentive Program
  • 16 groups 2,700 doctors 471,000 members
  • Rewards system transformation
  • One size doesnt fit all
  • Goal is uniform high quality and cost effective
    care, with proactive management of populations of
    patients with chronic illness
  • Focus is on implementing the Chronic Care Model
    Asthma, DM, CAD, HF, Depression as a
    co-morbidity linking specialists and PCPs

14
Chronic Care Model
  • Organization of the Delivery System
  • Community Linkages
  • Self-Management Support
  • Decision Support (for clinicians)
  • Delivery System Design (e.g., planned visits,
    shared visits, proactive, goal-directed outreach)
  • Clinical Information Systems
  • Integration of Chronic Care Model Components
    across settings of care

15
Chronic Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Prepared, Proactive Practice Team
Informed, Activated Patient
Productive Interactions
Improved Outcomes
16
PGIP Chronic Illness Workgroup Cross-group
collaboration
  • Self-management
  • Planned care visits
  • System integration
  • Process improvement
  • Performance measurement

17
Chronic Diseases Measures Gauge Impact and Guide
Transformation
PGIP Evidence Based Care Measures 2005 (Claims
Based)
  • CHF Measures
  • LDL Screening
  • Beta Blocker Prescription Last 12 months
  • ACE/ARB Use
  • CAD Measures
  • LDL Screening
  • Beta Blocker Use after AMI
  • Lipid Drug Use
  • Statin Drug Use

18
Chronic Diseases Measures Gauge Impact and Guide
Transformation
19
Physician Organization Gain-sharing Program
  • Physician Organization Gain-sharing Program
  • 15 additional groups total of 4,500 doctors
    900,000 members (combined PGIP/POGS)
  • Provider organizations take responsibility for
    acting on opportunities to improve efficiency
  • Share realized net savings in pharmacy, lab,
    imaging and referrals (in-network) with PGIP and
    POGS groups
  • Specialty gain-sharing
  • cardiology improved efficiency in diagnostic
    service and pharmacy use EMR based-ambulatory
    discharge contract
  • Oncology improved efficiency in diagnostic
    imaging and pharmacy use (epoetics anti-emetics
    emerging bio-tech drugs)

20
2005 PGIP Accomplishments
  • 8.9 million in incentive payments
  • Physician groups are making significant
    investments in quality
  • Physicians achieved 7 million in reduced
    prescription drug costs through the use of
    generic alternatives

21
Physician Group Highlights
  • PROMOTING INFORMATION INFRASTRUCTURE FOR
    IMPROVED PATIENT CARE
  • Committed over 3 million to implement electronic
    medical office to facilitate ability to identify
    specific patient populations and compliance with
    evidence-based medicine and guidelines
  • Planned electronic medical record implementation,
    including e-lab access and e-patient reminders
  • Electronic health record initiative includes
    incentives for early adoption of technology
  • Chose Chronic Disease Electronic Management
    System (CDEMS) for registries
  • MAKING DISEASE REGISTRY INFORMATION AVAILABLE AT
    POINT OF CARE
  • Populated registries for all four targeted
    conditions
  • Provided financial incentive for doctors to
    review the documents listing diabetics in their
    panel to assure accuracy of lists
  • Increased extent to which information is used and
    available electronically
  • Incorporated reminder system for identified gaps
    in care, to be used directly with patients at
    point of service, with CDEMS
  • incorporated lab data into registry
  • DECISION SUPPORT
  • Provided physicians with quarterly feedback on
    diabetes patients as well as group average, which
    allows identification of opportunities for
    improvement
  • SELF-MANAGEMENT SUPPORT
  • Successes reported associated with care of
    patients with diabetes in a Shared Medical
    Appointment mode
  • Implemented health coaching
  • ELECTRONIC INFORMATION ACCESS AND USE
  • Provided online asthma action plan
  • Piloted RelayHealth web visits, as a means of
    communicating with patients faxing prescriptions
    and managing scheduling
  • IMPROVING PRESCRIBING PATTERNS
  • Used incentive dollars to reward physicians who
    personally were responsible for over 50 generic
    dispensing rate
  • Implemented E-prescribing for some primary care
    physicians in advance of full EMO capability
  • Implemented e-prescribing at 35 sites with 113
    doctors
  • Tried out use of an electronic generic sample
    card (30 day supply) and may expand the approach
  • Introduced point of service generic dispensing

22
Collaborative Quality Initiativesunderlying
assumptions
  • Valid, evidence-based, nationally accepted
    performance measures cover a narrow slice of
    health care
  • While valuable, conventional quality measurement
    isnt a panacea

23
Collaborative Quality Initiativesunderlying
assumptions
  • Simple performance measures dont address areas
    of care which are highly technical,
    rapidly-evolving and associated with scientific
    uncertainty
  • Best addressed through collaborative,
    inter-institutional, clinical data registries,
    with coordinated QI programs

24
Partnering for Value Collaborative Quality
Initiatives
  • Essential elements of CQI Programs
  • Complete, accurate, risk adjusted, confidential,
    provider-owned data
  • Consortium as context for identifying and
    disseminating best practices
  • Coordinating Center to assure rigor and guide
    cross-institutional study of practice patterns
    and their relation to outcomes
  • Health plan support of consortium activity
  • Aggregate provider accountability for assuring
    health care value

25
Role of BCBSM
  • Use leverage to convene competitive hospitals
  • Provide neutral ground for collaboration
  • Provide resources for data gathering and analysis
  • Use Centers of Excellence program as catalyst for
    CQI

26
Blue Cross Blue Shield of Michigan Cardiovascular
ConsortiumCollaborative Quality Improvement
Initiative In Coronary Angioplasty Mauro
Moscucci, MD, University of Michigan Project Lead
27
BMC2 OBJECTIVES
  • Generate knowledge linking processes and outcomes
    of care to help define optimal care
  • Improve outcomes of PCI by collaboratively
    applying new knowledge in rapid-cycle, continuous
    quality improvement efforts
  • Engage clinical and administrative leaders as
    quality improvement champions

28
Areas of QI Focus
  • Systematize care based on established guidelines
  • e.g., aspirin, beta blockers, statins
  • Scientific examination of unanswered questions
    about links between processes and outcomes of
    care
  • e.g., pre-procedure statins lower renal failure
    and mortality risk identification of risk
    factors and preventive measures for kidney
    failure requiring dialysis

29
Accomplishments to Date
  • Evidence based learning linking processes and
    outcomes of care
  • Disseminated in peer-reviewed literature
  • Development of care management algorithms
  • CQI interventions demonstrable improvement in
    selected processes and outcomes of care
  • Using RCTs across hospitals to learn what works

30
Accomplishments to Date
  • Reduced heart attacks by 19
  • Reduced unplanned coronary artery bypass surgery
    by 22
  • Reduced kidney failure requiring dialysis by 57
  • Reduced hospital deaths by 27
  • Saved an estimated 8 million annually

31
BMC2 Lessons Learned
  • Blue leverage was key to convening competing
    providers and catalyzing effective, collaborative
    CQI
  • Given procedure-specific information, and
    incentives, competing providers can collaborate
    and rapidly improve the quality of care
  • Incentives to rigorously evaluate and re-engineer
    care accomplish more than focusing on selected
    performance metrics

32
Expansion of BMC2 Model
  • Cardiac Surgery (Michigan STCvS)
  • Bariatric Surgery
  • General and vascular surgery (NSQIP/ACS)
  • Breast Cancer (NCCN)
  • Hospital infection control MHA Keystone
  • Cardiac Imaging
  • Peripheral Vascular Intervention

33
Expansion of BMC2 Model
34
Hospital Incentive Program
  • Pre-qualifying conditions focus on culture of
    safety and patient safety practices (ISMP NQF)
  • 45 - 55 Quality and Patient Satisfaction
  • 35 Efficiency (e.g., cost per case regional
    comparison generic drug use)
  • 10 - 20 Collaborative Quality Initiatives

35
Partnering for Value Assuring Appropriateness
In Cardiac Imaging
  • Limit payment to providers participating in
    collaborative QI effort pertaining to new imaging
    services
  • Implement clinical registry for cases in which
    such imaging is used
  • Populate registry with data regarding the
    clinical context of such imaging (clinical
    scenario other testing and results)
  • Incorporate clinical testing algorithms for
    common clinical scenarios into the registry
  • Emphasize clinical management focus not
    modality-specific appropriateness criteria

36
Partnering for Value Assuring Appropriateness
In Cardiac Imaging
  • Examine patterns of use, and variation in such
    use, as they pertain to appropriateness criteria
    and efficiency concerns
  • Measurement focus is on physician groups
    (physicians practice in groups, whether formally
    or informally)

37
Partnering for Value Assuring Appropriateness
In Cardiac Imaging
  • Parameters to study with regard to efficiency
  • Imaging services per episode of care (for
    diagnosis post-event for chronic illness
    management)
  • of negative imaging studies
  • of use of multiple imaging modalities per
    patient in diagnosis and in care management
  • with new imaging study PLUS invasive
    imaging/PCI
  • services without known disease or active
    symptoms

38
Summary
  • Value Partnerships
  • Based on a distinctively collaborative BCBSM
    philosophy
  • Includes process, outcome, information
    technology, and cost measures
  • Eight separate initiatives target physicians,
    physician groups and hospitals
  • In 2005, paid out about 53.9 million in
    incentives
  • PGIP 8.9 million
  • Hospital P4P Program over 45 million
  • Programs impact over two million members
  • Improvements achieved in quality, cost and
    efficiency
Write a Comment
User Comments (0)
About PowerShow.com