CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Associat

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CareFirsts Collaborative Programs
Addressing Health Information Technology/Exchange
Presented by Jon Shematek, M.D. SVP and Chief
Medical Officer CareFirst BlueCross BlueShield
CareFirst BlueCross BlueShield is an independent
licensee of the Blue Cross and Blue Shield
Association. Registered trademark of the Blue
Cross and Blue Shield Association. Registered
trademark of CareFirst of Maryland, Inc.
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The CareFirst Commitment

• Rationale for supporting HIT/HIE initiatives
• Programs 2004 - 2007
• Focus on Bridges to Excellence Pilot
• New Programs for 2008

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Rationale

• Promote evidence-based care
• Reduce errors
• Reduce duplication and unnecessary services
• Better quality
• Less costly

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Programs 2004 - 2007

• Bridges to Excellence
• DrFirst ePrescribing
• La Clinica del Pueblo (diabetes)
• Montgomery Cares
• Community Health Integrated Partnership (CHIPS)
• MD/DC Collaborative for HIT
• MD eCare LLC
• CHIPS HIE
• LifeBridge-Agnes
• Programs for 2008 and beyond

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CareFirst BTE Pilot
CareFirst was the first health plan to directly
fund rewards through the Physician Office Link
Program.

• CareFirst licensed by BTE in January 2005
• CareFirst launched 4.5 M pilot project for 2005
  2007
• 30 PCP practices throughout service area
  selected to participate
• Over 60,000 CareFirst members cared for at those
  locations
• Physician Practice Connections Version 1 used as
  basis for recognition and rewards
• Standard BTE reward schedule used
• CareFirst support
• NCQA-Trained Nurses available to assist
• Readiness Assessment
• Prepare documents to meet standards
• eRx hardware and license
• Coordination with Health Plan as applicable

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21 Practices recognized in Physician Practice
Connections by NCQA
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Practice Innovations in BTE Groups
Implemented as a direct result of BTE
participation

• QI activities to improve colonoscopy rates
• QI activities to improve diabetic eye exam rates
• Developed patient education website
• Process to refer to Health Plan DM programs
• Implemented EMR
• Enhanced patient education material
• Flu clinics for children with asthma

• Chronic disease registry, tracking and follow up
• Tracking systems for Xray/lab/referrals
• Implemented e-Rx
• Enhanced health risk assessment
• Process for follow-up of ER and inpatient
  admissions

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Incremental Improvement
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CareFirst Programs New for 2008
Community Health Integrated Partnership (CHIP)
Integrated Electronic Patient Record System

• The model used for the Practice management system
  will be replicated, the health centers joint
  investment with a centralized management
  function. They will expand the capacity of the
  existing health information technology
  architecture to integrate and support Electronic
  Patient Records System. Critical components of
  the system include quality and outcome reporting
  and ePrescribing capabilities. The Network will
• Establish protocols for evidence-based care
• Monitor and evaluate clinical outcomes
• Standardize clinical workflows
• Host the application, provide backup and disaster
  recovery services, operate Tier 1 Help Desk,
  interface with the practice management system
• Conduct training

Request Year 1 728,499 Year 2 238,724
LifeBridge Health-St. Agnes Electronic Health
Information Interchange utilizing a consumer
controlled record bank

• Proposed model includes 3 components
• Consumer controlled health records stored in an
  independent health record bank
• Bi-directional communication of patient data from
  licensed providers using different EMR
  technologies through the bank
• Low cost clinical decision support tools in the
  hands of the providers
• Request Year 1 406,230 Year 2 143,970