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Better, Faster, and More Affordable
C. Craig Blackmore, M.D.Virginia Mason Medical CenterSeattle, WA
Leading Change in Health Care
Virginia Mason’s VisionTo Be the Quality Leader and Transform Health Care1.Quality leader requires efficient, effective systems.
2.Transforming health care requires collaboration.
Source: The Leapfrog Group, 2010.
Marketplace CollaborativesInnovation and Transparency
The Market-Relevant Quality Bundle
Stakeholder Accord on Defining Quality
1. Evidence-based care: what works2. 100% patient satisfaction3. Same-day access4. Rapid return to function5. Affordable price for buyer and seller
Building Quality into a Value Stream
1. Evidence is translated into standard practice.
2. Each step is designed to be value-added.
3. Variation is limited with mistake-proofing.
4. Tasks are assigned to the appropriate provider.
5. Value stream includes entire patient experience.
Headache Value StreamBefore and After Redesign
Value added Non-value added Variable value
Redesign creates:1. Evidence-based care 2. High patient satisfaction3. Same-day access4. Rapid return to function 5. Lower cost for buyers and sellers
Measuring Evidence-Based Medicine
Reporting with Transparency
Reduction in imaging
Headache: -23%Low back pain: -25%Sinusitis: -25%
Mistake-proofing implemented
What We’ve Learned• Accord on definition of quality is
fundamental.• An integrated system facilitates
alignment.• Quality is a systems attribute.• Collaboration facilitates transparency.• Controlling health care costs requires
a)Providers producing quality, b)Health plans reimbursing for quality, and c)Purchasers choosing to buy quality.
An Approach for Caring for Particular Types of Patients
A Presentation by Chet BurrellPresident and CEO
CareFirst BlueCross BlueShieldOwings Mill, MD
December 16, 2010
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
10
* Incentives and reward increases apply to all medical services and exclude supplies and drugs.
PCMH: Designed to preserve and enhance PCPs’ ability to practice medicine the way they want to practice medicine –
while improving quality and reducing costs
12% fee schedule
increase
upon enrolling
12% fee schedule
increase
upon enrolling
New fees paid
for Care Plan
development
and follow-up
New fees paid
for Care Plan
development
and follow-up
Significant
rewards*
based on quality
and efficiency
Significant
rewards*
based on quality
and efficiency
Incentive IncentiveIncentive
10 Essential Elements
1. Medical Care Panels are the central building blocks
2. Patients ‘attributed’ to panels
3. Calculating the illness burden score
4. Establishing global expected care costs and tracking experience
5. Referrals to specialists: patient authorization and consent
6. Enhanced focus on patients with chronic illnesses – care plans / teams
7. An online member health record (MHR)
8. Measuring quality of care
9. Annual settlement and calculation of incentive awards
10.Signing on and complying with program rules
Focusing on High-Risk Patients
Targeted
Group
Wellness/Illness Burden Pyramid – PCMH & Employers
Example PCMH Panel Experience Example Employer ExperiencePercent of Population
Percent of Cost
3% 35%
7% 25%
21% 25%
19% 9%
50% 6%
Percent of Population
Percent of Cost
2% 31%
9% 29%
22% 20%
17% 15%
50% 5%
For more information about CareFirst’s PCMH program, visit:
www.carefirst.com/providers/pcmh
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