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

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* 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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