Pennsylvania HealthCareCost Containment Council
Seeing is Believing
Francis S. SoistmanPresident and CEO
June 4, 2003
• Subsidiary of Coventry Health Care, Inc.
• HealthAmerica & HealthAssurance
• Regional health plan founded in 1975• Over 650,000 members• 132 hospitals & 17,000 doctors• Over $1.3 billion in revenue run rate• Full product spectrum• Highly experienced leadership team
HealthAmericaOverview
Service Area
• Never compromise quality–HEDIS®--highest quality ratings in the region and above national averages
• Customer-driven• Efficiency through
technology• Innovative in medical
management and products
Our Approach
• Shows how we compare against our peers & state averages
• HealthAmerica and/or HealthAssurance:–Surpassed competitors in 10 of 15 measures for preventive care
–Surpassed state and national averages in all but1of 15 measures
Utilization of PHC4
HEDIS Scores
HEDIS Scores
HEDIS Scores
HEDIS Scores
HEDIS Scores
• Gives ideas for new initiatives for improving–Always room for improvement–Diabetic incentive program to improve outcomes
We are well organized to supply data–HEDIS –Data warehouse
Utilization of PHC4
Quality Improvement
•Identify issue•Collect data
•Analyze data for concern
Baseline
Improvement
•Draw conclusion•Formulate action plan
•Implement plan•Remeasure
•Modify as needed
Utilization PHC4
• Quality comparative information about health care is minimal
• Heath care decisions can be the most important of an individual’s life
• Plethora of subjective, erroneous, and biased information
• Comparative information can be of help
Filling the Void
• To make educated decisions, unbiased information is needed
• PHC4 fills part of the void
• Useful to those who emphasize quality
• Cost of care is still important
• The available information serves as a good foundation
Managed Care
• Focus on competitive differences• Optimize outcome• Stimulates plans with lower scores to
improve• Plans with higher scores still focused on
improvement• Size of plan doesn’t matter• Health of community is improved
Future
• Help foster discussion between all players
• Set the stage for collaboration
• Best health care system in the world
• Solutions exist
Solutions
Solutions
Solutions
Future
• Accountability by all
• We’re in this together
• Courage to make change