Blue Cross Blue Shield of Michigan Taming the Healthcare Beast: A Plan for Michigan Federal Reserve Bank March 31, 2009 Presenter: Tom Simmer M.D. Chief Medical Officer.
Download ReportTranscript Blue Cross Blue Shield of Michigan Taming the Healthcare Beast: A Plan for Michigan Federal Reserve Bank March 31, 2009 Presenter: Tom Simmer M.D. Chief Medical Officer.
Blue Cross Blue Shield of Michigan Taming the Healthcare Beast: A Plan for Michigan Federal Reserve Bank March 31, 2009 Presenter: Tom Simmer M.D. Chief Medical Officer Overview • A few facts about health status, healthcare costs, and personal income in Michigan. • The Goal: Improve the competitive position of the state of Michigan for business while supporting access to needed medical services. • Provider Partnership Programs improve healthcare delivery through population based, collaborative initiatives, often connected with performance-based payment. • A quick look at results. 2 Michigan Personal Income Falling Relative to U.S. Michigan per Capita Income as a Percent of U.S. Per Capita Income 1.25 1.2 122% 1.15 1.1 1.05 1 93% 89% 0.95 0.9 0.85 29 933 937 941 945 949 953 957 961 965 969 973 977 981 985 989 993 997 001 005 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 Source: Department of Treasury calculations from Bureau of Economic Analysis data 3 Source: “Michigan’s Health Care Safety Net: In Jeopardy,” A MHA Special Report 4 Older, fatter, smokier, sicker 2007 Data Michigan U.S. Average % Change of U.S. Average Median age in years 37.5 36.6 2.5 Obesity prevalence among adults 28.2% 26.3% 7.2 Diabetes prevalence among adults 8.8% 8.1% 8.6 Smoking prevalence among adults 21.1% 19.7% 7.1 5 2008 Michigan Health Plan Costs* Average Annual Cost to Employer Per Employee State: $8,812 Regional: $7,557 National: $7,327 Employer Share State: $6,152 Employee Share State: $2,660 Regional: $4,904 Regional: $2,653 National: $4,117 National: $3,210 2008 health plan costs according to the annual United Benefit Advisors Health Plan Survey. The survey included 18,019 employers nationally, 5,283 in a four-state region and 828 in Michigan. United Benefits Advisors is a national alliance of independent insurance agencies that includes The Campbell Group in Grand Rapids, BenePro Inc. in Royal Oak, Pappas Financial in Farmington Hills, Saginaw Bay Underwriters in Saginaw and Employee Benefits Agency in Marquette. Why haven’t we succeeded in healthcare? • Lack of Population focus – fee for service / third party payment system drives increased delivery of services. • Cottage industry: Physician practices lack capacity to build information infrastructure and implement lean processes that are key to improving performance. • Health plan, rather than delivery system, focus introduces process variation and re-work, not clinical process improvement. • Weak primary care foundation misses opportunities for care coordination and lower cost approaches. • BCBSM programs are unique in rewarding population-based improvements in care, strengthening primary care, investing in infrastructure through large physician organizations, and reducing variation through lean process improvement across the delivery systems and across payers. 7 BCBSM Members Effective Providers Wellness & Care Management Michigan Basics -Precertification -Utilization Review BCBSM Clinical Programs 8 Current Partnering for Value Programs Physicians CQIs: Collaborative Quality Initiatives Hospitals Michigan Surgical Quality Collaborative PGIP: Physician Group Incentive Program Michigan Bariatric Surgery Collaborative Hospital Incentive Program BMC2: BCBSM Cardiovascular Consortium Angioplasty Collaborative Quality Initiative (in Participating Hospital Agreement) Michigan Society of Thoracic Surgeons Cardiac Surgery Collaborative Quality Initiative Etc. 9 PGIP Participants (June 2008) • • • Marquette County: Upper Peninsula Health Plan (176) 35 groups 6,471 physicians 1,700,000 members Ontonagon Genesee County: Genesys Integrated Group Physicians(87), Hurley PHO (116), McLaren Medical Management (95) Baraga Luce Marquette Gogebic Alger Iron Dickinson Schoolcraft Chippewa Oakland County: Medical Network One (303), Oakland Physician Network Services (144), Oakland Southfield Physicians (204), Oncology Physician Resource (64), Quality Partners of MI (34), St. John Medical Group (223), United Physicians (560) Mackinac Delta Saginaw County: Primary Healthcare Partners (57) Emmet Cheboygan St. Clair County: Mercy~ Physician Community PHO (38), Physician Healthcare Network (26) Charlevoix Kent County: Advantage Health Physicians (146), Michigan Medical, PC (MMPC) (90), Regional Delivery Network of West MI (136), West Michigan Physicians Network (227) Muskegon County: Hackley PHO (79) Presque Isle Alpena Otsego Antrim Leelanau Grand Kalkaska Oscoda Benzie Traverse Crawford Manistee Wexford Macomb County: DMC Primary Care Physicians (115), St. John HealthPartners (417) Alcona Missaukee Ogemaw Roscommon Iosco Arenac Mason Lake Ottawa County: Principal Health PHO (35) Osceola Clare Wayne County: Henry Ford Medical Group (328), Olympia Medical Services (127), UOP, LLC (252) Gladwin Huron Mecosta Oceana Isabella Bay Tuscola Montcalm Ingham County: Consortium of Independent Physician Associations (1,230), MSU Health Team (104), Sparrow Family Medical Services (45) Gratiot Genesee Lapeer Ottawa 10 Kent Allegan Calhoun County: Integrated Health Partners (69) Kalamazoo County: Bronson Medical Group (50) and ProMed Healthcare (83) Sanilac Saginaw Van Buren Berrien Cass Ionia Barry Clinton Eaton Shiawassee Macomb Oakland Ingham Livingston Calhoun Jackson Washtenaw Kalamazoo St. Joseph Branch Hillsdale St. Clair Wayne Monroe Washtenaw County: Huron Valley Physicians Association (245), Integrated Health Associates (109), UM Health System Faculty Group Practice (387) Jackson County: Jackson Physician Alliance (70) Lenawee 10 ValuePartnerships: Leveraging Provider Relationships and Market Share to transform healthcare delivery. Next-Generation PPO Current State Partnering for Value • Stronger role for primary care (medical home, not gatekeeper) • Strong link between performance and payment Foundation for Future ShortTerm Value • • Preparations • Incremental Savings and Improvement • 11 Build effective physician organizations. Care commitment to a defined population Facilitated practice improvement and technology dissemination. Substantial improvement in healthcare delivery Programs to Improve Hospital Care: MHA Keystone: Hospital-Associated Infection (HAI) The Challenge: • 5-10% of hospital inpatients develop infections each year, resulting in 90,000 deaths nationally • $5 billion to $6 billion in national health care costs The Response: • Launched in 2007 to eliminate Hospital Associated Infections • Hand hygiene compliance nearly 80% (U.S. average is 40%) • Eliminating nonessential catheters • 112 participating hospitals in MHA Keystone: HAI 12 Keystone Results in Michigan • Lives Saved – 1,729* • Patient Days Saved – in excess of 127,000* • Dollars Saved – 0ver $246 Million* • Culture of Safety improved 28% • Teamwork improved 15% * Based on the Johns Hopkins Opportunity Calculator 13 Improving Cardiac Interventions – Participating Centers – 2009 14 Percent Comparison of Outcomes for 2002-2008* 20 2002 2008 15 40% 10 5 22% 1.5% 18% 25% 26% 0 Death Kidney Failure 15 Transfusion Vascular Complications All CABG Revasc Improving Performance to the Population: Evidence Based Care Measures 2008 Measures (scored in 2008) • Diabetes – Comprehensive Diabetes Care - HbA1c Testing – Comprehensive Diabetes Care - LDL-C Screening – Comprehensive Diabetes Care - Monitoring Nephropathy – Lipid Lowering Drug Rate – Statin Therapy for Persons with Diabetes – ACE/ARB Use with Comorbidity CHF – ACE/ARB Use with Comorbidity Nephropathy – ACE/ARB Use with Comorbidity Hypertension • Asthma – Use of Appropriate Medications for People with Asthma – Combined • Congestive Heart Failure (CHF) – LDL-C Screening – Beta Blocker Prescription over Last 12 Months – Rate of ACE/ARB • Coronary Artery Disease (CAD) – Beta Blocker Treatment After a Heart Attack – Cholesterol Management for Patients with Cardiovascular Conditions - Screening – Lipid Lowering Drug Rate – Statin Use • Additional Measures – Appropriate Treatment for Children with an Upper Respiratory Infection – Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis New Measures for 2008 (scored in 2009) •Adult Prevention – Breast Cancer Screening – Cervical Cancer Screening •Child/Adolescent Prevention/Treatment – Adolescent Well Care Visit – Adolescent Immunization Status – Combo 2 – Childhood Immunization Status – Combo 3 – Well Child Visits in First 15 Months of Life – Well Child Visits in 3, 4, 5, 6 Years of Life •Chronic Obstructive Pulmonary Disease (COPD) – Use of Spirometry in Assessment and Diagnosis •Congestive Heart Failure (CHF) – ACE/ARB Continuation/Persistence •Coronary Artery Disease (CAD) – Persistence of Beta Blocker Treatment After AMI •Low Back Pain – Imaging Studies for Low Back Pain 16 16 EBCR Performance Trend PGIP Improvement in Evidence Based Care Measures: PGIP Overall EBCR Score by Measurement Period 80% ABC Benchmark 78% 76% Overall EBCR Score 75% 75% 72% 71% 70% 69% 68% 65% 60% 2006 2Q06-1Q07 3Q06-2Q07 4Q06-3Q07 Measurement Period 17 2007 2Q07-1Q08 U of va M nt a H ge ac kl ey W IH es A tM M I/S pe SU ct ru O m ly m pi a R D N H FH Pr S om ed H U ni C V te ov PA d Ph ena y s nt ic ia Sp ns ar ro w U O Pr P O in PN ci pa lH S S ea JM lth G PH O Ja SJ ck H so P n Br PA on so n IH M cL P ar en M er cy O C ak IP la nd U A So PH ut P hf ie ld D M C M N O H ur G ley en es ys PH N PG IP Ad Overall EBCR Score (Original 18 Measures) 1Q 2008 EBCR Performance 1Q 2008 Overall EBCR Score by Physician Organization 85% 83% 83% 81% 80% 80% 75% 79%79%79% 79% 78% 77%77% 77%77%77%77%76% 76%76% 76%76%75% 75%75%75% 74%74%74% 73% 73%73%73% 70% 18 76% 70% 65% 60% Increasing Generic Use PGIP Generic Dispensing Rate Improvement 64% 65% 64% 61% 59% 60% 57% 60% 56% 59% 55% Generic Dispensing Rate 55% 56% 53% 55% 52% 49% 50% 51% 54% 54% 52% 50% 51% 48% 49% 49% 50% PGIP Control 45% 40% 35% 30% 3Q05 4Q05 1Q06 2Q06 3Q06 4Q06 1Q07 Quarter 19 2Q07 3Q07 4Q07 1Q08 2Q08 PMPM by Year Initial PMPM Difference= $120.00 $4.84 $100.00 Overall PMPM PGIP vs. Control by Year $96.20 $95.40 Final Difference=$21.08 Savings=$16.24 PMPM $97.81 $85.89 $90.56 $80.00 PMPM $80.43 $77.77 $76.73 Control PGIP $60.00 $40.00 $20.00 $0.00 202005 2006 2007 2008 Improving Primary Care Performance • Performance assessment is based on attributed population rates. – PC-MH practice characteristics, based on national criteria – Performance on Quality metrics – “Evidence-Based Care Report” – Resource management • • • • Generic dispensing rate High tech imaging Low tech imaging Rate of use of ER for non-emergent care 21 Building the Primary Care Foundation: Patient Centered Medical Home PGIP Phys Org B PC-MH PGIP Phys Org A PCP PC-MH PCP PCP PCP PCP PCP PCP PC-MH Nominee PCP PCP PCP PCP PCP PCP PCP PC-MH Nominee PCP PCP PCP PCP 22 PCP PCP PCP PCP PCP PCP PCP PC-MH PCP PCP PGIP Phys Org C PCP PC-MH Nominee PCP PCP PCP “Control Group” PCP PCP PCP PCP PCP PCP PCP PCP PCP Summary • Michigan has unfavorable health status and medical costs compared to regional and national benchmarks. • BCBSM is working to make Michigan a more competitive state to attract business and job growth, while improving medical care. • Health Plan-based Wellness and Care Management programs are cost-effective and act as a safety net for failure of the primary clinical process, but they do not change healthcare delivery and do not significantly affect health benefit costs. • Population-based collaborative programs improve key clinical processes and achieve substantial savings. • PCP’s are actively transforming their practices by implementing the Patient-Centered Medical Home model, creating a lower cost model of care. 23