Quality Improvement and Physician Behavior Change

1
Quality Improvement and Physician Behavior
Change
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Model for Health Care Improvement
Deploy and Deliver Best Practices
Design Best Practices
Influence Physician Decision Making
Improved Outcomes
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Academic Literature on Changing Physician
Behavior

• Education
• Clinical Opinion Leaders
• Administrative Mandates
• Feedback
• Incentives

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4
The Economics of Disease Management
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Sample Disease States With Rapid Vesus Eventual
Economic Returns
Disease Program
Return on Investment
Asthma
Rapid
Congestive Heart Failure
Rapid
Diabetes
Eventual
Hyperlipidemia
Eventual
Hypertension
Eventual
Low Back Pain
Rapid
Osteoporosis
Eventual
Pneumonia
Rapid
Depression
Eventual
Weight Reduction
Eventual
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Hpresent/hmoprmce
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Basic And Advanced Return-On-Investment (ROI)
Equations
Basic ROI Equation
Direct Costs of Program an Allocated
Percentage of Overhead - Disease Episode Costs
Preimplementation - Disease Episode Costs
Postimplementation
ROI
Advanced ROI Equation
ROI
Direct Costs of Program Allocated Overhead -
(Disease Episode Costs Preimplementation -
Disease Episode Costs Postimplementation)
(Benefit of Avoided Complications in Dollars
Benefits of Improved Clinical Outcomes in
Dollars) Additional Revenue of Increased Use of
In-System Resources Attributed to the Disease
Management Implementation
Costs associated with the specific program
(e.g., disease-specific case managers,
educational materials, and development costs).
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Contracting Models
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Outcomes-Based Contracting

• Payments Should Align Reimbursement with the
  Implementation of Best Practices (Disease
  Management)
• Financial Success is Tied to the Outcomes of a
  Defined Population

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Shared Objectives for Managed Care Organizations
and Provider Systems
Component
Goal
Access to All Sites and Providers Where
Appropriate High Patient Satisfaction Across the
Entire Experience Best Practice
Approach Optimal Resource (s) Use (more or less)
1. ACCESS 2. SERVICE 3. QUALITY 4. VALUE
DISEASE MANAGEMENT
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Current System Versus Outcomes-Based Contracting
Current System
Outcomes-Based Contracting
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