Blue Cross Blue Shield of Michigan

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Vendor Introduction - Landmark Healthcare, Inc.
Blue Cross Blue Shield of Michigans TRUST
Network July 2008
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Landmark Overview

• Providing managing physical medicine services
  for insurance companies employer groups since
  1985
• 6.5 million lives under management
• Our services include
• Performance reporting
• Use management
• Network development
• Claims administration
• Office locations
• Corporate headquarters in Sacramento, CA
• Clinical services office in Southeast MI
• Sales offices in Louisville, KY

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URAC Accreditation

• URAC is an independent organization that reviews
  operational policies procedures
• Assures safeguards for consumers, providers
  employers
• Landmark awarded Health Utilization Management
  accreditation in 2005

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Landmarks Physical Therapy Team

• Physical Therapists experience
• Average 20 years in clinical practice
• Outpatient focused
• PT Board consulting
• CARF, JCAHO, AOA accreditation
• Michigan Rehabilitation Advisory Panel

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Our Guiding Principles

• Care that is patient centered and founded on
  evidence-based clinical guidelines
• Treatment regimens that are functionally oriented
  and measurable
• Transparent clinical expectations and
  administrative requirements
• Peers supporting peers to ensure best practices

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Program Goals

• Provision of actionable data through performance
  reporting and benchmarking
• Foster self-monitoring of practice patterns
• Decrease in unexplained variation
• Compliance with TRUST network utilization
  standards

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Benchmarking Physical Therapy
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Ingenix National Managed Care Benchmark Database

• Two years of outpatient physical therapy claims
• Data set represents
• Commercial, ASO, Medicare, Medicaid LOB
• All provider types (PT, MD/DO, Hospital)
• 43,000 providers of physical therapy services
• 1.6 million physical therapy patients
• Adjusted for geographic population distribution

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Key National Physical Therapy Population
Characteristics
Clinically Related Diagnostic Category Treatment Episodes
Orthopedic Spine 35
Orthopedic Lower Extremity 27
Orthopedic Upper Extremity 21
Orthopedic General 10
General Medical Rehabilitation 5
Pediatric Rehabilitation 1
Neurological Rehabilitation lt1
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Performance Reporting

• Regular assessment of provider practice patterns
  is good business practice
• Provider assessment is necessary to identify
  unexplained practice variation
• Comparisons must be fair to accurately identify
  those in need of improvement

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Why Risk Adjustment is Needed

• Patient characteristics can significantly effect
  clinical resource requirements
• Patient attributes are outside a providers
  control
• Levels the playing field by accounting for the
  factors that a patient brings to the encounter
• Allows for fair comparisons of aggregate and
  individual provider performance

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Risk Adjustment Methodology

• Factors that have significant effects on
  utilization include
• Diagnostic category
• Thirteen clinically-related categories
• Mapped to APTA Preferred Practice Patterns
• Member age
• Member gender
• Statistical weighting is applied to control or
  adjust for these member characteristics

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Importance of Risk Adjustment

• Two hypothetical Michigan physical therapists
• PT As patients are females aged 56-65
• PT Bs patients are males aged 16-25
• In both offices, these patients were treated for
  non-specific lumbar problems

Hypothetical Example Hypothetical Example Hypothetical Example
Average Visit Utilization PT A PT B
Unadjusted 8.25 7.75
Adjusted 7.50 9.25
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Importance of Risk Adjustment

• Risk adjustment works because it
• Inflates utilization levels where they are low
  due to age, gender and diagnostic category
• Deflates utilization where they are high due to
  age, gender and diagnostic category
• Adjustments equalize effect of member age, gender
  and diagnostic category on provider utilization

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Michigan Physical Therapy Practice Patterns
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Outpatient Physical Therapy(January 1, 2007 to
December 31, 2007)
Total Adjusted Utilization/Episode IPT MD/DO OPT HOPT National
Providers 471 921 168 143 24,274
Mean 10.3 3.4 13.2 9.5 7.2
Minimum 1.5 0.7 5.1 0.6 0.6
Maximum 33.6 34.1 31.9 17.6 60.3
Median 10.7 3.1 13.0 9.5 7.2
5th percentile 3.9 1.4 6.7 5.2 2.6
95th percentile 17.3 10.5 17.8 13.0 12.9
Providers with 10 or more episodes of care
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BCBSM HOPT Provider Distribution
Peer Mean 9.5 Visits / Episode
TRUST Network Standard lt 1.25 x Peer Mean
95th Percentile Threshold 13.0 Visits / Episode
Providers with 10 or more episodes of care
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BCBSM HOPT / National Comparison(Total Adjusted
Visits/Patient Episode)
HOPT Peer Mean 9.5
Providers with 10 or more treatment episodes
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Performance Summary
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Provider Performance Summary (PPS)

• Landmarks PPS provides
• Transparent access to performance data
• Clinically relevant dashboard metrics
• Michigan national comparative measures
• Performance trends
• Provides timely feedback benchmarking
• Identify opportunities to improve care delivery
• Accessible online and via hard copy

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Performance Reporting
Organization (Shared TIN)

• Based on the BCBSM Facility Code
• Aggregate organizational reporting as data
  permits
• Requires at least 10 treatment episodes to qualify

Location
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Performance Summary Dashboard

Performance History Show Performance
History for 12 months
Treatment Process
Metrics of Modality of Exercise of
Manual Therapy Units / Visit Units /
Visit Units / Visit
National Peer Standard
Michigan Peer Standard
Your Value
National Peer Standard
Michigan Peer Standard
Your Value
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Performance Trend
Performance HistoryShow performance history for
12 months
Michigan Peer Standard
National Peer Standard
Your Value
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Clinically Related Diagnostic Categories
National Peer Standard
Michigan Peer Standard
Your Value
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Summary Drill Down
Member Summary for 1/1/2006 to 12/31/2006
Member Episodes Visits Visits Risk Adjusted Visits Total Unitsof Service ModalityUnits ModalityUnits ExerciseUnits ManualTherapy Units
AA2194 1 1 5 4.9 10 10 0 9 0
BB4097 1 1 7 10.6 25 25 14 6 4
CC4884 1 1 1 0.8 4 4 2 1 1
DD5799 1 1 2 1.5 3 3 1 0 1
EE9656 1 1 12 11.9 26 26 0 25 01
FF1068 1 1 6 6.1 24 24 12 5 6
GG2194 1 1 8 7.5 22 22 16 5 0
HH3113 1 1 1 1.0 2 2 2 0 0
II6519 1 1 3 3.0 4 4 0 3 0
JJ9364 1 1 1 1.2 4 4 0 2 1
KK9946 1 1 38 41.9 109 109 36 68 1
LL0085 1 1 3 2.9 118 118 1 4 2
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Additional Clinical Resources

• Clinical Practice Guidelines
• Outcomes Assessment Toolbox
• Quality Medical Record Guideline
• ICD-9 Lookup Tool

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On-line Clinical Protocols
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Program Timeline

• PPS online security code will be mailed in July
• Online version access
• Register on Landmark Connect
• On the menu bar, click on the PPS link
• Enter your assigned PPS security code
• Support Tools
• Online Frequently Asked Questions (FAQ)
• Answers to technical and/or clinical questions

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Communicating with Landmark

• Michigan Regional Office
• Office HoursMonday - Friday from 830 a.m. to
  500 p.m. EST
• Telephone Number [phone]
• Sacramento Corporate Offices
• Office HoursMonday - Friday from 830 a.m. to
  500 p.m. EST
• Toll Free Telephone Number [phone]

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Q A