Leading Change in Health Care

1
Leading Change in Health Care
Better, Faster, and More Affordable
C. Craig Blackmore, M.D. Virginia Mason Medical
Center Seattle, WA
2
Virginia Masons VisionTo Be the Quality Leader
and Transform Health Care

• 1. Quality leader requires efficient, effective
  systems.
• 2. Transforming health care requires
  collaboration.

Source The Leapfrog Group, 2010.
3
Marketplace Collaboratives Innovation and
Transparency
4
The Market-Relevant Quality Bundle Stakeholder
Accord on Defining Quality

• Evidence-based care what works
• 100 patient satisfaction
• 3. Same-day access
• Rapid return to function
• Affordable price for buyer and seller

5
Building Quality into a Value Stream

• Evidence is translated into standard practice.
• Each step is designed to be value-added.
• Variation is limited with mistake-proofing.
• Tasks are assigned to the appropriate provider.
• Value stream includes entire patient experience.

6
Headache Value StreamBefore and After Redesign
Redesign creates 1. Evidence-based care 2. High
patient satisfaction 3. Same-day access 4. Rapid
return to function 5. Lower cost for buyers and
sellers
7
Measuring Evidence-Based Medicine Reporting with
Transparency
Mistake-proofing implemented
Reduction in imaging   Headache -23 Low
back pain -25 Sinusitis -25
8
What Weve 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
• Providers producing quality,
• Health plans reimbursing for quality, and
• Purchasers choosing to buy quality.

9
An Approach for Caring for Particular Types of
Patients A Presentation by Chet
Burrell President and CEO CareFirst BlueCross
BlueShieldOwings Mill, MD December 16, 2010
10

PCMH Designed to preserve and enhance PCPs
ability to practice medicine the way they
want to practice medicine while improving
quality and reducing costs

Participation 12 percentage points upon
enrollment
Incentive
Participation 12 percentage points upon
enrollment
Participation 12 percentage points upon
enrollment
12 fee schedule increase upon enrolling
Incentive
Incentive
Significant rewards based on quality and
efficiency
New fees paid for Care Plan development and
follow-up
Incentives and reward increases apply to all
medical services and exclude supplies and drugs.
11

• 10 Essential Elements
• Medical Care Panels are the central building
  blocks
• Patients attributed to panels
• Calculating the illness burden score
• Establishing global expected care costs and
  tracking experience
• Referrals to specialists patient authorization
  and consent
• Enhanced focus on patients with chronic illnesses
  care plans / teams
• An online member health record (MHR)
• Measuring quality of care
• Annual settlement and calculation of incentive
  awards
• Signing on and complying with program rules

12
Focusing on High-Risk Patients
Targeted Group
13
Wellness/Illness Burden Pyramid PCMH Employers
Example PCMH Panel Experience
Example Employer Experience
Percent of Population Percent of Cost
2 31
9 29
22 20
17 15
50 5
Percent of Population Percent of Cost
3 35
7 25
21 25
19 9
50 6
14
For more information about CareFirsts PCMH
program, visit www.carefirst.com/providers/pcm
h
6