CEO Dan Loepp’s “Rx Plan for A Healthier Michigan” Featured in DBusiness

Blue Cross’ efforts to strengthen Michigan’s core cities, build healthier communities and continue its mission of providing access to quality health care in a changing economic and regulatory landscape are spotlighted in a new 16-page supplement in the current issue of DBusiness magazine.

This special section, titled “Daniel Loepp’s Rx Plan For A Healthier Michigan,” appears in the November/December 2011 issue of DBusiness.

The supplement articulates the president and CEO’s vision for the company to lead Michigan to a future of good health, economic growth and prosperity. Its six stories include features on the Blues’ various partnerships with providers (including the patient-centered medical home program (PCMH), the nation’s largest program of its kind), how the company is preparing for federal health care reform, and the company’s efforts to strengthen the core cities of Detroit, Grand Rapids and Lansing.

DBusiness is the most widely circulated monthly business publication in southeast Michigan, focusing on business leadership, innovation, industry trends and market forces shaping the regional economic climate.

Action Plan Unveiled in Washington D.C. to Promote Partnerships in Health Care Quality, Cost Savings

The "Building Tomorrow's Healthcare System" plan from the Blue Cross and Blue Shield Association calls for inspiring healthier living, among other recommendations.

Blues CEO Daniel J. Loepp traveled to Washington D.C. last week to join Scott Serota of the Blue Cross and Blue Shield Association in announcing a comprehensive action plan to overhaul the nation’s health care system by improving quality and reining in costs.

Loepp was on hand to help Scott Serota, CEO of the BCBSA, unveil “Building Tomorrow’s Healthcare System: The Pathway to High-Quality, Affordable Care in America,” a four-pronged approach to building tomorrow’s health care system based on efforts to contain costs and improve quality where BCBSM is already making measurable progress.

The “Pathway” plan focuses on rewarding quality and safety while taking on rising health care costs. It advocates for a public-private partnership in four areas:

  • Rewarding safety
  • Doing what works and focusing on quality outcomes, instead of paying for expensive services that may be ineffective or redundant
  • Reinforcing front-line primary care
  • Inspiring Americans to live healthy and make better choices

Loepp, who is also chairman of the BCBSA board of directors, told the media about the Keystone Center for Patient Safety and Quality, BCBSM’s widely recognized partnership with the Michigan Health & Hospital Association. He also shared some of the early achievements of the Patient-Centered Medical Home program, the largest in the country.

“We are helping to create a culture of patient safety in Michigan,” Loepp said. “We know our efforts are saving money and creating more consistent application of best practices, but more importantly, these efforts are leading to better outcomes and ultimately saving lives.”

If adopted, the recommendations would save $319 billion over the next decade, according to a study by Ken Thorpe, chair of the Department of Health Policy and Management at the Rollins School of Public Health at Emory University.

For more information, read the BCBSA news release, or read the Pathway action plan.

BCBSA is the parent organization of the 39 independent, locally based Blue Cross Blue Shield plans, including the Michigan Blues.

Photo by Christiana Care.

How Our PCMH Program Improves Delivery of Health Care

Our patient-centered medical home program has grown to 2,500 physicians at 770 practices around the state in its third year of operation. The program is the nation’s largest for the third year running, helping to improve the quality and delivery of health care for all Michigan residents.

The growth in the program — the number of designated physicians has more than doubled since it began in 2009 — reflects significant momentum by physicians to bolster the primary care system, improve quality and make health care more effective and safer for patients.

PCMH by the Numbers

A deep dive into the data now shows our PCMH program is actually helping to lower unnecessary use of health care services that contribute to higher health care costs for everyone.

Here are a few ways that PCMH practices compared to non-PCMH practices in 2010:

  • 6.3 percent lower rate of adult high-tech radiology usage
  • 3 percent lower per-member per-month cost
  • 6.6 percent lower rate of adult emergency department visits
  • 11.1 percent lower rate of hospital admissions for people with chronic conditions (like asthma or diabetes)
  • 7 percent lower rate of emergency department admissions for people with chronic conditions

What’s in it For Patients?

If you’ve ever gotten sick and had to alternate visits between primary care doctors, specialists or hospitals, then you may know how frustrating the experience can be. A lack of communication between providers, duplicative services and a sense that no one’s paying close attention to your health unfortunately are common features of the patient experience. And that’s a big part of why we think the patient-centered medical home model is so important for the future of health care.

The PCMH model lets pediatricians, internists and family practice physicians spend more time with individual patients to keep them healthy, coordinate their care among different providers and offer services and capabilities that typically aren’t available at most doctor’s offices.

More than 95 percent of BCBSM-designated practices are:

  • Offering 24-hour phone access for patients to reach a clinical decision-maker
  • Fully informing patients about after-hours care options
  • Creating processes to make sure all patients receive medication review and management
  • Reporting and analyzing patient outcomes, efficiency of service and patient satisfaction at both the physician and practice-wide levels
  • Regularly informing patients about abnormal results

What About Wellness and Preventive Care?

Designated doctors must also clearly communicate the roles of both the physician and patient, develop patient registries to track and monitor progress and work with patients to set individualized health goals, track appointments and ensure follow-up on needed services.

Designated PCMH doctors are also working to develop more advanced capabilities, like coordinating referrals to specialists and providing them with all relevant patient information and providing patients with an online portal that allows them to access their medical information electronically.

Find a PCMH Doctor

See the document below to find out whether your doctor has received the Blues’ PCMH designation:

Photo credit: Seattle Municipal Archives

The Role of Information Technology in Improving Health Care

Imagine your loved one has a certain chronic condition. When a doctor asks whether she’s had an MRI recently, your loved one says “no” because she doesn’t remember receiving one — even though she just had one two weeks prior at another doctor’s office across town. Let’s say there was also a prescription for follow-up care, but she never received that, either. Maybe she was also prescribed medication, but the prescription was never filled at the pharmacy.

Without a centralized record, this person might theoretically receive the same test over and over without ever following up with subsequent treatment or medicine the doctor feels is necessary. She may feel she’s doing everything in her power to do what the doctor instructs, but the record may tell another story.

What many healthy people often don’t realize is how much time and attention to detail it takes to manage your own health care when problems arise. It’s not uncommon for several different doctors to prescribe multiple medications, tests and follow-up care. Without a centralized medical record, many don’t even realize the treatment they’re receiving is a duplication of effort. That redundancy adds to the already high costs of obtaining health care.

Information technology has the potential to give doctors and providers of medical care a much more complete picture of the patient in front of them, and patients a much easier way to access their complete medical history.

That’s why Blue Cross Blue Shield of Michigan was proud to be a sponsor of the Wiring Michigan Conference, a health information technology symposium held last month in Ypsilanti.

Our Patient-Centered Medical Home program is one example of how we’re persuading providers to adopt health IT. Our PCMH program, the nation’s largest at 1,800 designated physicians, encourages doctors to implement information technology such as e-prescribing into their practices as one way to improve quality, open up access to care and help manage costs.

Here’s a rundown of what we’re doing to promote health IT:

  • E-prescribing — The Blues have collaborated with large customers and industry leaders to lead on electronic prescriptions. Physicians who use electronic prescriptions can view patient records, confirm medications and dosages listed on formularies and know what medications have already been prescribed by other doctors. E-prescribing helps eliminate problems with illegible penmanship, reduces pharmacy staff time and avoids paper waste. Michigan ranked No. 2 nationally for the number of e-prescriptions filled in 2009, according to Surescripts.
  • Electronic transactions — BCBSM since 2008 has been helping business partners and providers prepare for the 2012 deadline to implement EDI 5010, a new, federally mandated electronic transaction standard. The changes will enhance business functionality, clarify data ambiguities and support the new National Provider Identifier number required under the Health Insurance Privacy and Portability Act.
  • New ICD-10 medical code set — With the rise of electronic medical records, e-prescriptions and connectivity between providers and specialists, the Blues have responded nimbly to maintain market leadership. For starters, the company is on track for early implementation of ICD-10 medical code billing standards, which will provide greater ability to measure health care services and monitor population health, provide better data and cut down on paperwork when submitting claims. Our process for associating the new codes in our systems have been featured at national forums and adopted by other insurers. We’ve also made our solution available to other health care entities to keep implementation costs down.

When approached with the subject of technology in health care, you might think of expensive diagnostic tools and cutting-edge procedures. But what you may not realize is that information technology — the kind of information systems we use at home or at work to track multiple projects or household expenses — can be used on a wider scale to make health care more efficient, safer and maybe even less expensive for everyone.

Photo by Tricia Wang.