Daniel J. Loepp Op-Ed in Detroit News Celebrates Success of Michigan Hospital Partnerships

Daniel J. Loepp

Initiatives under way across Michigan that benefit from Blue Cross’ support are receiving national recognition for their success in slowing health care costs, BCBSM President and Chief Executive Daniel J. Loepp writes in a recent Detroit News opinion piece.

In the op-ed, “Michigan sets example for saving health care costs,” Loepp discusses how four BCBSM-led Collaborative Quality Initiatives saved $232.8 million by improving clinical quality and patient safety. He also touches on the Blues’ support for the Keystone Center for Patient Safety and Quality, a voluntary program run by the Michigan Health and Hospital Association that has helped improve health care and lower costs.

Loepp writes:

The programs that Blue Cross has under way with doctors involve the voluntary participation of often competing hospitals or physician groups and a willingness to share and compare data around common medical procedures.

This level of collaboration is unprecedented in Michigan health care.

With help from the University of Michigan Health System and Beaumont Hospitals, we’ve been able to determine best-practice protocols for procedures like bariatric surgery, breast cancer treatment and angioplasty.

By having everyone work together, we can determine what’s working and what isn’t, giving huge systemwide boosts to patient safety and clinical quality while lowering costs.

Read the rest of Loepp’s commentary here.

Quality Improvement Projects in Michigan Helping Bend the Health Care Cost Curve

If you are concerned about what’s going on with the escalating cost of health care in this country, you should feel good about the work going on right here in Michigan.

Four programs BCBSM sponsors with Michigan hospitals have saved a combined $232.8 million over three years, lowering complication rates for Michigan patients and literally saving lives.

The Collaborative Quality Initiatives, as we call them, target health care quality, patient safety and improved outcomes. They cover some of the most commonly performed and costly areas of medical care: general surgery, cardiac and thoracic surgery, angioplasty, and bariatric surgery.

Widespread Benefits

The savings benefit more than just people who carry Blue Cross insurance. About two-thirds of the savings was spread across patients with Medicare, Medicaid or non-BCBSM private insurance and the uninsured.

We started these initiatives in 1997 when we joined five hospitals to study variation in angioplasty procedures and treatment. The initiative resulted in drastically fewer emergency bypass surgeries and other complications and saved $15.2 million in an early analysis (this program saw the largest savings — $102 million — from 2008 through 2010).

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BluesWeek: Helping Health Care Consumers Benefit from Patient Safety Awareness Week

Starting today, we’ll be publishing BluesWeek, a weekly snapshot of initiatives, events and other newsworthy items, here on Blues Perspectives. It previously was an email advisory sent mostly to news media.

March 4-10 is Patient Safety Awareness Week, and the Blues will be spotlighting the issue with a series of blog posts featuring helpful tips and other resources for patients. Watch for posts here and on A Healthier Michigan on topics like things health care consumers can do to stay safe.

BCBSM is offering tips for how to “Get Your Plate in Shape” and make good food choices during National Nutrition Month. Registered dietitian Grace Derocha has simple suggestions available to help take the complexity out of nutrition. Occasional blog posts exploring the theme will also appear on A Healthier Michigan.

The Blues Community Challenge wraps up Saturday, March 10 in Lansing. Blue Cross Blue Shield of Michigan will award grants to the nine participating Lansing-area communities to support public health and wellness. The ceremony takes place at 9 a.m. at the Lansing Mall and includes health screenings, health and wellness displays, a celebratory walk through the mall and more.

There are two more Polar Plunge events taking place March 17 — one in Kalamazoo and another in Marquette. Participants jump into frigid waters to benefit Special Olympics Michigan. Blue Cross is encouraging employees and others to participate as part of a yearlong sponsorship of Special Olympics Michigan’s Healthy Athletes Program.

In case you missed it…

The March installment of the Healthier Michigan Radio Show takes an in-depth look at efforts to transform health care in Michigan. Joining host Ann Thomas were Dr. Jean Malouin, co-chair of the Michigan Primary Care Transformation project; Dr. Gina Buccalo, chief medical officer at St. John Providence Partners in Care; Dr. Kim Coleman, a Bloomfield Hills pediatrician who is part of the Blues’ Patient-Centered Medical Home program; and Marianne Udow, director of the Center for Healthcare Research and Transformation. You can still catch the show Sunday, March 11 at 9 p.m. on WOOD-AM in Grand Rapids, or download a podcast version or listen online here.

There are just a few short weeks remaining in the “Make the Play for Healthy Habits” kid video contest on A Healthier Michigan. Children in grades 4 through 8 have through March 25 to upload a video that creatively demonstrates their ideas to make Michigan healthier. The public will have the opportunity to vote on the final 10 contestants, and the winner gets a school assembly visit from Detroit Lions quarterback Matthew Stafford and an opportunity to guest blog on A Healthier Michigan.

Photo by UMHealthSystem

Why Paying Health Care Providers for Outcomes Benefits Everyone

There’s a movement among insurers policymakers and health care leaders about embracing pay-for-performance as a way to improve health care quality and lower costs. In recent weeks, Blue Cross has announced contracts based on this model of reimbursement with both Beaumont Health System and St. John Providence Health System. So what exactly will performance-based health care look like?

Blue Cross Blue Shield of Michigan recently announced a partnership with St. John Providence to launch the first such model in the state. And last week we announced a similar contract with Beaumont, ending a long-running dispute that threatened to end the hospital system’s participation with Blue Care Network.

Our goal in both cases is to construct a better system of managing patient health, with hospitals, physicians and insurers working together to increase the value of medical care provided to patients. Hospitals, in turn, would see their reimbursements improve as a reward for more successful management of the health of their entire patient population.

This approach moves dramatically away from the long-established fee-for-service model where insurers pay for every test and procedure conducted on a patient, regardless of whether patient health improves because of them.

Fee-for-service is an antiquated approach. Reimbursements climb the more tests, procedures and other services are performed. The incentive for hospitals is to churn as much volume as possible through the facility — more patients, more tests, more surgeries, more admissions and more delays in the hospital. This model has fueled the huge increases in health care costs we’ve seen in the past decade, yet it’s done little to improve patient outcomes in the U.S., which lag behind other industrialized nations.

Simmer

The new model encourages hospitals to move away from the quantity of services performed on patients in favor of quality of services. It also encourages physician organizations and hospitals to join forces and build better systems of sharing patient information and coordinating the delivery of care. Long-term, St. John Providence may well see lower utilization of things like high-tech radiation scans and even hospital admissions. But if more patients get healthier more quickly, their hospitals will benefit financially from incentive payments for achieving these goals — all of which are in the best interest of the patient.

Patients likely won’t notice any change in the quality of care they receive. If anything, they’ll encounter less frustration over redundant services and administrative headaches as the coordination of care improves.

While the details of the performance-based standards at Beaumont are pending, the Blues will support the funding of IT and other infrastructure improvements at the five participating St. John Providence hospitals until the new model begins in 2013. Some of the value-based improvements the hospitals must make include:

  • Development of a fully functioning integrated Organized System of Care all-patient registry system
  • Development of an integrated performance measurement system
  • Better coordinated processes of care so that patients have smooth transitions from their primary care physicians to specialists or hospitals
  • Capability to measure a patient’s experience with care

Patients will also notice an increase in attention from their providers. Clinical staff will be more prepared in advance for their visit, having pulled information on things like whether or not they’re up to date in immunizations or which medications they should or should not be taking. Doctors will be able to more proactively support their patients’ needs.

That leads to less redundancy, waste and time spent on administrative tasks for providers and hopefully, more time with patients.

It’s our hope that the agreements with the two Detroit-area health systems will help other hospitals realize that the performance-based model is both achievable and desirable for a better-functioning, lower-cost health care system. Many hospitals across Michigan are already expressing interest in joining us in moving to a performance-based system.

It’s been our experience through initiatives like our Patient-Centered Medical Home program that sustained efforts to improve the quality of care also helps put the brakes on runaway health care costs.

With more proactive patient care, better communication and improved coordination of care, there’s less waste in the health care system. And that benefits us all.

Thomas Simmer is Senior Vice President, Health Care Value and Chief Medical Officer for Blue Cross Blue Shield of Michigan.

BlueWorks Award Highlights Progress in Improving Health Care Quality, Lowering Costs for All Michigan Residents

Two surgical initiatives developed by Blue Cross Blue Shield of Michigan and Blue Care Network have been recognized as tops among 48 programs run by Blues plans nationwide, providing further validation of BCBSM’s efforts to improve health care quality, patient safety and outcomes.

Together, the two collaborative quality initiatives have removed an estimated $100 million in costs from the health care system in Michigan, including from non-Blues plans.

The 2011 BlueWorks Award was announced last week by the Blue Cross and Blue Shield Association and the Harvard Medical School Department of Health Care Policy. The award recognizes Blues-sponsored programs that improve health care safety, quality, accessibility and affordability while engaging providers, consumers and communities.

It’s the second consecutive year that BCBSM has received the prestigious BlueWorks Award. In 2010, BCBSM was recognized for its Patient-Centered Medical Home program, which emphasizes the roles of primary care and increased patient involvement to improve health outcomes and lower costs.

The BCBSA and Harvard Medical School recognized the Michigan Blues for two statewide initiatives aimed at improving quality and patient outcomes in surgical procedures:

  • The Michigan Surgical Quality Collaborative, which collects and analyzes procedural and outcome data to improve the quality of care for patients undergoing general and vascular surgery, which is commonly performed at hospitals across Michigan. Rates for surgical morbidity are lower under this program and dropped more quickly than at other hospitals in the National Surgical Quality Improvement Program, after which the program is modeled.
  • The Michigan Bariatric Surgery Collaborative Quality Initiative, which analyzes and shares patient data and outcomes from a clinical registry database. Among other goals, this CQI aims to reduce both emergency room visits and the use of pre-operative Inferior Vena Cava filter placements to improve care for patients who undergo bariatric surgery. This initiative has served as a guide for other regional collaborative efforts and can be easily replicated to improve patient care in other clinical areas.

Early data suggest that the Michigan Surgical Quality Collaborative led to $85.9 million in cost savings statewide in 2009 and 2010. That figure includes procedures covered by all commercial insurers — including the Blues — as well as self-payers, Medicare and Medicaid.

An analysis of the Michigan Bariatric Surgery CQI suggests that the program has saved Michigan $14.6 million between 2008 and 2010.

All told, Blue Cross Blue Shield of Michigan and Blue Care Network sponsor 10 collaborative quality initiatives with Michigan hospitals. Another two are planned for launch in early 2012: one on arthroplasty (hip and knee replacement surgery) and the other on intensity modulated radiation therapy, which is used to treat breast and lung cancer.

Photo by Army Medicine.

Blues CEO Dan Loepp Talks Health Care Costs, Quality and Accountability on WJR’s Paul W. Smith Show

Daniel J. Loepp

Blue Cross made its presence felt at the Crain’s Health Care Leadership Summit in Detroit on Thursday. Daniel J. Loepp, president and CEO, delivered the welcoming address and earlier stopped by the WJR-AM radio booth for a live interview with host Paul W. Smith to talk about health care reform, partnering to lower costs and improve the quality of care and other topics in the news. A snippet:

Smith: We don’t know for sure the impacts of reform but we do know that there’s an opportunity to make health care work better for everyone. We need to save costs, save money, but we also need to make sure that the quality of care is there.

Loepp: Absolutely, and I think the two words that come to mind for me, and you and I have talked often about this, is accountability and responsibility, I think both on the provider’s side, the insurer’s side and the subscriber’s side. People taking care of themselves, paying attention to their health, best practices by hospitals and physicians and insurance companies. And if we can do that and we continue to talk—I was up in Marquette on Monday, I spoke to the economic club—talking about collaboration and when we do collaborate with each other and we’ve done that with the hospitals and the docs, we’re seeing savings in Michigan because of that and I think that’s part of what we’re going to talk about today.

Listen here: Paul W Smith Broadcast with Dan Loepp

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.

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.

Michigan Health Insurance Payers Collaborate in National Program to Improve Health Care

It’s really happening.  Every private, Michigan-based health insurer in Michigan, plus an additional 11 Medicaid managed care health plans, is collaborating in a project to improve patient health, control cost of care, and enhance the patient health care experience.
Michigan is one of eight states approved to participate in a Center for Medicare and Medicaid Services (CMS) demonstration project that will evaluate how to pay health professionals who improve patient care through a patient-centered medical home. Of the approximately 1,200 physicians practices expected to participate in this project nationally, approximately 480 will be in Michigan.

Michigan’s project is groundbreaking, because all health insurers have agreed to use one medical home model – the Blue Cross Blue Shield of Michigan Physician Group Incentive Program patient-centered medical home model – as the standard, rather than each health plan designing its own model.

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Statewide hospital collaboration reduces complications from surgeries, improves quality

A collaboration among 16 Michigan hospitals has successfully reduced complications following surgery by 10 percent, during a period where there was no reduction in complications nationally.  The results are published in the October 18 issue of Archives of Surgery.

In the Michigan Surgical Quality Collaborative, one of nine statewide initiatives funded and founded by Blue Cross Blue Shield of Michigan, participants agree to pool data and share information about what keeps patients safe. Physicians discuss their findings, and develop best practices that lead to better outcomes and safer practices.

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