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.

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.

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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How BCBSM is working with hospitals, managing costs and improving quality of health care

Discounts that Blue Cross Blue Shield of Michigan negotiates with health care providers and collaborations with physicians and hospitals have realized more than $13 billion in savings, according to the 2010 Annual Report of Program Value (PDF), released Friday.

We’ve gone on record saying that one of our biggest concerns with health care reform is a lack of measures to contain costs. That concern is also echoed by many business owners, many of whom will have to begin offering insurance to employees in the coming years.

That’s why we feel it’s important to spotlight the important work taking place to lower costs and improve health care quality right here in Michigan.

The report outlines savings on hospital, professional, pharmacy and dental rates for members that total $12.9 billion. In addition, the Blues work with more than 8,100 physicians and more than 40 hospitals across the state on projects that address factors that drive up costs and diminish the quality of health care.

A few examples:

  • Doctors participating in our Physician Group Incentive Program saved nearly $9.5 million in 2009 through more judicious use of high- and low-tech radiology services.
  • An initiative to increase use of generic drugs helped save $700 million over seven years.
  • A collaborative initiative targeting angioplasty in hospitals saves an estimated $15.2 million annually and has reduced both hospital deaths and post-procedure blood transfusions by nearly a third.
  • A cardiac surgery initiative has decreased incidence rates of post-surgical prolonged ventilation, saving $25,000 per case.
  • And our Patient-Centered Medical Home program, at 1,800 participating physicians, is the largest in the nation and is beginning to see positive effects in just its second full year.
  • Preliminary data have shown that PCMH practices have lower rates for adult and pediatric inpatient admissions, radiology utilization and ER visits than non-PCMH practices. Comprehensive data on first-year results of the program are expected later this year.

Blue Cross is proud of these accomplishments, of course because they are saving valuable health care dollars, but more importantly, because they are creating a safer, higher quality atmosphere for health care in Michigan for everyone.

Michigan business owners express concerns over health care reform

Lack of cost containment, onerous tax reporting among biz concerns over health care reform

What can Michigan businesses expect as federal health care reform gains momentum? That was the big question being asked during a Health Care Reform: Defined event and panel discussion Tuesday at the Detroit Regional Chamber.

The answer, of course, depends upon many factors, including the shape of yet-to-be-written regulations and how the Nov. 2 election shakes out in both Washington, D.C. and Lansing. But the consensus was that businesses will likely need help both from tax and employee-benefit advisors as well as from statewide insurance exchanges set to be established in 2014.

One of business’ biggest concerns about the Patient Protection and Affordable Care Act was the lack of measures to contain costs, experts said.

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Michigan leads the way for patient-centered medical homes

Michigan is at the forefront of improving the way primary health care is delivered. The largest patient-centered medical home (PCMH) program in the nation is in our state, with 1,800 physicians in 500 practices now designated as a Blue Cross Blue Shield of Michigan patient-centered medical home.

The medical home is a primary care practice in which a health care team is completely focused on the goals and needs of each patient.  Health problems are detected and treated earlier. The team coordinates patients’ care and guides them as they make their way through the health care system.

National health care leaders and policy makers are watching Michigan to see how the program is working, including it in national and state health reform discussions. Another 3,200 primary care doctors across Michigan are working to implement patient-centered medical home capabilities into their practices, affecting almost 2 million residents.

A recent news release about patient-centered medical home posted on this site a few weeks ago discussed the preliminary data showing that PCMH-designated doctors are improving patient care.

You can find the new list of 1,800 PCMH doctors here.

Still Wondering What the Benefits of PCMH are for Patients? See this slide presentation we put together to help individuals understand what’s in it for them. Patient-Centered Medical Home (PCMH): The Benefits of a Team Approach to Health Care

PCMH: Looking good so far

Today, we announced meaningful, forward progress in the Michigan Blues’ Patient-Centered Medical Home program.

In looking at initial pieces of data, we found that Patient-Centered Medical Home (PCMH) practices are changing the way they practice medicine to be more attuned to their patients’ ongoing needs.

In fact, we found that patients in PCMH practices have lower hospital admissions, fewer ER visits and lower use of radiology services.

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