We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byKarley Rasberry
Modified about 1 year ago
Third Sino-U.S. Conference on Medical Professionalism Allan M. Korn M.D., FACP Blue Cross Blue Shield Association Happier Doctors Healthier Patients
© 2008 Blue Cross Blue Shield Association 2 Happier Doctors, Healthier Patients ● Evidence Based Care ● Better Outcomes ● Meaningful doctor-patient relationship ● Durable doctor-patient relationship ● Trusting doctor-patient relationship ● Much more pride in medical practice ● The basis for a harmonious society
© 2008 Blue Cross Blue Shield Association 3 Medical Professionalism ● Results in more satisfaction with clinical practice ● Results in patients trusting you while engaging in their own care ● Nurtures trust between doctors, hospitals and patients ● Meets the needs of society with personal pride and scientific accuracy ● Opens minds, opens hearts, and demands integrity in all that is done for patients, peers, and nation.
© 2008 Blue Cross Blue Shield Association 4 Hospital Rewards accelerate quality improvement New England Journal of Medicine February 2007 “Public Reporting and Pay for Performance in Hospital Quality Improvement”; New England Journal of Medicine; February 2007; Peter K. Lindenauer, M.D., M.Sc.; Denise Remus, Ph.D., R.N.; Sheila Roman, M.D., M.P.H.; Michael B. Rothberg, M.D., M.P.H.; Evan M. Benjamin, M.D.; Allen Ma, Ph.D.; and Dale W. Bratzler, D.O., M.P.H. ● Rewarded hospitals showed greater improvement in all composite measures of quality ● Rewards associated with improvements above public reporting ranging from 2.6 to 4.1% over the 2-year study period
© 2008 Blue Cross Blue Shield Association 5 More Patients Receive Evidence-based Care Avg. improvement in all clinical areas (15 quarters) 52.6% Clinical Area Percent Improvement AMI (Heart Attack) 21.6% CABG (Coronary Bypass) 64.3% Pneumonia67.8% Heart Failure50.5% Hip & Knee58.6% Appropriate Care Score Source: Center for Medicare & Medicaid and Premier Inc. Hospital Quality Improvement Demonstration Project (HQID)
© 2008 Blue Cross Blue Shield Association 6 Government sponsored programs Study demonstrates that when evidence-based care is reliably delivered, quality is higher and costs are lower (over 1.1 million patients). Patient Process Measure Study finds higher reliable care yields lower mortality rates for heart bypass surgery patients Study finds higher reliable care yields lower hospital costs for patients with pneumonia Source: Center for Medicare & Medicaid and Premier Inc. Hospital Quality Improvement Demonstration Project (HQID)
© 2008 Blue Cross Blue Shield Association 7 Findings from Government sponsored programs ● Financial incentives combined with public reporting of transparent data can drive significant improvement in quality – Hospitals held the gains and continued to improve ● More patients are reliably receiving evidenced-based care ● Improved quality is associated with saving lives and reducing costs
© 2008 Blue Cross Blue Shield Association 8 Designation for quality recognition in physician directories, award certificates for office display, etc. Recognition Aligning incentives is a key driver for successful collaboration. Physician Specialist Incentives Integration of American Board of Internal Medicine Practice Improvement Modules, or Blue Cross Blue Shield quality based recognition programs, or Special recommendations to patients to seek physicians and hospitals which have achieved high-quality, evidence-based care. Reward
© 2008 Blue Cross Blue Shield Association 9 Evidence: Recognized physicians have higher quality results! Study 1 examined routine screening for a variety of patients: – Cancer screening – Routine laboratory screening for diabetics – Routine laboratory screening for heart disease patients – Routine laboratory screening for hypertensive patients Study 2 examined several dimensions of diabetic care: – Routine laboratory screening – Eye exams In two separate studies, it was demonstrated that recognized physicians score higher at essential elements of patient care.
© 2008 Blue Cross Blue Shield Association 10 When Primary Care Doctors Treat Patients… ● Chronic diseases receive better care – Patients with congestive heart failure had 35% fewer hospital days; – Patients with diabetes had significant reductions in cardiovascular risk; – Asthma and diabetes patients were more likely to receive appropriate therapy. ● Access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially. ● If every American had access to comprehensive primary care, national health care expenditures would drop by 5.6% -- equal to national savings of at least $67 billion per year.
© 2008 Blue Cross Blue Shield Association 11 The Primary Care Model ● Trusted personal physician ● Physician who provides, manages and facilitates care ● Care is coordinated or integrated across healthcare system ● More accessible practice with increased hours and easier scheduling ● Enhanced payment that recognizes the added value of delivering care through the PCMH model ● Assistance to practices seeking transformation ● Support to practices adopting HIT for QI PatientPersonal Physician
© 2008 Blue Cross Blue Shield Association 12 The Primary Care Model Changes in Clinician Incentives Fee For Service Fee for service Prospective payment Pay for outcomes Blended Payment Improved Patient Interaction Better Work Environment Team effort Increased responsibility for admin and clinicians More time for patients Better communication and access Case management Personal Physician
© 2008 Blue Cross Blue Shield Association 13 Financial incentives lead to meaningful outcomes improvements in primary care
© 2008 Blue Cross Blue Shield Association 14 Sending the right message to physicians with financial incentives How do we provide the right incentives for physicians to deliver high quality, patient-centric, efficient care? Problems with productivity SalarySalary Problems with overuse Fee-for-serviceFee-for-service Problems with underuse CapitationCapitation Problems with ignoring what’s not attached to additional payment Pay-for-QualityPay-for-Quality
© 2008 Blue Cross Blue Shield Association 15 Blue Distinction raises the level of care delivered across the country by focusing on evidence-based quality and outcomes that are reinforced through national incentives Physician Controlled, Evidence Based Blue Distinction Vision
© 2008 Blue Cross Blue Shield Association 16 National Presence Blues achieve national presence, with over 800 Blue Distinction designations spanning 45 states Blue Distinction Centers for Cardiac Care SM Blue Distinction Centers for Bariatric Surgery SM Blue Distinction Centers for Transplants SM Blue Distinction Centers Complex & Rare Cancers SM
© 2008 Blue Cross Blue Shield Association 17 Outcomes from Clinical Data Inpatient Mortality Cardiac BDCs demonstrate better overall outcomes Inpatient Mortality Post Heart Attack Statistically significant difference Inpatient Mortality Post Bypass Surgery *Risk-adjusted Source: Hospital RFI Data Submitted to the Blue Cross and Blue Shield Association 7% 9% 3% 2% MeanMean* BDCOther
© 2008 Blue Cross Blue Shield Association 18 Outcomes from Clinical Data Blue Distinction Centers demonstrates better, more consistent overall outcomes Source: Hospital RFI Data Submitted to the Blue Cross and Blue Shield Association Inpatient Mortality Post Heart Attack Mortality Rate One-year Post Heart Transplant BDCOther 11% 19% Mean 7% 9% Mean
© 2008 Blue Cross Blue Shield Association 19 Happier Doctors ● Reward from medical practice: pride and peer approval ● Reward from payers: higher income based on better patient outcomes ● Reward from the nation: admiration and gratitude ● Reward from international colleagues: acceptance and integration of joint programs and initiatives
© 2008 Blue Cross Blue Shield Association 20 Healthier Patients ● Better clinical outcomes ● Consistent management of chronic illness ● Trust that there is a caring relationship with a healer ● Belief that someone with special knowledge cares for him or her ● Safety from ineffective or unnecessary care ● Security for families and individuals
© 2008 Blue Cross Blue Shield Association 21 Harmonious Society ● Doctors and professional societies have aligned incentives ● Doctors, hospitals, and patients have aligned incentives ● Ministries and all healthcare stakeholders have aligned incentives ● Chinese patients deserve optimal health and productivity. THE INCENTIVE: Doing the right thing right, the first time, based on the best available clinical evidence. This creates the opportunity for medical and financial security.
© 2008 Blue Cross Blue Shield Association 22 Contact Information Allan M. Korn, M.D., FACP Senior Vice President Clinical Affairs and Chief Medical Officer Blue Cross Blue Shield Association 225 North Michigan Avenue Chicago, Illinois
MEDICAL HOME 1/2009 Mary Goldman, D.O., President of MAOFP.
How hospitals and health systems fit into the pay for performance puzzle Richard A. Norling President and CEO Premier Inc.
A Blue Cross and Blue Shield Association Presentation Office of Policy and Representation Changing Payment Incentives: 'Crucial Step' In Healthcare Reform.
May 11, 2015 Wellmark Blue Cross and Blue Shield Presenters: Dr. Rick Miller Elodie Opstad Driving to Quality Providing Transparency Iowa Health Buyers.
0 Hospital Quality Incentive Demonstration (HQID) Key Facts Three year demo ( ); extended for three additional years through Oct hospitals.
A Blue Cross and Blue Shield Association Presentation Consumers Take Center Stage 2007 Health Leaders Forum Federal Reserve Bank of Chicago and Detroit.
Bob Doherty Senior Vice President, Governmental Affairs and Public Policy American College of Physicians March 3, 2009 Designing new payment models for.
1 Emerging Provider Payment Models Medical Homes and ACOs.
Improving Quality Through Systems Change National Health Policy Conference, Washington, DC Stephanie Alexander, Sr. VP, Premier Healthcare Informatics.
New Approaches to Disease Management Get Connected Knowledge Forum Larry G. Anderson MD MMC Physician-Hospital Organization June, 2005.
Payment and Delivery Reform Steve Arner Senior Vice President / Chief Operating Officer June 6, 2013.
Component 1: Introduction to Health Care and Public Health in the U.S. 1.9: Unit 9: The evolution and reform of healthcare in the US 1.9d: The Patient.
Tad P. Fisher Executive Vice President Florida Academy of Family Physicians Patient Centered Medical Home A Medicaid Managed Care Alternative.
Unit 1a: Health Care Quality and HIT Introduction to QI and HIT This material was developed by Johns Hopkins University, funded by the Department of Health.
Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d This material (Comp1_Unit9d) was developed.
1 Hospital P4P: The CMS/Premier Hospital Quality Incentive Demonstration Project March 10, 2009 Mary B. Bergerson Regional Quality Director St. Helena.
Primary Care & New Jersey James E. Barr, MD Medical/Executive Director, Central Jersey Physician Network IPA Horizon BCBS of NJ HMO Board Member Member,
Primary Care Improvement Infrastructure: The Role of Practice Facilitation Michael L. Parchman, MD MPH MacColl Center for Health Care Innovation AHRQ Annual.
Practice Transformation for Physicians and Health Care Teams
Memorial Hermann Healthcare System Clinical Integration & Disease Management Dan Wolterman April 15, 2010.
Better, Smarter, Healthier: Delivery System Reform U.S. Department of Health and Human Services 1.
The Business Case for Bidirectional Integrated Care: Mental Health and Substance Use Services in Primary Care Settings and Primary Care Services in Specialty.
Alternative Quality Contract: Improving Health Care Quality While Reducing Spending Growth Alliance for Health Reform Deborah Devaux Monday, August 10,
Promoting Health Information Technology Linda Magno Director, Medicare Demonstrations Group.
1 Michigan Medical Home. 2 What is a Medical Home? A Medical Home is not a building. It’s a “home base” for your health care needs. A Medical Home is.
Clinical Initiatives Supporting the Treatment of Tobacco Use Dependence Jim Bluhm, MPH Project Manager Blue Cross and Blue Shield of Minnesota Center for.
Jim Jenkins, MD President, Fairfax Family Practice Centers.
Chapter 9 Case Management Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Quality in Laboratory Medicine Conference Business Case for Quality Recognizing Excellence in Practice Presented to the Institute for Quality in Laboratory.
Virginia Chamber of Commerce Health Care Conference Steve Arner SVP / Chief Operating Officer June 6, 2013.
The Rhode Island Chronic Care Sustainability Initiative: Building a Patient-Centered Medical Home Pilot in Rhode Island.
Chronic Care in the 21 st Century Building an Infrastructure for Quality and Efficiency March 2, 2009 Philadelphia, PA John Tooker MD,MBA,FACP Chief Executive.
Healthy patients. Healthy hospitals. Early Results from the Premier-CMS Hospital Quality Incentive Demonstration Program Stephanie Alexander Senior Vice.
Primary Care and Behavioral Health 2/4/2011 CIBHA.
1 A Crystal Ball: How to Improve the Health Care System Tom Closson President and CEO Ontario Hospital Association NAPAN 8th Annual Conference Sunday,
Racial/Ethnic Disparities in Health Care: Narrowing the Gap through Solutions Joseph R. Betancourt, M.D., M.P.H. Director, The Disparities Solutions Center.
The Cost-Quality Connection in Southeast Michigan A Call for Consistency in Performance-Based Differential Reimbursement John E. Billi, MD University of.
The Changing Landscape of Healthcare. Important Terms ACO: Accountable care Organization- group of healthcare providers that agree to be accountable for.
Striving Towards Excellence in Comprehensive Care: What do Children Need? July 10, 2007 Christopher A. Kus, M.D., M.P.H.
2014 Summit Co-Convener:Founder: Patient Safety Science & Technology Summit 2014.
NASHP - October 5, 2010 Lisa M. Letourneau MD, MPH Quality Counts Learning the ABCs of APCs and Medical Homes.
Disease State Management The Pharmacist’s Role. Why the Interest ?? Chronic diseases account for billions of dollars in annual medical expenditures Loss.
THE CHALLENGE: CHRONIC DISEASE CARE AND THE PROMISE OF HIT Health Care Information Technology 2004: Improving Chronic Care in California San Francisco.
Community Paramedic Payment Reform December 2 nd,2015 Terrace Mall- North Memorial.
Healthcare Organization Employee Experience Michael Mabanglo, PhD, LCSW February 16, 2016.
Component 1: Introduction to Health Care and Public Health in the U.S. 1.5: Unit 5: Financing Health Care (Part 2) 1.5d: Controlling Medical Expenses.
September 2008 NH Multi-Stakeholder Medical Home Overview.
PRACTICE TRANSFORMATION NETWORK 2/24/ Transforming Clinical Practice Initiative (TCPI) Practice Transformation Network (PTN) $18.6 million –
PATIENT SAFETY ORGANIZATION Michigan Surgical Quality Collaborative
Linette T Scott, MD, MPH Chief Medical Information Officer, DHCS “Population Health” HIMSS NCal Educational Program, Sacramento, CA| February 4, 2014.
© 2017 SlidePlayer.com Inc. All rights reserved.