1. Community Collaborative to Impact Cost and Quality Mary Ellen Benzik Rick Hensley MichPHA September 22,2011

2. Battle Creek, Calhoun County, Michigan

3. “All growth is a leap in the dark—a spontaneous, unpremeditated act without benefit of experience.” –Henry Miller

4. 2006 Integrated Health Partners Opportunity Knocks Tom Simmer, MD, VPMA, CMO, Blue Cross Blue Shield of Michigan (BCBSM) – Challenge “We want you to look at the Wagner Model” “Start a registry” Development of conceptual framework for the CCPTH “Ability has nothing to do with opportunity.” –Napoleon Bonaparte

5. Calhoun County Pathways to Health Framework Quality Leadership Team Patient Community Partners Consumers Physicians Wagner Model of Chronic Illness Care Identify barriers to care Transform the delivery system of care Remove barriers to care related to benefit design Transform the community care system (added in 2009) Employers/ Health Plans

6. Special Request to the WK Kellogg Foundation

7. IHI Learning Collaborative Model - “I think you should have a collaborative.”–Mike Hindmarsh

8. Physician Learning Collaborative Year long commitment to improving quality of care –Team based redesign –Commitment to measurement –Public reporting of data Three collaboratives to date involving 66 teams – half from Calhoun County Learning Collaborative #4 – 13 additional teams – 75% of primary care providers in Calhoun County

9. Evolution of IHP Learning Collaboratives

10. Evolution of IHP Learning Collaborative Learning Collaborative #1 –Diabetes focus for 10 teams Learning Collaborative #2 –Expansion of number of teams to 26 Learning Collaborative #3 –Broader chronic disease focus –Expansion to prevention –Introduction of efficiency metrics Learning Collaborative #4 –Expansion to the late adopters –Attention to care management

11. Collaborative Measurements Learning Collaborative #3  Focused chronic conditions Asthma Childhood Obesity Chronic Obstructive Pulmonary Disease Diabetes Hypertension  Preventive Services Breast Cancer Screening Colorectal Cancer Screening Childhood Immunizations Adolescent Well Visit Efficiency Measure

12. Learning Collaborative #1 begins Learning Collaborative #2 begins LC Phys Learning Collaborative Physicians LC Offices Learning Collaborative Offices Non LC offices Offices who have not participated in Learning Collaboratives

13. Learning Collaborative #1 begins Learning Collaborative #2 begins LC Phys Learning Collaborative Physicians LC Offices Learning Collaborative Offices Non LC offices Offices who have not participated in Learning Collaboratives

14. Learning Collaborative #1 begins Learning Collaborative #2 begins LC Phys Learning Collaborative Physicians LC Offices Learning Collaborative Offices Non LC offices Offices who have not participated in Learning Collaboratives

15. Learning Collaborative #1 begins Learning Collaborative #2 begins LC Phys Learning Collaborative Physicians LC Offices Learning Collaborative Offices Non LC offices Offices who have not participated in Learning Collaboratives

16. Expanding Learning Collaboratives to the Community Care Management Collaborative Employer Learning Collaborative

17. Care Management Collaborative #1 “Fortuitous learning from abysmal failure” Community partners with physicians to address the transitions of care Successes –Brought community partners into the room together –Began improving transitions and care experience one patient at a time Challenges –Cross organizational work more difficult than imagined –Metrics and pilot –population difficult to quantify

18. Care Management Collaborative #2 “Like the phoenix arising from the ashes” Care Management Collaborative 2010 - current -Five pillars Assessing and meeting the needs of our patients Communications Transitions of care Referral process Medication reconciliation

19. Employer Learning Collaborative

20. Employer Collaborative Phase I – Healthy Employer Summit January 2009 In cooperation with Regional Health Alliance Half day meeting –Dee Edington –Dr. Jack Mahoney –Local success stories 90 participants, 40 employers

21. Employer Collaborative Phase II – Employer Collaborative Leverage structure of physician collaborative –Two day opening session – March 22 - 23 –Two one day sessions later in the year –Monthly conference calls Zero Trend – Dee Edington served as the framework Moving networking and best practice sharing to ACTION!

22. Employer Collaborative Phase II – Employer Collaborative Leverage structure of physician collaborative –Two day opening session – March 22 - 23 –Two one day sessions later in the year –Monthly conference calls –Zero Trend – Dee Edington served as the framework Moving networking and best practice sharing to ACTION !

23. Employer Collaborative Phase II – Employer Collaborative Leverage structure of physician collaborative –Two day opening session – March 22 - 23 –Two one day sessions later in the year –Monthly conference calls –Zero Trend – Dee Edington served as the framework Moving networking and best practice sharing to ACTION !

24. Employer Collaborative Purpose: To further improve the health of the community and to bend the health care cost trend by encouraging local employers to improve employee health management programs at each respective employer

25. Employer Collaborative Phase II – Employer Collaborative Leverage structure of physician collaborative –Two day opening session – March 22 - 23 –Two one day sessions later in the year –Monthly conference calls –Zero Trend – Dee Edington served as the framework Moving networking and best practice sharing to ACTION !

26. Framework for Employer Learning Collaborative

27. Employer Collaborative Phase II – Employer Collaborative Leverage structure of physician collaborative –Two day opening session – March 22 - 23 –Two one day sessions later in the year –Monthly conference calls –Zero Trend – Dee Edington served as the framework Moving networking and best practice sharing to ACTION !

28. V BID aligned with multiple pillars Senior Leadership Self Leadership Reward Behavior Quality Assurance

30. CITY OF BATTLE CREEK The Pathway to Health Rick Hensley, ARM, SPHR Risk Manager

31. History of Health Care 1990 Moved program to BCBSM in response to rising cost1990 Moved program to BCBSM in response to rising cost 2004 Moved program into BCBSM Self- Funded Plan2004 Moved program into BCBSM Self- Funded Plan 2008 Total Program Cost $7,238,1882008 Total Program Cost $7,238,188 Cost Sharing for same period $845,116Cost Sharing for same period $845,116

32. History of Health Care 1990 Initiated $2.00 Pharmacy Co-Pay1990 Initiated $2.00 Pharmacy Co-Pay 1995 Increased Phar Co-Pay to $5.001995 Increased Phar Co-Pay to $5.00 1996 First Employee Premium Contribution set at $2.00 per week1996 First Employee Premium Contribution set at $2.00 per week Current Employee Contributions range from $12.70 to $25.00 per weekCurrent Employee Contributions range from $12.70 to $25.00 per week 2007 Pharmacy Co-Pay set at 15/302007 Pharmacy Co-Pay set at 15/30 2010 RX Initiative2010 RX Initiative

33. History of Health Care Disease management services offered by carrier without the use of a Value Based Benefit Design

34. History of Health Care

35. CHRONIC CONDITIONS MATRIX COUNT OF MEMBERS *TOTAL COST COPD1$4,310 CAD28$364,329 CAD and COPD 2$34,676 DIABETES69$421,670 DIABETES and COPD 1$3,941 DIABETES and CAD 13$88,923 DIABETES, CAD AND COPD 1$22,584 CHF2$10,294 CHF and CAD 1$23,124 CHF and DIABETES 1$37,957 CHF, DIABETES and CAD 1$4,238 ASTHMA82$259,411 ASTHMA and COPD 7$22,470 ASTHMA and CAD 3$76,909 ASTHMA, CAD and COPD 1$27,779 ASTHMA and DIABETES 9$90,048 ASTHMA, DIABETES and COPD 2$19,721 ASTHMA, DIABETES and CAD 2$53,676 ASTHMA and CHF 1$15,345 ASTHMA, CHFand DIABETES 1$11,303 ASTHMA, CHF, DIABETES and CAD 1$137,781 TOTAL229$1,730,488

36. City of Battle Creek VBID Design and Planned Implementation Effective July 1, 2009Effective July 1, 2009 Diabetes Focused,Diabetes Focused, VBID will overlay Rather than Replace the existing BCBSM benefit plans. VBID plan will eliminate member cost-sharing for diabetic members who participate in required wellness and Care management activities.VBID will overlay Rather than Replace the existing BCBSM benefit plans. VBID plan will eliminate member cost-sharing for diabetic members who participate in required wellness and Care management activities.

37. City of Battle Creek VBID Design and Planned Implementation Removes Financial barriersRemoves Financial barriers Improve enrollment and engagement in Blue Health ConnectionImprove enrollment and engagement in Blue Health Connection Increase use of high value services (i.e., diabetes prevention and treatment)Increase use of high value services (i.e., diabetes prevention and treatment) End State: Member has the ability to successfully self manage their conditionEnd State: Member has the ability to successfully self manage their condition

40. City of Battle Creek WHAT’S NEXTWHAT’S NEXT

41. The Kellogg Experience 12/14 of the chronic disease metrics are significantly higher than the book of business Those that engaged in VBID had more co morbidities Initially, higher ER and hospital admissions in engaged participants Steeper declining trend, with subsequent lower rates than unengaged at year end

43. Data for Quality Improvement

44. Sometimes gathering data can bring new and surprising knowledge!

45. Evaluation of the Calhoun County Experience Case studies –Patient Centered Primary Care Collaborative White Papers (PC-PCC) PCMH Performance Metrics for Employers PCMH and VBBD –Advisory Board –RWJF Improving Chronic Illness Care website Robert Wood Johnson Foundation Analytic Grant –Impact of PCMH –Impact and synergy of VBBD Kellogg Company with BCBSM

46. Impact of Patient Centered Medical Home (PCMH)

47. Impact of PCMH

50. Flexibility in Design Changes Failed grant applications  Robert Wood Johnson ·Aligning Forces for Quality ·Vulnerable Populations Community Funding Partners  Trinity Call to Care Grant ·Two cycle failures Ineffective structure for the Physician Advisory Council  Establish relationship with Mike Hindmarsh, Hindsight Healthcare Strategies with funding from leadership team Redesign of the Employer Collaborative Care Management Collaborative – “Abysmal Failure”

51. But – It’s the Coolest Thing We’ve Ever Done! Mary Ellen Benzik, MD 269- 245-3850 mebstork@aol.com Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever does” Margaret Mead