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Advancing Primary Care through Changing Reimbursement: Provider Based Disease Management and the Advanced Medical Home. David S Hanekom, M.D. Medical Director.

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Presentation on theme: "Advancing Primary Care through Changing Reimbursement: Provider Based Disease Management and the Advanced Medical Home. David S Hanekom, M.D. Medical Director."— Presentation transcript:

1 Advancing Primary Care through Changing Reimbursement: Provider Based Disease Management and the Advanced Medical Home. David S Hanekom, M.D. Medical Director Blue Cross Blue Shield of North Dakota The National Healthcare Incentives Institute October 21, 2008 Washington, DC

2 Outline North Dakota Healthcare Market Diabetes Disease Management
Medical Home Proof of Concept (POC) Advanced Medical Home POC MediQhome Quality Project MediQhome and Physician Reimbursement

3 Diabetes Disease Management
$542 Difference PMPY $1,795 Difference PMPY MeritCare Health System Period Diabetes DM Program 192 Patients 2 Clinical Sites + ROI of $ 531 PMPY Improved Clinical Outcomes Improved Patient Satisfaction Improved Provider Satisfaction BCBSA Blue Works Winner 2007 $531 Difference PMPY

4 Medical Home Pilot Program
MeritCare Diabetes DM Expansion Study Period 2 years (Sept Sept 2009) Diabetes & Hypertension & CAD Patient-Centered Medical Home Information Technology and Infrastructure Medical Practice Re-design Payment Re-design

5 Diabetes Clinical Outcomes

6 CAD Clinical Outcomes

7 HTN Clinical Outcomes

8 ER and Inpatient Admissions

9 Global Costs: Actual vs. Expected
2.46% -6.06% -7.79% Sept 06 – Sept 07 Sept 07 – Sept 08 Average Cost Trend 10% Blue Cross Blue Shield Contributed Dollars Member Contributed Dollars

10 Pharmacy Claims

11 Professional Claims 7.41% 6.47% 6.25% Average Cost Trend 10%

12 Institutional Claims -6.26% -20.34% -21.4% Average cost trend 10%

13 ROI

14 Global Cost Trend 2006-2008 3 year follow-up 115 Members
AMH Care Desk 35 Longitudinal claims and clinical data. Medical inflation Clinical Quality Improving

15 Global Cost Trend 2006-2008 3 year follow-up 160 Members
AMH SouthPointe Clinic Improving Quality

16 Philosophical Expectations: MediQhome Quality Project.
Philosophy Transformative Change Evidence-based clinical care Reduce/eliminate patient harm Care Coordination norm not exception. Shared financial social responsibility Expectation Provider-based practice redesign. Minimum care standards must be pursued for every patient. Explicit safety design for care application. Collaboration and shared responsibility for outcomes. Explicit partnership and stewardship of financial resources.

17 MediQhome Quality Project
Patient-Centered Advanced Medical Home BCBS ND funded Program Payor Agnostic enrollment Primary Care redefined and focused Multiple Clinical Conditions HTN, CAD, DM, Asthma, ADHD, CHF, Immunization, Cancer Screening Clinical data driven Labs, medications, vitals, etc. Predominantly outcomes focused Process vs. intermediate outcomes Minimal claims data support Abolition of clinical data silos Patient-centricity of data Patient-Centric Design Information Technology Clinical Quality Reporting Program Provider Re-imbursement

18 MediQhome Information Technology

19 MediQhome Quality Advisory Committees (Adult & Pediatric)
Cooperative research opportunities External Partnerships Multiple Functionalities- PQRI and CMS Medical Home Demonstration Project Information sharing with Patients (Wellness Initiative)

20 Summary Cooperative Relationship Building
Commitment to quality clinical care Delivery System Redesign Reimbursement System Redesign Attitudinal Changes Trust Commitment Shared Savings David s Hanekom, M.D. Medical Director BCBS of North Dakota Tel:

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