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Leading Change in Health Care

Leading Change in Health Care. Better, Faster, and More Affordable. C. Craig Blackmore, M.D. Virginia Mason Medical Center Seattle, WA. Virginia Mason’s Vision To Be the Quality Leader and Transform Health Care. 1. Quality leader requires efficient, effective systems.

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Leading Change in Health Care

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  1. Leading Change in Health Care Better, Faster, and More Affordable C. Craig Blackmore, M.D. Virginia Mason Medical Center Seattle, WA

  2. Virginia Mason’s VisionTo Be the Quality Leader and Transform Health Care 1. Quality leader requires efficient, effective systems. 2. Transforming health care requires collaboration. Source: The Leapfrog Group, 2010.

  3. Marketplace Collaboratives Innovation and Transparency

  4. The Market-Relevant Quality Bundle Stakeholder Accord on Defining Quality • Evidence-based care: what works • 100% patient satisfaction • 3. Same-day access • Rapid return to function • Affordable price for buyer and seller

  5. Building Quality into a Value Stream • Evidence is translated into standard practice. • Each step is designed to be value-added. • Variation is limited with mistake-proofing. • Tasks are assigned to the appropriate provider. • Value stream includes entire patient experience.

  6. Headache Value StreamBefore and After Redesign Redesign creates: 1. Evidence-based care 2. High patient satisfaction 3. Same-day access 4. Rapid return to function 5. Lower cost for buyers and sellers Value added Non-value added Variable value

  7. Measuring Evidence-Based Medicine Reporting with Transparency Mistake-proofing implemented Reduction in imaging Headache: -23% Low back pain: -25% Sinusitis: -25%

  8. What We’ve Learned • Accord on definition of quality is fundamental. • An integrated system facilitates alignment. • Quality is a systems attribute. • Collaboration facilitates transparency. • Controlling health care costs requires • Providers producing quality, • Health plans reimbursing for quality, and • Purchasers choosing to buy quality.

  9. An Approach for Caring for Particular Types of Patients A Presentation by Chet Burrell President and CEO CareFirst BlueCross BlueShieldOwings Mill, MD December 16, 2010

  10. PCMH: Designed to preserve and enhance PCPs’ ability to practice medicine the way they want to practice medicine – while improving quality and reducing costs Participation 12 percentage points upon enrollment Incentive 12% fee schedule increase upon enrolling Participation 12 percentage points upon enrollment Participation 12 percentage points upon enrollment Incentive Incentive Significant rewards* based on quality and efficiency New fees paid for Care Plan development and follow-up * Incentives and reward increases apply to all medical services and exclude supplies and drugs.

  11. 10 Essential Elements • Medical Care Panels are the central building blocks • Patients ‘attributed’ to panels • Calculating the illness burden score • Establishing global expected care costs and tracking experience • Referrals to specialists: patient authorization and consent • Enhanced focus on patients with chronic illnesses – care plans / teams • An online member health record (MHR) • Measuring quality of care • Annual settlement and calculation of incentive awards • Signing on and complying with program rules

  12. Focusing on High-Risk Patients Targeted Group

  13. Wellness/Illness Burden Pyramid – PCMH & Employers Example PCMH Panel Experience Example Employer Experience

  14. For more information about CareFirst’s PCMH program, visit: www.carefirst.com/providers/pcmh 6

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