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Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
Medical Home & Reimbursement Methodology & ROI
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Medical Home & Reimbursement Methodology & ROI

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Provider Reimbursement Enhancement and the Advanved Medical Home-results of a Pilot Study.

Provider Reimbursement Enhancement and the Advanved Medical Home-results of a Pilot Study.

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  • 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
    • MeritCare Health System
    • Period 2004-2006
    • 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
    $542 Difference PMPY $531 Difference PMPY $1,795 Difference PMPY
  • 4. Medical Home Pilot Program
    • MeritCare Diabetes DM Expansion
    • Study Period 2 years (Sept 2007- 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% -7.79% -6.06% Blue Cross Blue Shield Contributed Dollars Member Contributed Dollars Sept 06 – Sept 07 Sept 07 – Sept 08 Average Cost Trend 10%
  • 10. Pharmacy Claims
  • 11. Professional Claims 7.41% 6.25% 6.47% Average Cost Trend 10%
  • 12. Institutional Claims -6.26% -21.4% -20.34% 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
          • [email_address]
          • Tel: 701-282-1350

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