Advancing Primary Care through Changing Reimbursement: Provider Based Disease Management and the Advanced Medical Home. Da...
Outline <ul><li>North Dakota Healthcare Market </li></ul><ul><li>Diabetes Disease Management </li></ul><ul><li>Medical Hom...
Diabetes Disease Management <ul><li>MeritCare Health System </li></ul><ul><li>Period 2004-2006 </li></ul><ul><li>Diabetes ...
Medical Home Pilot Program <ul><li>MeritCare Diabetes DM Expansion </li></ul><ul><li>Study Period 2 years (Sept 2007- Sept...
Diabetes Clinical Outcomes
CAD Clinical Outcomes
HTN Clinical Outcomes
ER and Inpatient Admissions
Global Costs: Actual vs. Expected 2.46% -7.79% -6.06% Blue Cross Blue Shield Contributed Dollars Member Contributed Dollar...
Pharmacy Claims
Professional Claims 7.41% 6.25% 6.47% Average Cost Trend 10%
Institutional Claims -6.26% -21.4% -20.34% Average cost trend 10%
ROI
Global Cost Trend 2006-2008 <ul><li>3 year follow-up </li></ul><ul><li>115 Members </li></ul><ul><li>AMH Care Desk 35 </li...
Global Cost Trend 2006-2008 <ul><li>3 year follow-up </li></ul><ul><li>160 Members </li></ul><ul><li>AMH SouthPointe Clini...
Philosophical Expectations: MediQhome Quality Project. <ul><ul><li>Philosophy </li></ul></ul><ul><li>Transformative Change...
MediQhome Quality Project <ul><li>Patient-Centered Advanced Medical Home </li></ul><ul><ul><li>BCBS ND funded Program </li...
MediQhome Information Technology
MediQhome  <ul><li>Quality Advisory Committees (Adult & Pediatric) </li></ul><ul><li>Cooperative research opportunities </...
Summary <ul><li>Cooperative Relationship Building </li></ul><ul><li>Commitment to quality clinical care </li></ul><ul><li>...
Upcoming SlideShare
Loading in …5
×

Medical Home &amp; Reimbursement Methodology &amp; ROI

725 views

Published on

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

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
725
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Medical Home &amp; Reimbursement Methodology &amp; ROI

  1. 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. 2. Outline <ul><li>North Dakota Healthcare Market </li></ul><ul><li>Diabetes Disease Management </li></ul><ul><li>Medical Home Proof of Concept (POC) </li></ul><ul><li>Advanced Medical Home POC </li></ul><ul><li>MediQhome Quality Project </li></ul><ul><li>MediQhome and Physician Reimbursement </li></ul>
  3. 3. Diabetes Disease Management <ul><li>MeritCare Health System </li></ul><ul><li>Period 2004-2006 </li></ul><ul><li>Diabetes DM Program </li></ul><ul><li>192 Patients </li></ul><ul><li>2 Clinical Sites </li></ul><ul><li>+ ROI of $ 531 PMPY </li></ul><ul><li>Improved Clinical Outcomes </li></ul><ul><li>Improved Patient Satisfaction </li></ul><ul><li>Improved Provider Satisfaction </li></ul><ul><li>BCBSA Blue Works Winner 2007 </li></ul>$542 Difference PMPY $531 Difference PMPY $1,795 Difference PMPY
  4. 4. Medical Home Pilot Program <ul><li>MeritCare Diabetes DM Expansion </li></ul><ul><li>Study Period 2 years (Sept 2007- Sept 2009) </li></ul><ul><li>Diabetes & Hypertension & CAD </li></ul><ul><li>Patient-Centered Medical Home </li></ul><ul><li>Information Technology and Infrastructure </li></ul><ul><li>Medical Practice Re-design </li></ul><ul><li>Payment Re-design </li></ul>
  5. 5. Diabetes Clinical Outcomes
  6. 6. CAD Clinical Outcomes
  7. 7. HTN Clinical Outcomes
  8. 8. ER and Inpatient Admissions
  9. 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. 10. Pharmacy Claims
  11. 11. Professional Claims 7.41% 6.25% 6.47% Average Cost Trend 10%
  12. 12. Institutional Claims -6.26% -21.4% -20.34% Average cost trend 10%
  13. 13. ROI
  14. 14. Global Cost Trend 2006-2008 <ul><li>3 year follow-up </li></ul><ul><li>115 Members </li></ul><ul><li>AMH Care Desk 35 </li></ul><ul><li>Longitudinal claims and clinical data. </li></ul><ul><li>Medical inflation </li></ul><ul><li>Clinical Quality Improving </li></ul>
  15. 15. Global Cost Trend 2006-2008 <ul><li>3 year follow-up </li></ul><ul><li>160 Members </li></ul><ul><li>AMH SouthPointe Clinic </li></ul><ul><li>Improving Quality </li></ul>
  16. 16. Philosophical Expectations: MediQhome Quality Project. <ul><ul><li>Philosophy </li></ul></ul><ul><li>Transformative Change </li></ul><ul><li>Evidence-based clinical care </li></ul><ul><li>Reduce/eliminate patient harm </li></ul><ul><li>Care Coordination norm not exception. </li></ul><ul><li>Shared financial social responsibility </li></ul><ul><ul><li>Expectation </li></ul></ul><ul><li>Provider-based practice redesign. </li></ul><ul><li>Minimum care standards must be pursued for every patient. </li></ul><ul><li>Explicit safety design for care application. </li></ul><ul><li>Collaboration and shared responsibility for outcomes. </li></ul><ul><li>Explicit partnership and stewardship of financial resources. </li></ul>
  17. 17. MediQhome Quality Project <ul><li>Patient-Centered Advanced Medical Home </li></ul><ul><ul><li>BCBS ND funded Program </li></ul></ul><ul><li>Payor Agnostic enrollment </li></ul><ul><li>Primary Care redefined and focused </li></ul><ul><li>Multiple Clinical Conditions </li></ul><ul><ul><li>HTN, CAD, DM, Asthma, ADHD, CHF, Immunization, Cancer Screening </li></ul></ul><ul><li>Clinical data driven </li></ul><ul><ul><li>Labs, medications, vitals, etc. </li></ul></ul><ul><li>Predominantly outcomes focused </li></ul><ul><ul><li>Process vs. intermediate outcomes </li></ul></ul><ul><li>Minimal claims data support </li></ul><ul><li>Abolition of clinical data silos </li></ul><ul><ul><li>Patient-centricity of data </li></ul></ul><ul><li>Patient-Centric Design </li></ul><ul><ul><li>Information Technology </li></ul></ul><ul><ul><li>Clinical Quality Reporting </li></ul></ul><ul><ul><li>Program Provider Re-imbursement </li></ul></ul>
  18. 18. MediQhome Information Technology
  19. 19. MediQhome <ul><li>Quality Advisory Committees (Adult & Pediatric) </li></ul><ul><li>Cooperative research opportunities </li></ul><ul><li>External Partnerships </li></ul><ul><li>Multiple Functionalities- PQRI and CMS Medical Home Demonstration Project </li></ul><ul><li>Information sharing with Patients (Wellness Initiative) </li></ul>
  20. 20. Summary <ul><li>Cooperative Relationship Building </li></ul><ul><li>Commitment to quality clinical care </li></ul><ul><li>Delivery System Redesign </li></ul><ul><li>Reimbursement System Redesign </li></ul><ul><li>Attitudinal Changes </li></ul><ul><li>Trust </li></ul><ul><li>Commitment </li></ul><ul><li>Shared Savings </li></ul><ul><ul><ul><ul><li>David s Hanekom, M.D. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Medical Director </li></ul></ul></ul></ul><ul><ul><ul><ul><li>BCBS of North Dakota </li></ul></ul></ul></ul><ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tel: 701-282-1350 </li></ul></ul></ul></ul>

×