Blue Health Coach - BCBS of Massachusetts BCBSMA collaborated with Pfizer Health Solutions to understand how their InformaCare® web-based software system could work within a care management environment. Smoking Cessation Quitline - BCBS of Michigan BCBSM partnered with Michigan State University to test interventions for their smoking cessation quitline, applying research in a real world setting. Men’s Health Program - BCBS of North Carolina Program to improve men’s utilization of preventive care services. The key program objectives were to increase men’s preventive care screenings, educate men about their preventive health needs, determine the best method for communicating these health messages to men, and provide physicians with reminder tools. Arkansas Fitness Challenge – Arkansas BCBS The Arkansas Fitness Challenge (AFC) is a contest during which employees from opposing teams – in 2004, the Arkansas Department of Health and Arkansas Blue Cross and Blue Shield – participate in eligible aerobic exercises for a three-month period. Concierge Service Delivery Plus - BCBS of Massachusetts A pilot team of approximately 50 associates and leaders was asked to re-define the future of service. Innovations included a non-conventional interview process, an environment where risk-taking is encouraged, and a creative incentive and rewards plan. Partnerships with internal business partners are also fostered as part of the framework. Collaborative Appropriate Antibiotic Prescribing Initiative - Excellus BlueCross BlueShield A collaborative model among two competing health plans and a large physician group to reduce inappropriate antibiotic prescriptions for URIs. Out of the ER: The Tulare Project - Blue Cross of California Out of the ER: The Tulare Project was designed to reduce overuse of emergency room facilities for routine care that could be received at the primary care physician’s office by Blue Cross of California Medicaid Managed Care members in Tulare County.
Gaps in Care Closing the gaps in care is the primary objective for recognizing physician excellence Patients Receiving Evidence-based Care Source: McGlynn et al, “The Quality of Health Care Delivered to Adults in the United States,” NEJM, 2003; To Err Is Human, Institute of Medicine, 1998 $ $ $ $ Source: Pham et al, “Delivery of Preventive Services to Older Adults by Primary Care Physicians ,” JAMA, July 27, 2005
Note: Coverage is for a family of four. Source: Calculated based on “Employer Health Benefits 2005 Annual Survey,” (#7315), The Henry J. Kaiser Family Foundation and Health Research and Educational Trust, September 2005 This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation, based in Menlo Park, California, is a nonprofit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. Average Annual Premium Contribution for Family Coverage 1999-2005 Unsustainable Rise in Premiums Savings from better outcomes and reduced waste will make insurance more affordable
Recognizing Physician Excellence Core values guide… <ul><li>Measures approved by nationally recognized groups </li></ul><ul><li>Relative ease of data collection </li></ul><ul><li>Breadth of measures to ensure a valid, comprehensive picture of physician performance </li></ul><ul><li>Credible and actionable to clinicians & transparent to patients </li></ul>Measurement <ul><li>Report by tertiles/quartiles rather than rank order </li></ul><ul><li>Reward commitment to improvement </li></ul><ul><li>Promote environment for practice transformation </li></ul>Recognition