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					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.
2. Transforming health care requires collaboration.




            Source: The Leapfrog Group, 2010.
Marketplace Collaboratives
Innovation and Transparency
The Market-Relevant Quality Bundle
Stakeholder Accord on Defining Quality



1.   Evidence-based care: what works
2.   100% patient satisfaction
3.   Same-day access
4.   Rapid return to function
5.   Affordable price for buyer and seller
Building Quality into a Value Stream

1. Evidence is translated
   into standard practice.
2. Each step is designed to
   be value-added.
3. Variation is limited with
   mistake-proofing.
4. Tasks are assigned to the
   appropriate provider.

5. Value stream includes
   entire patient experience.
Headache Value Stream
Before 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
Measuring Evidence-Based Medicine
Reporting with Transparency

                               Mistake-proofing
                               implemented


                               Reduction in imaging
                               Headache:        -23%
                               Low back pain: -25%
                               Sinusitis:  -25%
 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
    a)Providers producing quality,
    b)Health plans reimbursing for quality, and
    c)Purchasers choosing to buy quality.
    An Approach for Caring
for Particular Types of Patients
    A Presentation by Chet Burrell
          President and CEO
    CareFirst BlueCross BlueShield
           Owings Mill, MD


          December 16, 2010
          PCMH: Designed to preserve and enhance PCPs’ ability
       to practice medicine the way they want to practice medicine –
                 while improving quality and reducing costs




              Incentive                                                                                Incentive
                                                              Incentive
           Participation                                                                              Significant
        12% fee schedule                                  Participation
                                                         New fees paid                                Participation
       12 percentage points
            increase                                   for Care Plan                                   rewards*
                                                    12 percentage points                          12 percentage points
           upon enrollment
           upon enrolling                              development                                 based on quality
                                                      upon enrollment                               upon enrollment
                                                       and follow-up                                 and efficiency
                                                                                                      10
* Incentives and reward increases apply to all medical services and exclude supplies and drugs.
                   10 Essential Elements
1. Medical Care Panels are the central building blocks
2. Patients ‘attributed’ to panels
3. Calculating the illness burden score
4. Establishing global expected care costs and tracking experience
5. Referrals to specialists: patient authorization and consent
6. Enhanced focus on patients with chronic illnesses – care plans / teams
7. An online member health record (MHR)
8. Measuring quality of care
9. Annual settlement and calculation of incentive awards
10.Signing on and complying with program rules
Focusing on High-Risk Patients




        Targeted
         Group
Wellness/Illness Burden Pyramid – PCMH & Employers
Example PCMH Panel Experience                 Example Employer Experience
                    Percent of   Percent of                       Percent of   Percent of
                    Population     Cost                           Population     Cost

                       3%          35%                               2%          31%


                       7%          25%                               9%          29%



                      21%          25%                              22%          20%



                      19%           9%                              17%          15%



                      50%           6%                              50%           5%
For more information about CareFirst’s
        PCMH program, visit:

 www.carefirst.com/providers/pcmh




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