Advancing Primary Care through Changing ….pptVIP

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 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 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 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 Diabetes Clinical Outcomes CAD Clinical Outcomes HTN Clinical Outcomes ER and Inpatient Admissions Global Costs: Actual vs. Expected Pharmacy Claims Professional Claims Institutional Claims ROI 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 Global Cost Trend 2006-2008 3 year follow-up 160 Members AMH SouthPointe Clinic Improving Quality 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. MediQhome Quality Project Patient-Centered Advance