Posts Tagged ‘phm’

BCBSM Physician Incentives Target 5 Root Causes of High-Cost Healthcare

February 17th, 2015 by Cheryl Miller

Designed to target underlying reasons for high-cost healthcare, Blue Cross Blue Shield of Michigan’s (BCBSM) Physician Group Incentive Program (PGIP) rewards and incentivizes providers to enhance the delivery of care. To address poorly aligned incentives, for example, they developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level, says Donna Saxton, BCBSM’s field team manager of BCBSM’s value partnerships program.

How has the program evolved? The several root causes of high-cost healthcare within our system were readily apparent: poorly aligned incentives, a lack of population focus, very fragmented healthcare delivery, a lack of focus on process excellence or process improvement and a weak primary care foundation. As we’ve developed our Physician Group Incentive Program (PGIP) initiative, we were strategic and deliberate in how we were going to address the root causes of our high-cost system, keeping in mind the tenets and the philosophy of the PGIP program.

To address poorly aligned incentives, we developed tiered fees based on performance measured at the population level, not just at the individual physician level or patient’s level.

Tiered performance fees also addresses the lack of population focus and places emphasis on all patients and payor registries.

The one thing that really makes our PGIP program unique is that we are payor-agnostic. The incentive dollars we have distributed through the life of the program readily help and incentivize other payors in the state, because if these capabilities are implemented, they ultimately serve all the patients in our state. We’re very proud of that because we feel that that is part of the servant leadership we need to do for patients and members in our state.

To attack the fragmented healthcare delivery, we’ve organized our systems of care, aligning our incentives for primary care physicians, hospitals and specialists.

We also have collaborative quality initiatives, which help sharpen our physicians, specialists and care delivery people on the science of process improvement.

Our PCMH initiative is our pinnacle initiative, which we believe has strengthened our primary care foundation across the state.

generating medical home savings
Donna Saxton, field team manager of Blue Cross Blue Shield of Michigan’s (BCBSM) value partnerships program, currently oversees the team of representatives that support the statewide collaborative relationships with 44 physician organizations (PO) and 39 organized systems of care (OSCs) that participate in the BCBSM Physician Group Incentive Program (PGIP).

Source: Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures

Is a Population Health Management Approach Sustainable?

February 10th, 2015 by Cheryl Miller

Beyond the undeniable imprint of big data on the field of population health management (PHM) and the emergence of primary care on the PHM team, the most ringing endorsement of population health management derived from the Healthcare Intelligence Network’s second annual PHM survey is the resounding belief by almost all respondents (92 percent of hospital/health systems, and 100 percent of health plans) that a population health management approach is sustainable.

One respondent went so far as to say, “Nothing comes close [to population health management] in terms of managing systemic healthcare costs.”

Still, compared to conventional care management, PHM is still in its infancy, despite the plethora of analytics harnessing healthcare data for PHM consumption. Many respondents are careful to bear in mind the individual patient behind the electronic health record or health risk assessment, balancing the use of risk stratification tools like predictive modeling with a hands-on approach.

Underscoring this, a half-dozen respondents pointed to specially trained case managers, human communication, and interdisciplinary conversations as their most successful PHM tools, along with a host of behavior change techniques employed in telephonic and face-to-face interventions: motivational interviewing, intrinsic coaching and patient activation.

While these approaches are gaining ground in terms of reducing avoidable utilization and healthcare costs, the survey indicated that engagement of patients in population health management remains a significant challenge for almost a third of 2014 respondents (although it is less a barrier now than two years ago, when almost half of respondents struggled with patient engagement).

Perhaps with more primary care physicians on the front lines of PHM, reluctant patients will become less of an issue. As one respondent noted, “For PHM to work, it requires both physician and patient engagement for a selected population. Being all things for all people is not sustainable.”

Source: 2014 Healthcare Benchmarks: Population Health Management

2014 Healthcare Benchmarks: Population Health Management Now in its second edition, this 50-page resource analyzes the responses of healthcare organizations to HIN’s second comprehensive industry survey on PHM trends administered in June 2014. It delivers the latest metrics and measures on current and planned PHM initiatives, providing actionable data on the most effective PHM tools and workflows, risk identification strategies, tools to boost health plan member and consumer engagement, modalities for program delivery, and much, much more.

Are Accountable Care Organizations Improving Population Health?

March 27th, 2013 by Cheryl Miller

What does the phrase ‘improving population health’ really mean? And are ACOs truly designed to improve it?

Researchers from Weill Cornell recently tackled these questions in a thought provoking piece featured this week, questions that need to be addressed in order to formulate effective healthcare and social service policy.

At issue is the widespread use of the phrase population health tied to ACOs, and whether ACOs actually have the incentives or the tools to improve the health of the entire community in which they are located, or whether they are just responsible for improving medical care for their own population of patients.

To read more on this discussion, click here.

In another story about improving healthcare, notably the issues of access, quality and cost, the Robert Wood Johnson Foundation (RWJF) has launched a $3 million initiative with the AARP to implement the Institute of Medicine’s (IOM) evidence-based recommendations on the future of nursing. The foundation will provide states with the support they need to build a more highly educated, diverse nursing workforce that will improve health outcomes for patients, families and communities.

Another effort to decrease healthcare costs is presented in a study from Brigham and Women’s Hospital and CVS Caremark, published in the American Journal of Medicine. Patients with coronary artery disease (CAD) who are medication adherent can save the healthcare system up to $868 per patient per year. Researchers found a consistent trend toward improvement in coronary artery-related events, mortality, readmissions, and costs among those patients who most adhered to their medication regimens.

In other more cost-related news, a collaborative of 333 hospitals intent on improving costs and care have saved $9.1 billion and 92,000 deaths since 2008 by replicating the performances of top performing hospitals, according to Premier Healthcare Alliance’s QUEST™ collaborative.

If hospitals nationwide followed QUEST’s™ lead, they could save 950,000 lives and approximately $93 billion over the next five years, officials said.

And don’t forget to take our new survey, Managing Care Transitions in 2013. Proper management of a transition in care — the process by which an individual’s care moves from one health setting to another, such as from hospital or ER to home, or from SNF to hospital — has the potential to dramatically hasten that person’s return to optimal health, as well as reduce the likelihood of a return ER visit or readmission. The quality of transitional care is also shaping up to be a critical factor in value-based reimbursement, as federal and private payors ask patients to rate the quality of the transitional care they receive.

Please share your organization’s efforts to improve care transitions by completing HIN’s third qualitative survey on this topic by Friday, April 12, and we’ll send you a free executive summary of the compiled results.

These stories and more in this week’s issue of the Healthcare Business Weekly Update.