Presenter: Tom Simmer M'D'

1
Blue Cross Blue Shield of Michigan Taming the
Healthcare Beast A Plan for Michigan
Federal Reserve Bank
March 31, 2009

• Presenter Tom Simmer M.D.
• Chief Medical Officer

2
Overview

• A few facts about health status, healthcare
  costs, and personal income in Michigan.
• The Goal Improve the competitive position of the
  state of Michigan for business while supporting
  access to needed medical services.
• Provider Partnership Programs improve healthcare
  delivery through population based, collaborative
  initiatives, often connected with
  performance-based payment.
• A quick look at results.

3
Michigan Personal Income Falling Relative to U.S.
Michigan per Capita Income as a Percent of U.S.
Per Capita Income
122
93
89
Source Department of Treasury calculations from
Bureau of Economic Analysis data
4
Source Michigans Health Care Safety Net In
Jeopardy, A MHA Special Report
5
Older, fatter, smokier, sicker
6
2008 Michigan Health Plan Costs
Average Annual Cost to Employer Per Employee
State 8,812 Regional 7,557 National
7,327
Employer Share
Employee Share
State 6,152 Regional 4,904 National
4,117
State 2,660 Regional 2,653 National
3,210

• 2008 health plan costs according to the annual
  United Benefit Advisors Health Plan Survey. The
  survey included 18,019 employers nationally,
  5,283 in a four-state region and 828 in Michigan.
  United Benefits Advisors is a national alliance
  of independent insurance agencies that includes
  The Campbell Group in Grand Rapids, BenePro Inc.
  in Royal Oak, Pappas Financial in Farmington
  Hills, Saginaw Bay Underwriters in Saginaw and
  Employee Benefits Agency in Marquette.

7
Why havent we succeeded in healthcare?

• Lack of Population focus fee for service /
  third party payment system drives increased
  delivery of services.
• Cottage industry Physician practices lack
  capacity to build information infrastructure and
  implement lean processes that are key to
  improving performance.
• Health plan, rather than delivery system, focus
  introduces process variation and re-work, not
  clinical process improvement.
• Weak primary care foundation misses opportunities
  for care coordination and lower cost approaches.
  
• BCBSM programs are unique in rewarding
  population-based improvements in care,
  strengthening primary care, investing in
  infrastructure through large physician
  organizations, and reducing variation through
  lean process improvement across the delivery
  systems and across payers.

8
BCBSM Members
Support
Wellness Care Management
Michigan
BCBSM Clinical Programs
9
Current Partnering for Value Programs
Physicians
Hospitals
Hospital Incentive Program (in Participating Hospi
tal Agreement)
PGIP Physician Group Incentive Program
10

• PGIP Participants (June 2008)
• 35 groups
• 6,471 physicians
• 1,700,000 members

Keweenaw
Marquette County Upper Peninsula Health Plan
(176)
Houghton
Genesee County Genesys Integrated Group
Physicians(87), Hurley PHO (116), McLaren Medical
Management (95)
Ontonagon
Baraga
Luce
Marquette
Gogebic
Chippewa
Oakland County Medical Network One (303),
Oakland Physician Network Services (144), Oakland
Southfield Physicians (204), Oncology Physician
Resource (64), Quality Partners of MI (34), St.
John Medical Group (223), United Physicians (560)
Alger
Schoolcraft
Mackinac
Iron
Dickinson
Delta
Saginaw County Primary Healthcare Partners (57)
Menominee
Emmet
Presque Isle
St. Clair County Mercy Physician Community PHO
(38), Physician Healthcare Network (26)
Cheboygan
Charlevoix
Kent County Advantage Health Physicians (146),
Michigan Medical, PC (MMPC) (90), Regional
Delivery Network of West MI (136), West Michigan
Physicians Network (227)
Alpena
Otsego
Antrim
Montmorency
Leelanau
Macomb County DMC Primary Care Physicians (115),
St. John HealthPartners (417)
Grand Traverse
Kalkaska
Oscoda
Benzie
Alcona
Crawford
Muskegon County Hackley PHO (79)
Ogemaw
Missaukee
Iosco
Wexford
Roscommon
Manistee
Arenac
Wayne County Henry Ford Medical Group (328),
Olympia Medical Services (127), UOP, LLC (252)
Osceola
Lake
Mason
Clare
Gladwin
Ottawa County Principal Health PHO (35)
Huron
Mecosta
Midland
Oceana
Newaygo
Bay
Isabella
Sanilac
Tuscola
Montcalm
Saginaw
Muskegon
Ingham County Consortium of Independent
Physician Associations (1,230), MSU Health Team
(104), Sparrow Family Medical Services (45)
Gratiot
Washtenaw County Huron Valley Physicians
Association (245), Integrated Health Associates
(109), U-M Health System Faculty Group Practice
(387)
Genesee
Lapeer
St. Clair
Ottawa
Kent
Clinton
Shiawassee
Ionia
Macomb
Ingham
Oakland
Eaton
Calhoun County Integrated Health Partners (69)
Livingston
Barry
Allegan
Wayne
Calhoun
Jackson
Kalamazoo County Bronson Medical Group (50) and
ProMed Healthcare (83)
Van Buren
Washtenaw
Kalamazoo
Jackson County Jackson Physician Alliance (70)
Monroe
Cass
Hillsdale
St. Joseph
Branch
Lenawee
Berrien
10
11
ValuePartnerships Leveraging Provider
Relationships and Market Share to transform
healthcare delivery.
Current State
12
Programs to Improve Hospital Care MHA Keystone
Hospital-Associated Infection (HAI)

• The Challenge
• 5-10 of hospital inpatients develop infections
  each year, resulting in 90,000 deaths nationally
• 5 billion to 6 billion in national health care
  costs
• The Response
• Launched in 2007 to eliminate Hospital Associated
  Infections
• Hand hygiene compliance nearly 80 (U.S. average
  is 40)
• Eliminating nonessential catheters
• 112 participating hospitals in MHA Keystone HAI

13
Keystone Results in Michigan

• Lives Saved 1,729
• Patient Days Saved in excess of 127,000
• Dollars Saved 0ver 246 Million
• Culture of Safety improved 28
• Teamwork improved 15

Based on the Johns Hopkins Opportunity
Calculator
14
Improving Cardiac Interventions Participating
Centers 2009
15
Comparison of Outcomes for 2002-2008
16
Improving Performance to the Population Evidence
Based Care Measures

• New Measures for 2008 (scored in 2009)
• Adult Prevention
• Breast Cancer Screening
• Cervical Cancer Screening
• Child/Adolescent Prevention/Treatment
• Adolescent Well Care Visit
• Adolescent Immunization Status Combo 2
• Childhood Immunization Status Combo 3
• Well Child Visits in First 15 Months of Life
• Well Child Visits in 3, 4, 5, 6 Years of Life
• Chronic Obstructive Pulmonary Disease (COPD)
• Use of Spirometry in Assessment and Diagnosis
• Congestive Heart Failure (CHF)
• ACE/ARB Continuation/Persistence
• Coronary Artery Disease (CAD)
• Persistence of Beta Blocker Treatment After AMI
• Low Back Pain
• Imaging Studies for Low Back Pain

• 2008 Measures (scored in 2008)
• Diabetes
• Comprehensive Diabetes Care - HbA1c Testing
• Comprehensive Diabetes Care - LDL-C Screening
• Comprehensive Diabetes Care - Monitoring
  Nephropathy
• Lipid Lowering Drug Rate
• Statin Therapy for Persons with Diabetes
• ACE/ARB Use with Comorbidity CHF
• ACE/ARB Use with Comorbidity Nephropathy
• ACE/ARB Use with Comorbidity Hypertension
• Asthma
• Use of Appropriate Medications for People with
  Asthma Combined
• Congestive Heart Failure (CHF)
• LDL-C Screening
• Beta Blocker Prescription over Last 12 Months
• Rate of ACE/ARB
• Coronary Artery Disease (CAD)
• Beta Blocker Treatment After a Heart Attack
• Cholesterol Management for Patients with
  Cardiovascular Conditions - Screening

16
17
EBCR Performance Trend
18
1Q 2008 EBCR Performance
19
Increasing Generic Use
20
PMPM by Year
Final Difference21.08 Savings16.24 PMPM
Initial PMPM Difference 4.84
21
Improving Primary Care Performance

• Performance assessment is based on attributed
  population rates.
• PC-MH practice characteristics, based on national
  criteria
• Performance on Quality metrics Evidence-Based
  Care Report
• Resource management
• Generic dispensing rate
• High tech imaging
• Low tech imaging
• Rate of use of ER for non-emergent care

22
Building the Primary Care Foundation Patient
Centered Medical Home
PGIP Phys Org B
PCP
PC-MH
PGIP Phys Org A
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PC-MH Nominee
PCP
PCP
PC-MH
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PGIP Phys Org C
PCP
PC-MH
Control Group
PCP
PC-MH Nominee
PCP
PCP
PCP
PCP
PC-MH Nominee
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
PCP
23
Summary

• Michigan has unfavorable health status and
  medical costs compared to regional and national
  benchmarks.
• BCBSM is working to make Michigan a more
  competitive state to attract business and job
  growth, while improving medical care.
• Health Plan-based Wellness and Care Management
  programs are cost-effective and act as a safety
  net for failure of the primary clinical process,
  but they do not change healthcare delivery and do
  not significantly affect health benefit costs.
• Population-based collaborative programs improve
  key clinical processes and achieve substantial
  savings.
• PCPs are actively transforming their practices
  by implementing the Patient-Centered Medical Home
  model, creating a lower cost model of care.