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The MidAtlantic Business The MidAtlantic Business Group on Health Group on Health
Working Together to Improve Working Together to Improve Healthcare ValueHealthcare Value
David JohnsonJohn Miller
MidAtlantic Business Group on Health
David JohnsonJohn Miller
MidAtlantic Business Group on Health
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Membership
Voting MembersNon-voting Corporate MembersNon-voting Individuals
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Voting Membership
Adventist Healthcare Legg Mason Sodexo, Inc.Baltimore Air Coil LifeBridge Health System T. Rowe Price Associates, Inc.Baltimore County Govt. Local Govt. Insurance Trust Trigen-Baltimore Energy Corp.Baltimore County Schools Marriott International TriState Health PartnersConstellation Energy Maryland State Teachers University of MD Medical SystemDelmarva Foundation McCormick & Co., Inc. Verizon Erickson Retirement Communities Mercy Medical Center City of HagerstownGreater Baltimore Medical Center Millennium Chemicals, Inc. P. G. County Board Of EducationJohns Hopkins Hospital Northrup Grumann Prince Georges County GovernmentKCI Technologies Rouse Company
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Corporate Membership
Aetna, Inc. LumenosAON MAMSIAstra Zeneca Mercer Human ResourcesBoehringer Ingelheim Palmer & CayCareFirst BlueCross BlueShield Pfizer, Inc.Delta Dental The Segal CompanyExpress Scripts Watson Wyatt Worldwide
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GeographyGeography
MarylandVirginiaDistrict of Columbia
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Mission
Sharing and analyzing dataEducation, coordination, solutions to health
services issuesCooperative, objective forum promoting
affordable, high quality, and accessible health care
Meetings and conferences; publications
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Data
Health Management SurveyMembership InformationeValue8
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Education
Education Committee– Disparities in Health Care
Health Management Committee– Strategic Health Management
Legislative Committee– Legislative Updates
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Objective Forum
MABGH History– (Maryland Health Care Coalition)
Practice of Hearing Both Sides
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eValue8: eValue8: A Coordinated Health Plan A Coordinated Health Plan
Quality Improvement ProcessQuality Improvement Process
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Premises:Premises:
MCOs Should Remain Employers “Lieutenants”
The Loudest “Plurality” Drives the System
Improving Processes Will Lower Cost
“Rising Tide Raises all Healthcare”
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MethodMethod
1. Consolidate and Articulate Expectations: Example eValue8 Expectations:
– Provider differentiation and reward
– Clinical Guideline for Alcohol
– Provider Education on CVD Risk Factors
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MethodMethod
2. Measure Performance Against Expectations
Objectively as Possible
National Benchmarks of the “Possible”
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MethodMethod
3. Open, 2-way Discussion of Results: WITH CLINICAL DECISION-MAKERS
eValue8 Scores
eValue8 Process
“How can we help you?”
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Clinical Decision-MakersClinical Decision-Makers
Aetna Attendance:- Chuck Cutler, MD (Head of National Quality Management)- Pat Mueller, MD (Regional Medical Director)- Rick Fornadel, MD (Local Medical Director- Tammie McGonigle, R Ph (Clinical Pharmacist)- Fran Grabosky (Quality Manager, Behavioral Health) - Sue Grauer (Product Manager, Disease Management)- Quincy Garfield (Product Head, Disease Management)- Mark Friedlander, MD (Medical Director, Behavioral Health)- Larry Nardozzi, MD (Medical Director, Magellan)- Sam Freeman (Sales Vice President)- Carol Rosebrook (Account Executive)- Mary Eller (Account Executive)
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MethodMethod
4. Identify and Agree on Targets for Improvement
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Our Four Goals: Our Four Goals: Across All MCOsAcross All MCOs
Cardiovascular: Improving Practitioner Compliance with Guidelines
Using Performance Data to Differentiate and Reward Providers
Consolidate Diabetes “Registry”
Alcohol Screening and Referral
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Individual Plan GoalsIndividual Plan Goals
PCP Alcohol Screening Initiative
Colorectal Cancer Screening
Depression Management (X 3)
Cultural Competency Program– 2 Hr. Web-based Program
– Goal: 95% completed by 1 Qtr. 2004
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Alcohol: Plan CAlcohol: Plan CAction Steps Time
FrameMeasurement Metric
Goal Collab- oration?
Audit medical records for alcohol/drug screen
4Q2003 Baseline performance measured
Completion within time frame
No
Promote use of CAGE screening tool 1Q2004 Practitioner newsletter article
Completion within time frame
No
Revise preventive services guideline/screenings
2Q2004 Guideline approved Completion within time frame
No
Measure impact of programs 2Q2005 Screening rates TBD based on baseline measures
No
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Local Results 2003Local Results 2003
Alcohol Use Screening/Treatment
0 10 20 30 40 50 60
Aetna
CareFirst
Kaiser
Optimum
Maximum
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Local Results 2004Local Results 2004
Alcohol Use Screening / Treatment
0 20 40 60 80 100
Aetna
CFBCBS
Kaiser
MAMSI
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HIT Driving HIT: 2005HIT Driving HIT: 2005
Plan Structure and OrganizationCommunity CollaborationStandards Practitioner Administrative Support
Tools (Eligibility, Member Financial Requirements, Claims)
Practitioner Clinical Support Tools (Referrals, Electronic Ordering and Reporting)
MHCCMHCC
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HIT Driving HIT: 2005HIT Driving HIT: 2005
Outpatient Electronic Prescribing ToolsMember Provider Selection and
Connectivity ToolsElectronic Personal Health Record
(PHR)Purchaser Cost and Utilization
Management Tools
MHCCMHCC
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HIT Driving HIT: 2005HIT Driving HIT: 2005
Incentives for HITPerformance Measurement
MHCCMHCC
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Overall ResultsOverall Results
Employer:“This is what we expect: we’re watching, thank you for listening.”
MCOS:“We’re glad you’ve started to watch: together we can improve healthcare and all save money.”
MHCCMHCC
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MABGH SummaryMABGH Summary
Data Education Cooperative, objective forum Meetings and conferences; publications
NETWORKING– Voting Member-to-Voting Member – Members-to-Vendors
MHCCMHCC
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The MidAtlantic Business The MidAtlantic Business Group on Health Group on Health
Working Together to Improve Working Together to Improve Healthcare ValueHealthcare Value
[email protected]@mabgh.org301-552-4237301-552-4237