Better, Faster, and More Affordable C. Craig Blackmore, M.D. Virginia Mason Medical Center Seattle, WA Leading Change in Health Care

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 Value addedNon-value addedVariable value 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

Measuring Evidence-Based Medicine Reporting with Transparency Reduction in imaging Headache: -23% Low back pain: -25% Sinusitis: -25% Mistake-proofing implemented

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

Participation 12 percentage points upon enrollment Participation 12 percentage points upon enrollment Participation 12 percentage points upon enrollment Participation 12 percentage points upon enrollment Participation 12 percentage points upon enrollment Participation 12 percentage points upon enrollment 10 * Incentives and reward increases apply to all medical services and exclude supplies and drugs. PCMH: Designed to preserve and enhance PCPs’ ability to practice medicine the way they want to practice medicine – while improving quality and reducing costs 12% fee schedule increase upon enrolling 12% fee schedule increase upon enrolling New fees paid for Care Plan development and follow-up New fees paid for Care Plan development and follow-up Significant rewards* based on quality and efficiency Significant rewards* based on quality and efficiency Incentive

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 Population Percent of Cost 3%35% 7%25% 21%25% 19%9% 50%6% Percent of Population Percent of Cost 2%31% 9%29% 22%20% 17%15% 50%5%

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