1. Michigan Quality Improvement Consortium 2005 Activity Highlights

2. Member Organizations Blue Cross Blue Shield of Michigan Blue Care Network Care Choices Community Choice Michigan Great Lakes Health Plan- New Member Health Alliance Plan HealthPlus of Michigan Health Plan of Michigan M-CARE Midwest Health Plan Michigan Association of Health Plans

3. Member Organizations (cont’d) Michigan Department of Community Health Michigan Osteopathic Association Michigan State Medical Society Molina Health Care of Michigan Michigan Peer Review Organization Physicians Health Plan of Mid-Michigan Physicians Health Plan of South Michigan Physicians Health Plan of Southwest Michigan Priority Health Total Health Care, Inc. – New Member University of Michigan Health System

4. Guideline review/updating in 2005 Medical Management of Adults with Osteoarthritis Screening and Management of Substance Use Disorders Outpatient Management of Uncomplicated Deep Venous Thrombosis Medical Management of Adults with Hypertension Screening and Management of Hyperlipidemia Tobacco Control Management of Osteoporosis Medical Directors’ Activities

5. New guideline development in 2005 Identification, Evaluation and Treatment of Overweight and Obesity in the Adult (approved 03/05) Adult Preventive Services (approved 07/05) Prenatal Care (draft #3) Pediatric Preventive Services (draft #1) Medical Directors’ Activities

6. Medical Directors’ Activities (Cont’d) Future Guideline Development Agenda Chronic Kidney Disease Low Back Pain Pediatric Obesity Acute Bronchitis Medical Management Post Myocardial Infarction

7. MQIC Measurement Group HEDIS ® and non-HEDIS ® compliance measures and measurement specifications have been developed for the following MQIC guidelines: Diabetes Asthma Tobacco Control Depression Substance Use Hyperlipidemia Hypertension Acute Pharyngitis

8. MQIC Measurement Group (Cont’d) Revised lipid-lowering drug list and AHFS codes for diabetes non-HEDIS ® measure (percent members on lipid-lowering drugs) Significant work has been done to develop measures and measurement methodologies for the heart failure and osteoporosis guidelines Analysis completed on MQIC Diabetes Pilot aggregate physician reports MQIC health plans submitted HEDIS ® 2005 and non-HEDIS ® data for MQIC performance reporting

9. MQIC Implementation Group Instrumental in the distribution and review of MQIC guidelines and collection of feedback Promoted MPRO DOQ-IT project Developed list of potential future collaborative initiatives, including: Multi-payer performance reports for diabetes, asthma and depression using administrative data Adoption of Asthma Initiative of Michigan’s Mark Toolkit as supplemental tool for MQIC asthma guideline

10. MQIC Implementation Group (Cont’d) Increase physician recognition and awareness of MQIC guidelines, activities and resources Identify supplemental materials/tools that will facilitate guideline usage in the practice setting Coordinate and assist Michigan Primary Care Initiative work group in assessing existing tools

11. Coordination with Other Efforts  GDAHC “Save Lives Save Dollars” Initiative  Primary Care Initiative for a Healthier Michigan

12. GDAHC “Save Lives Save Dollars”

13. PROPRIETARY © Thomas Group, Inc All Rights Reserved How We Got Here GDAHC formed Future Directions Initiative  Steering Committee  Measurement and Reporting Expert Panel  Payment Expert Panel  Cost Savings Ad Hoc Committee  Public Reporting Ad Hoc Committee  Out patient / In Patient Ad Hoc Committee  Business Case Ad Hoc Committee Save Lives Save Dollars (SLSD) resulted Business Plan published Thomas Group hired to manage

14. PROPRIETARY © Thomas Group, Inc All Rights Reserved How We Got Here GDAHC formed Future Directions Initiative  Steering Committee  Measurement and Reporting Expert Panel  Payment Expert Panel  Cost Savings Ad Hoc Committee  Public Reporting Ad Hoc Committee  Out patient / In Patient Ad Hoc Committee  Business Case Ad Hoc Committee Save Lives Save Dollars (SLSD) resulted Business Plan published Thomas Group hired to manage

15. PROPRIETARY © Thomas Group, Inc All Rights Reserved Organizational Process GDAHC Board CFT 4 Measurements 5 Members CFT 3 Public Reporting 5 Members CFT 2 Differential Payment 5 Members CFT 1 Evidence Based Practice, Cost Savings & Quality 7 Members SLSD Steering Committee Results Improvement TEam (RITE) – 11 Members Generic Rx BRT 1BRT 2BRT 1BRT 2BRT 1BRT 2Diab. CFT – Cross Functional Team BRT – Barrier Removal Team Sub CFT 3 Sub CFT 4

16. PROPRIETARY © Thomas Group, Inc All Rights Reserved CFT Membership Industry M. Manning GM S. Peters Comerica  K. Kohn-Parrott  Daimler Chrysler  R. Lueders  DTE R. Turner-Bailey Ford Providers  J. Billi  U of M R. Frank Oakland Co Med Soc D. Muenk MSMS P. LaCasse Botsford M. Johnson Beaumont M. Henoch Oakwood Health Care  S. Grant  United Physicians T. Lundstrom - DMC Payor / HP B. Pai HAP G. Kipa BCBS K. Seitz BCN Z. Geyer-Sylvia MCare W. Alvin Care Choices J. Halman MCar e E. Tuller Care Choices Others M. Abbott Thomas Group D. Ebers GDAHC H. Lock Thomas Group J. Kerr GDAHC R. Robinson Thomas Group B. Hurd GDAHC H. Lock Thomas Group D. Ebers GDAHC CFT 1 – Evidence Based Practice, Cost Savings and Quality CFT 3 – Public Reporting CFT 4 – Measurements  Chairperson  Updated 11/15/05 CFT 2 – Differential Payment

17. Primary Care Initiative for a Healthier Michigan

18. Michigan Steps Up: Stakeholder Groups Business Healthcare Schools Faith-based Community

19. Mission The Primary Care Initiative for a Healthier Michigan is a statewide, broad-based group of key stakeholders and other interested parties convened to collaborate to improve the system of delivering prevention services and management of chronic disease and/or other conditions in primary care settings throughout Michigan.

20. Priority System Barriers Referral and Access to other Professionals/ Community Resources Access to a Comprehensive Patient Data Base (Health Record) Payment Structure/Reimbursement Multiple Guidelines (Work group co-chair – Marc Keshishian) Shift from Episodic Care to Health Promotion

21. Goals 1. The Primary Care Initiative (PCI) will endorse Michigan Quality Improvement Consortium (MQIC) as a central source for practice guidelines in Michigan. 2. The Primary Care Initiative and partners will facilitate the dissemination and implementation of MQIC guidelines to all primary care providers in Michigan. 1. Obtain MQIC collaboration and agreement to be the central source of practice guidelines in MI. 2. Secure agreement of payers and other stakeholders to support MQIC as the central source of practice guidelines 3. Identify a process for addressing input for and gaps in MQIC guidelines. 4. Identify a process for incentives to primary care providers to promote the use of MQIC guidelines. 5. Develop a single set of performance measures based on MQIC guidelines to be used for evaluation and reporting. 6. Educate primary care health professionals in MI about MQIC guidelines and facilitate their use. Objectives

22. Other Activities Interview with Robert Wood Johnson National Guideline Clearinghouse HAP Quality Expo BCBSM Provider Information Fairs Southfield, Port Huron, Saginaw