1. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health AIM for Excellence – A collaborative initiative to promote health care quality in the outpatient setting

2. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health AIM Project Collaborators Dallas-Fort Worth Business Group on Health American Airlines UnitedHealthcare Primary Care Physicians in N. TX

3. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health What “AIM” Stands For: A - Awareness I - Improvement M - Measurement

4. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Coalition of 120 employers (55 Corporate & 65 Allied) Represents over 800,000 DFW-based employees and their dependents Members spend >$2.1 billion on employee health care in DFW Member of Texas Business Group on Health and National Business Coalition on Health Mission:  Promote health care quality, accountability and cost effectiveness  Empower employers and their employees to make informed health care purchase decisions DFW Business Group on Health

5. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Employs approximately 22,000 workers in DFW area Purchases health care services for over 55,000 DFW-based employees and their dependents Spends over $15 million/year on health care in DFW Offers worksite wellness, health promotion and disease management programs to employees Uses UnitedHealthcare as its third party administrator for self- insured claims Board Member of Dallas-Fort Worth Business Group on Health American Airlines

6. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Second largest health insurer in Texas Claims administrator for American Airlines’ self-insured plans Evaluates physicians against evidence-based medical quality standards Provides performance report cards to individual physicians Recently rolled out UnitedHealth Premium Program in 20 markets (including Austin, Dallas, Houston, San Antonio) Premium designation based on quality and efficiency standards United HealthCare

7. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Project Goals Ensure quality care for AA employees with heart disease, stroke and diabetes Evaluate purchaser influence on clinical practices

8. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Physician Participants Test Group: PCPs in UHC’s N.TX network who treated >100 DFW-based AA employees and/or dependents in 2004 Control Group: All PCPs in UHC’s N.TX network

9. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Performance Measures* Heart Disease & Stroke: –LDL Cholesterol –Beta Blockers –ACE Inhibitors Diabetes: –HgA1c –LDL Cholesterol * Evidence-based Medical standards

10. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Physician Task Force Ad hoc committee of 5 Aim physicians Provide feedback to project leaders regarding physician communications Provide physician to physician advocacy for proactive participation in project Review aggregate performance data and help identify opportunities for improvement

11. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health AIM Interventions Clinical Practice Toolkit: Diabetes & CAD educational materials; EBM checklist; Chart flow-sheet; Resources list CME Workshops Quarterly Teleconferences Performance Feedback Personal Visits by UHC Medical Director

12. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health AIM Baseline Measures (July 2004 – June 2005) AIM FPAIM IMControl FPControl IM HEDIS 2004 LDL-CAD96%91% 93%82% HgA1C94% 92% 87% LDL-Diabetes91%85%87% 91%

13. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health AIM Baseline Measures

14. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Opportunities For Improvement Number of Aim FP < 85% Implementation Number of Aim IM < 85% Implementation LDL-CAD5 of 63 (8%)4 of 21 (20%) HgA1C9 of 77 (12%)2 of 21 (10%) LDL-Diabetes * 16 of 77 (21%)9 of 21 (43%) * Biggest opportunity for improvement

15. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Physician Recognition Framed plaque recognizing physician as AIM participant AIM participants recognized on DFWBGH and AA websites* “Star” next to physician names in UHC Directory AIM participants names included in Project Report* * With AIM participant’s permission

16. AIM Delivering Quality Outpatient Care For Excellence © 2005 Dallas-Fort Worth Business Group on Health Expected Outcomes Better quality care for AA employees with diabetes and heart disease Stronger relationship between DFW employers and physicians Recognition and promotion of AIM physicians An effective model for similar employer-led QI initiatives in other communities