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

Membership

Voting MembersNon-voting Corporate MembersNon-voting Individuals

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

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

GeographyGeography

MarylandVirginiaDistrict of Columbia

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

Data

Health Management SurveyMembership InformationeValue8

Education

Education Committee– Disparities in Health Care

Health Management Committee– Strategic Health Management

Legislative Committee– Legislative Updates

Objective Forum

MABGH History– (Maryland Health Care Coalition)

Practice of Hearing Both Sides

eValue8: eValue8: A Coordinated Health Plan A Coordinated Health Plan

Quality Improvement ProcessQuality Improvement Process

Premises:Premises:

MCOs Should Remain Employers “Lieutenants”

The Loudest “Plurality” Drives the System

Improving Processes Will Lower Cost

“Rising Tide Raises all Healthcare”

MethodMethod

1. Consolidate and Articulate Expectations: Example eValue8 Expectations:

– Provider differentiation and reward

– Clinical Guideline for Alcohol

– Provider Education on CVD Risk Factors

MethodMethod

2. Measure Performance Against Expectations

Objectively as Possible

National Benchmarks of the “Possible”

MethodMethod

3. Open, 2-way Discussion of Results: WITH CLINICAL DECISION-MAKERS

eValue8 Scores

eValue8 Process

“How can we help you?”

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)

MethodMethod

4. Identify and Agree on Targets for Improvement

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

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

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

Local Results 2003Local Results 2003

Alcohol Use Screening/Treatment

0 10 20 30 40 50 60

Aetna

CareFirst

Kaiser

Optimum

Maximum

Local Results 2004Local Results 2004

Alcohol Use Screening / Treatment

0 20 40 60 80 100

Aetna

CFBCBS

Kaiser

MAMSI

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

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

HIT Driving HIT: 2005HIT Driving HIT: 2005

Incentives for HITPerformance Measurement

MHCCMHCC

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

MABGH SummaryMABGH Summary

Data Education Cooperative, objective forum Meetings and conferences; publications

NETWORKING– Voting Member-to-Voting Member – Members-to-Vendors

MHCCMHCC

The MidAtlantic Business The MidAtlantic Business Group on Health Group on Health

Working Together to Improve Working Together to Improve Healthcare ValueHealthcare Value

john.miller@mabgh.orgjohn.miller@mabgh.org301-552-4237301-552-4237