Managed Healthcare Executive - November 2008 - (Page 1)

{ FOR YOUR BENEFIT } Collaborative models fuel healthcare quality In light of the recent NCQA report, plans should consider adopting emerging collaboration models BY JULIE MILLER E Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at julie.miller@ advanstar.com liminating the weak links in delivery of evidence-based care by bringing them up to the level of the top performers could save as many as 88,000 lives per year, according to NCQA’s 2008 State of Healthcare Quality report, released last month. Imagine the combined student body of Penn State and Michigan State—that’s 88,000 people. A record 845 health plans reported their performance measures to NCQA, which is something the industry should be exceptionally proud of. It’s an indication of the growing earnestness among plans to achieve quality. According to Richard Snyder, MD, senior vice president of health services for Independence Blue Cross in Pennsylvania, collaboration at the patient-care level and at the plan level (yes, he does mean that local health plan competitors are collaborating with each other) has increased, all in the interest of quality. “There are very wide variations in performance, even if you look within a geography,” Dr. Snyder tells me. After reviewing speci c regional performance data, Pennsylvania plans get together regularly and discuss best practices to improve care for the area’s entire population, he says. Although they might be competitors, the plans have a business case for improving care among each other’s members as well as their own because members frequently turn over among plans. Turnover is inevitable, so increasing the pool of healthier members in the local market helps level the playing eld and reduces the burden of adverse selection somewhat. He says there’s really no value, competitive or otherwise, in not taking care of all the region’s members. “In our patient-centered medical home pilot, there are six plans that are participating,” Dr. Snyder says. “We sit in a room together and try to gure out how to improve the management of patients. That’s exciting to me that we’re not competing on the quality of care. We’re trying to improve the quality of care across all of our patients.” MEDICAL HOME Independence Blue’s patient-centered medical-home pilot includes 32 practices, 166 physicians and 220,000 patients. Dr. Snyder believes the model has obvious potential to prove itself through NCQA measures, among other things. For example, NCQA performance measures for mammograms and diabetic retinal eye exams have leveled o . With a medical-home team collaboration, those measures can improve through the application of patient registries that track care needs, case managers who coordinate services, and electronic medical records that keep primary care in the loop with specialists. The disconnect between specialists—for example, gynecologists who provide mammograms and ophthalmologists who provide retinal exams—and primary care is often the reason patients fail to complete those screenings or the reason why the measurements are impossible to track. “Patients are not reminded again and again until they get those tests, and we see those performance trends that initially started up, leveling o at a level that is just not acceptable,” Dr. Snyder says. He says the pilot has already shown improvement on process measures and believes it will prove its cost-e ectiveness and outcomes improvement within two or three years. MHE NOVEMBER 2008 1

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Managed Healthcare Executive - November 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Letter of the Law Affordable Access Economic Ripple Effect Hospitals &�Providers Technology Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - November 2008

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