Managed Care - January 2009 - (Page 44)

PLAN WATCH Empowered Physicians Are Key To Diabetes Program’s Success Wellmark Blue Cross & Blue Shield finds that technology can enhance doctor buy-in with dramatic results By Frank Diamond “We caught the attention of the provider community,” says Rick Miller, DO, a Wellmark medical director. The company’s diabetes program rewards doctors. nsurers discovered long ago that tying physician performance to extra income is pretty effective for improving outcomes and controlling costs. One health plan in the Midwest finds that giving clinicians power can also go a long way to improving medical services. Wellmark Blue Cross & Blue Shield, with more than 2 million members in Iowa and South Dakota, launched a diabetes program that shows dramatic improvement in clinical process measures as well as outcomes. Before the launch of Collaboration on Quality in 2006, only 46 percent of the 9,012 diabetic members in a study group received an annual HbA1C test. That jumped to 90 percent by the end of the program. The percentage of patients with an HbA1C level below 8 rose from 37 to 75. I Attracting physicians Wellmark likes to speak of its collaboration with physicians, and with good reason, says Rick Miller, DO, a medical director at Wellmark. “We didn’t just build the thing and go out and say, ‘You will love it.’ The clinicians picked the conditions and the measures, and we even discussed rewards with them. They helped us pick the software we used with MDdatacor, the vendor we hired to do this. Doctors were involved every step of the way.” MDdatacor is a health information technology company. Miller continues: “I’ve been doing medical management for about 12 years now and I’ve done this for hospitals and clinic systems and health plans. In all the places I’ve been, I’ve always hit the same barrier. Improving quality is either perceived to cost money or in some cases even to erode the bottom line. So the ability to do this in a way that both improves the quality of care and improves the bottom line, that’s the magic combination, and I’ve not seen this degree of improvement on such a wide scale ever before. When I tell people about this they are really amazed and they have an element of disbelief. These are hard numbers that we’re very confident are real.” A case study published by Wellmark and MDdatacor notes that “Wellmark realized that clinicians [physicians, nurse practitioners, others] may not have patient-level diabetes clinical information readily available. To add to the complexity, network clinicians used a variety of information technology systems and platforms, with many using paper records containing dictated progress notes and laboratory reports.” Wellmark hired MDdatacor in 2006 to cut through the cacophony and analyze what was going on with the plan’s diabetic population. “MDdatacor was a startup, and we said, these people are doing good things, let’s work with them, and let’s develop this,” says Miller. Wellmark and MDdatacor monitored patients from Jan. 1, 2006 to Feb. 28, 2007 and then again after physicians acted on the collected data between Jan. 1, 2007 and Feb. 28, 2008. Physicians or members of their staffs can view MDdatacor’s “care center” on the Web to see which patients require intervention. Lists of patients The care center includes “lists of patients who did not receive needed tests over the past year (such as blood pressure, HbA1C level, LDL, microalbumin, and retinal eye exams) and patients whose blood pressures, HbA1C levels, and LDL levels were higher than normal,” according to the case study. The system alerted clinicians and their care 44 MANAGED CARE / JANUARY 2009

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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