Managed Care - January 2009 - (Page 45)

PLAN WATCH Technology led to cooperation that led to success ellmark Blue Cross & Blue Shield saw dramatic improvement in the care and outcomes for 9,012 patients with diabetes as a result of its Collaboration on Quality program. The technology supplied by its vendor enabled the insurer to work with physicians and other providers in an intense way, according to Rick Miller, DO, a medical director at Wellmark. “It’s a unique opportunity to use clinical data as opposed to claims data and have the clinicians be in charge of the data,” says Miller. “And so we’ve got both clinical and financial alignments with the clinicians around a critical disease state: diabetes. When you’ve got that kind of alignment, the traditional butting of heads that occurs between health plans and clinicians kind of evaporates.” W As number of people getting tests soars Pre-program By end of program 73% 61% 45% 34% 23% 46% 85% 90% favorable outcomes rise 75% 59% 37% 23% 38% 76% Retinal exam Microalbumin exam Low-density lipoprotein exam HbA1c exam Blood pressure <140/80 HbA1c ≤ 8% LDL <130 mg/dl Source: “Clinician Access to Clinical Patient Data in Quality Improvement Program Dramatically Improves Outcomes of Diabetic Patients,” Wellmark Blue Cross & Blue Shield and MDdatacor, 2008 teams to “care opportunities” and provided a list of patients who needed help. Clinical targets were: • Blood pressure less than 140 systolic and less than 80 diastolic each visit • HbA1C less than 8 percent or a 1 percent unit decrease from previous measure • LDL less than130 mg/dl Of the 2,500 primary care physicians in Wellmark’s network, about 1,500 volunteered to participate. You could say there is an element of pay for performance because it costs the physicians something to do the extra work. The insurer has launched other programs to monitor screening levels and outcomes for hypertension, asthma, immunizations under age 2, and cancer. The company launched the hypertension program in 2007. Wellmark started immunizations, cancer screening, and asthma programs in 2008. Clinicians can earn up to $15,000 each if they achieve the highest level of performance for treatment in all those areas and prescribe more generics. They must also use electronic records and electronic prescribing. Preventive care Patients who are coming through the door are not the sole focus, Miller stresses. Emphasis is also placed on those patients in need of regular care for chronic conditions who are missing appointments. It’s getting those absentee patients in for care to manage the chronic illness that will lead to long-term health care savings, he says. “The program lost money in the first two years, but last year generated more savings JANUARY 2009 / MANAGED CARE 45

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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