Managed Care - January 2009 - (Page 46)

PLAN WATCH than costs and by conservative estimates generated approximately a 2:1 return on investment,” says Miller. “That return should increase over time as our members stay healthy, the data matures, and we can quantify the value of the more recently added clinical conditions.” The pharmacy incentive measures a clinician’s overall use of generic medications. “The measure is designed to encourage higher utilization of generic medications without reducing clinical efficacy,” says Miller. “For this reason, we take the average utilization of generic medications in our network and create incentives for clinicians to prescribe generics at a rate that starts around average. As utilization goes up from there, the awards increase. So a clinician could use generics at Did you miss? Martin Sepulveda, MD Blaine Bos Reed Tuckson, MD Bruce Bagley, MD Barbara Starfield, MD Emad Rizk, MD James Schibanoff, MD We don’t run our Question & Answer feature every month. That’s because we don’t talk to just anybody. a slightly lower rate than average (60 percent) and still receive the first level of award. The highest level of award starts at 70 percent, and as new generics become available that number could go higher.” This too is included in the $15,000 award mentioned above. “We are simply trying to get clinicians to be efficient and use equally effective generics at a level comparable to, or better than, their peers,” says Miller. The health plan’s clinical staff has monthly meetings with doctors in which attendees discuss how MDdatacor has worked so far and how the program can be improved. “Collaboration with clinicians has not been done to this degree before at Wellmark,” says Miller. “I am not saying that we haven’t collaborated, but this is groundbreaking and we plan to do a lot more of it. If you can find a way to improve health and save money that is valued by the clinicians, you have found something extraordinary and we think we have.” Additional support Physicians involved with the MDdatacor program are now getting additional support for their patients in a new way. “We have programs for case management, disease management, wellness, and a number of other member support programs,” says Miller. “We’re right now working with groups of physicians so that these services can be ordered by and directed by the clinician, as opposed to more traditional DM programs that provide services independent of the clinician’s office.” Drawing interest The diabetes program has been emulated mostly by other Blues plans. “The North Dakota Blues plan adopted MDdatacor,” says Miller. “They use it a little differently in support of the medical home concept. Nebraska is bringing up a program that’s very similar to ours. Massachusetts has a demonstration project using it, and I understand that the Blue Cross plan in the D.C. area is starting a pilot.” MC Read these interviews at www.managedcaremag.com Just search for the subject’s last name. All of our past articles are free on the Web. 46 MANAGED CARE / JANUARY 2009 http://www.managedcaremag.com http://www.managedcaremag.com

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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