community collaborative to impact cost and quality mary ellen benzik rick hensley michpha september...

Community Collaborative to Impact Cost and Quality

Mary Ellen BenzikRick Hensley

MichPHA September 22,2011

Battle Creek, Calhoun County, Michigan

“All growth is a leap in the dark—a spontaneous, unpremeditated act without benefit of experience.” –Henry Miller

2006 Integrated Health Partners

Opportunity Knocks

Tom Simmer, MD, VPMA, CMO, Blue Cross Blue Shield of Michigan (BCBSM) – Challenge• “We want you to look at the Wagner Model”• “Start a registry”• Development of conceptual framework for the

CCPTH

“Ability has nothing to do with opportunity.” –Napoleon Bonaparte

Calhoun County Pathways to Health Framework

Patient

Community Partners

Consumers

Physicians

Identify barriers to care

Transform the delivery system of care

Remove barriers to care related to benefit design

Transform the community care system (added in 2009) Employers/

Health Plans

Special Request to the WK Kellogg Foundation

IHI Learning Collaborative Model -

“I think you should have a collaborative.”–Mike Hindmarsh

Physician Learning Collaborative

• Year long commitment to improving quality of care – Team based redesign – Commitment to measurement – Public reporting of data

• Three collaboratives to date involving 66 teams – half from Calhoun County

• Learning Collaborative #4 – 13 additional teams – 75% of primary care providers in Calhoun County

Evolution of IHP Learning Collaboratives

Evolution of IHP Learning Collaborative

• Learning Collaborative #1 – Diabetes focus for 10 teams

• Learning Collaborative #2 – Expansion of number of teams to 26

• Learning Collaborative #3 – Broader chronic disease focus – Expansion to prevention – Introduction of efficiency metrics

• Learning Collaborative #4 – Expansion to the late adopters– Attention to care management

Collaborative MeasurementsLearning Collaborative #3

Focused chronic conditions Asthma Childhood Obesity Chronic Obstructive Pulmonary Disease Diabetes Hypertension

Preventive Services Breast Cancer Screening Colorectal Cancer Screening Childhood Immunizations Adolescent Well Visit

• Efficiency Measure

Diabetic BP <130/80

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Baseline 12/31/06 12/31/07 6/30/08 12/31/08 6/30/09 12/31/09 06/30/10

LC Phys LC Offices Non LC Offices

LC1 LC2

Learning Collaborative #1 begins


LC Phys Learning Collaborative Physicians LC Offices Learning Collaborative Offices Non LC offices Offices who have not participated

in Learning Collaboratives

Diabetic Self Management Goal

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Baseline 12/31/06 12/31/07 12/31/08 12/31/09


LC1 LC2

Learning

Collaborative #1 begins Learning Collaborative #2 begins

LC Phys Learning Collaborative Physicians LC Offices Learning Collaborative Offices Non LC offices Offices who have not participated in Learning Collaboratives

Diabetic Depression Screening

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

Baseline 12/31/06 12/31/07 12/31/08 12/31/09


LC1 LC2Learning Collaborative

#1 begins

Learning Collaborative

#2 begins


Diabetic HbA1c <7

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

Baseline 12/31/06 12/31/07 12/31/08 12/31/09


LC1 LC2




Expanding Learning Collaboratives to the Community

Care Management Collaborative Employer Learning Collaborative

Care Management Collaborative #1 “Fortuitous learning from abysmal failure”

• Community partners with physicians to address the transitions of care

• Successes – Brought community partners into the room together – Began improving transitions and care experience one

patient at a time • Challenges

– Cross organizational work more difficult than imagined – Metrics and pilot – population difficult to quantify

Care Management Collaborative #2 “Like the phoenix arising from the ashes”

• Care Management Collaborative 2010 - current - Five pillars

• Assessing and meeting the needs of our patients• Communications• Transitions of care• Referral process• Medication reconciliation

Employer Learning Collaborative

Employer Collaborative

Phase I – Healthy Employer Summit

• January 2009

• In cooperation with Regional Health Alliance

• Half day meeting– Dee Edington– Dr. Jack Mahoney– Local success stories

• 90 participants, 40 employers


• Phase II – Employer Collaborative• Leverage structure of physician collaborative

– Two day opening session – March 22 - 23– Two one day sessions later in the year– Monthly conference calls

• Zero Trend – Dee Edington served as the framework

• Moving networking and best practice sharing to ACTION!


Phase II – Employer Collaborative• Leverage structure of physician collaborative


– Zero Trend – Dee Edington served as the framework



Purpose: To further improve the health of the community and to bend the health care cost trend by encouraging local employers to improve employee health management programs at each respective employer

Framework for Employer Learning Collaborative

VBID aligned with multiple pillarsSenior LeadershipSelf Leadership Reward Behavior Quality Assurance

CITY OF BATTLE CREEKCITY OF BATTLE CREEKThe Pathway to HealthThe Pathway to Health

Rick Hensley, ARM, SPHRRick Hensley, ARM, SPHR

Risk ManagerRisk Manager

History of Health CareHistory of Health Care

• 1990 Moved program to BCBSM in 1990 Moved program to BCBSM in response to rising costresponse to rising cost

• 2004 Moved program into BCBSM Self-2004 Moved program into BCBSM Self-Funded PlanFunded Plan

• 2008 Total Program Cost $7,238,1882008 Total Program Cost $7,238,188

• Cost Sharing for same period $845,116Cost Sharing for same period $845,116


• 1990 Initiated $2.00 Pharmacy Co-Pay1990 Initiated $2.00 Pharmacy Co-Pay

• 1995 Increased Phar Co-Pay to $5.001995 Increased Phar Co-Pay to $5.00

• 1996 First Employee Premium 1996 First Employee Premium Contribution set at $2.00 per weekContribution set at $2.00 per week

• Current Employee Contributions range Current Employee Contributions range from $12.70 to $25.00 per weekfrom $12.70 to $25.00 per week

• 2007 Pharmacy Co-Pay set at 15/302007 Pharmacy Co-Pay set at 15/30

• 2010 RX Initiative2010 RX Initiative


Disease management services offered by carrier without the use of a Value Disease management services offered by carrier without the use of a Value Based Benefit DesignBased Benefit Design

CHRONIC CONDITIONS MATRIXCHRONIC CONDITIONS MATRIX COUNT OF MEMBERSCOUNT OF MEMBERS *TOTAL COST *TOTAL COST

COPDCOPD 11 $4,310$4,310

CADCAD 2828 $364,329$364,329

CAD and COPDCAD and COPD 22 $34,676$34,676

DIABETESDIABETES 6969 $421,670$421,670

DIABETESDIABETES and COPD and COPD 11 $3,941$3,941

DIABETESDIABETES and CAD and CAD 1313 $88,923$88,923

DIABETESDIABETES, CAD AND COPD, CAD AND COPD 11 $22,584$22,584

CHFCHF 22 $10,294$10,294

CHF and CADCHF and CAD 11 $23,124$23,124

CHF and CHF and DIABETESDIABETES 11 $37,957$37,957

CHF, CHF, DIABETES DIABETES and CADand CAD 11 $4,238$4,238

ASTHMAASTHMA 8282 $259,411$259,411

ASTHMA and COPDASTHMA and COPD 77 $22,470$22,470

ASTHMA and CADASTHMA and CAD 33 $76,909$76,909

ASTHMA, CAD and COPDASTHMA, CAD and COPD 11 $27,779$27,779

ASTHMA and ASTHMA and DIABETESDIABETES 99 $90,048$90,048

ASTHMA, ASTHMA, DIABETESDIABETES and COPD and COPD 22 $19,721$19,721

ASTHMA,ASTHMA, DIABETES DIABETES and CAD and CAD 22 $53,676$53,676

ASTHMA and CHFASTHMA and CHF 11 $15,345$15,345

ASTHMA, CHFand ASTHMA, CHFand DIABETESDIABETES 11 $11,303$11,303

ASTHMA, CHF, ASTHMA, CHF, DIABETESDIABETES and CAD and CAD 11 $137,781$137,781

TOTALTOTAL 229229 $1,730,488$1,730,488

City of Battle Creek City of Battle Creek VBID Design and Planned ImplementationVBID Design and Planned Implementation

• Effective July 1, 2009Effective July 1, 2009

• Diabetes Focused,Diabetes Focused,

• VBID will overlay Rather than Replace the VBID will overlay Rather than Replace the existing BCBSM benefit plans. VBID plan existing BCBSM benefit plans. VBID plan will eliminate member cost-sharing for will eliminate member cost-sharing for diabetic members who participate in diabetic members who participate in required wellness and Care management required wellness and Care management activities.activities.

City of Battle Creek City of Battle Creek VBID Design and Planned ImplementationVBID Design and Planned Implementation

• Removes Financial barriersRemoves Financial barriers

• Improve enrollment and engagement in Improve enrollment and engagement in Blue Health ConnectionBlue Health Connection

• Increase use of high value services (i.e., Increase use of high value services (i.e., diabetes prevention and treatment)diabetes prevention and treatment)

• End State: Member has the ability to End State: Member has the ability to successfully self manage their conditionsuccessfully self manage their condition

Book of Business

DIABETES PopulationNo.

CompliantRate Rate

HbA1c Testing 79 66 83.5% 73.1%

Microalbuminuria Testing 79 37 46.8% 34.8%

Dilated Retinal Exam 79 32 40.5% 29.6%

Lipid Testing 79 65 82.3% 70.4%

ACE or ARB (& treated for nephropathy) 4 4 100.0% 69.5%

Lipid Lowering Agent (& over 50) 46 26 56.5% 61.0%

CORONARY ARTERY DISEASE (CAD)

Lipid Testing 23 19 82.6% 72.3%

Lipid Lowering Agent 23 9 39.1% 68.0%

Beta-Blocker 23 13 56.5% 56.3%

ACE or ARB (with HF, Diabetes, or Hypertension) 17 7 41.2% 63.7%

Beta-Blocker (with Myocardial Infarction) 19 12 63.2% 82.8%

HEART FAILURE (HF)

Lipid Testing 8 8 100.0% 62.2%

ACE ARB 8 6 75.0% 64.5%

ASTHMA

Asthma Controller Medication 63 41 65.1% 50.5%

Clinical Quality Indicators By Disease

City of Battle CreekCity of Battle Creek

• WHAT’S NEXTWHAT’S NEXT

The Kellogg Experience

• 12/14 of the chronic disease metrics are significantly higher than the book of business

• Those that engaged in VBID had more co morbidities

Initially, higher ER and hospital admissions in engaged participants

Steeper declining trend, with subsequent lower rates than unengaged at year end

Data for Quality Improvement

Sometimes gathering data can

bring new and

surprising knowledge!

Evaluation of the Calhoun County Experience

• Case studies – Patient Centered Primary Care Collaborative White

Papers (PC-PCC) • PCMH Performance Metrics for Employers• PCMH and VBBD

– Advisory Board – RWJF Improving Chronic Illness Care website

• Robert Wood Johnson Foundation Analytic Grant – Impact of PCMH – Impact and synergy of VBBD

• Kellogg Company with BCBSM

Impact of Patient Centered Medical Home (PCMH)

Diabetic Blood Pressure <130/80

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

12/31/08 6/30/09 12/31/09 6/30/10 12/31/10

2009 PCMH 2010 PCMH 2009 & 2010 PCMH Non PCMH

Impact of PCMH Diabetic HbA1c <7

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

12/31/08 6/30/09 12/31/09 6/30/10 12/31/10


Impact of PCMH Diabetic Self Management Goal

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

12/31/08 6/30/09 12/31/09 6/30/10 12/31/10


Flexibility in Design Changes• Failed grant applications

Robert Wood Johnson · Aligning Forces for Quality · Vulnerable Populations Community Funding Partners

Trinity Call to Care Grant · Two cycle failures

• Ineffective structure for the Physician Advisory Council Establish relationship with Mike Hindmarsh, Hindsight

Healthcare Strategies with funding from leadership team

• Redesign of the Employer Collaborative • Care Management Collaborative – “Abysmal Failure”

But – It’s the Coolest Thing We’ve Ever Done!

Mary Ellen Benzik, MD269- [email protected]

Never doubt that a small group of thoughtful, committed Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that citizens can change the world; indeed, it's the only thing that ever does” ever does” Margaret Mead Margaret Mead

community collaborative to impact cost and quality mary ellen benzik rick hensley michpha september...

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