Blues Steps Up Collaborative Programs

September 1, 2006
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DETROIT — Blue Cross Blue Shield of Michigan has been working on a large scale partnership with physician groups and hospitals in the hopes of improving the quality and efficiency of health care in Michigan.

The cooperative effort, known as Value Partnerships, has doctors and hospitals working hand-in-hand to identify the most effective processes and treatments. It represents an “unprecedented” level of cooperation among physicians, physician groups, hospitals and the Michigan Blues, said Daniel Loepp, president and CEO of the Blues.

Loop said bottom line results will be an enhanced quality of care for patients, and significant dollars saved for businesses and individual health care purchasers.

The collaborative Value Partnerships program includes eight different initiatives that promote “partnering for value.” The programs are expected to affect more than 900,000 Michigan patients visiting their primary care physician or a specialist physician, and more than 100,000 patients undergoing certain major surgeries or procedures.

Thomas Simmer, M.D., the Blues chief medical officer, said, typically, it’s the physicians who recognize areas of care that need improvement and then take their concerns to Blue Cross Blue Shield.

“We fund them for the cost of performing the intervention, getting the software and meeting and collecting the data, and they work on improving the care they give,” Simmer explained. “The physicians know what the issues are in delivering care, and then we help them engage in measurement of the outcomes to show that they made a difference.”

The five most recently established physician collaborations are in the areas of angioplasty, cardiac/thoracic surgery, general and vascular surgery, bariatric surgery and breast cancer treatment.

“We’re just trying to provide the environment and the rewards system and the covering of costs, so people whose primary mission is delivering care can get together and turn good care into great care,” Simmer said.

“We’ve had great relationships with physicians in West Michigan as well as east Michigan in participating with this.”

Virtually all hospitals in Michigan do some partnering for value because it’s part of Blue Cross Blue Shield’s participating hospital agreement with them, Simmer said

“Under the contract, there’s a certain amount of money that goes to hospitals to reward performance. We have been paying $30 million to $40 million annually in rewards to hospitals for seven years.”

In the past, rewards were handed out based on categories such as quality, customer satisfaction, utilization and community efforts, he noted. Those categories have changed over time, and what’s expected of hospitals to receive rewards has evolved, as well. As hospitals meet program goals, new goals are set to raise the bar on quality.

“One of the reasons why the program has received recognition is that in Michigan it created sort of the readiness of the hospitals to work together under the leadership of the Michigan Health & Hospital Association to really start to achieve some improvements in quality that have everybody in the country taking notice.”

In April, for example, the MHA Keystone Center for Patient Safety & Quality launched a partnership with the Blues, hospitals and doctors to reduce the incidence of hospital-acquired infections in intensive care units. The more than 70 Michigan hospitals involved successfully reduced to zero the median number of blood stream infections caused by hospitalizations in ICUs, Simmer said.

“They’ve estimated that over two years, the program has saved more than $170 million, over 80,000 ICU days and over 1,700 human lives,” he added. “They’re doing amazing work, and it means that in this state, there is just a greater preparedness and readiness of hospitals to work together and achieve great things. We’re very eager to reward their efforts.” 

The Blues first physician incentive program began operating in 2005 with 10 physician groups representing 1,500 physicians across 33 Michigan counties. The goal was to encourage physician groups to more effectively and proactively manage patients with chronic illness.

The physician groups were rewarded for implementing programs that boost the quality of health care and were further rewarded for dispensing generic drugs whenever possible.

According to Blue Cross, during 2005 the generic dispensing rate for participating groups increased 3 percent, yielding an estimated $7 million in drug savings.

“When these doctors are improving care, they are not just improving care for Blue Cross members; they’re improving care for everybody — because, frankly, doctors aren’t thinking about the insurance. They’re thinking about what the patient needs,” Simmer remarked.   

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