Third Sino-U.S. Conference on Medical Professionalism Allan M. Korn M.D., FACP Blue Cross Blue...

Third Sino-U.S. Conference on Third Sino-U.S. Conference on Medical ProfessionalismMedical ProfessionalismThird Sino-U.S. Conference on Third Sino-U.S. Conference on Medical ProfessionalismMedical Professionalism

Allan M. Korn M.D., FACPAllan M. Korn M.D., FACP

Blue Cross Blue Shield AssociationBlue Cross Blue Shield Association

Happier DoctorsHappier DoctorsHealthier PatientsHealthier Patients

2© 2008 Blue Cross Blue Shield Association

Happier Doctors, Healthier PatientsHappier Doctors, Healthier Patients

● Evidence Based Care

● Better Outcomes

● Meaningful doctor-patient relationship

● Durable doctor-patient relationship

● Trusting doctor-patient relationship

● Much more pride in medical practice

● The basis for a harmonious society


Medical ProfessionalismMedical Professionalism

● Results in more satisfaction with clinical practice

● Results in patients trusting you while engaging in their own care

● Nurtures trust between doctors, hospitals and patients

● Meets the needs of society with personal pride and scientific accuracy

● Opens minds, opens hearts, and demands integrity in all that is done for patients, peers, and nation.


Hospital Rewards accelerate quality improvementHospital Rewards accelerate quality improvement

New England Journal of Medicine February 2007

“Public Reporting and Pay for Performance in Hospital Quality Improvement”; New England Journal of Medicine; February 2007; Peter K. Lindenauer, M.D., M.Sc.; Denise Remus, Ph.D., R.N.; Sheila Roman, M.D., M.P.H.; Michael B. Rothberg, M.D., M.P.H.; Evan M. Benjamin, M.D.; Allen Ma, Ph.D.; and Dale W. Bratzler, D.O., M.P.H.

● Rewarded hospitals showed greater improvement in all composite measures of quality

● Rewards associated with improvements above public reporting ranging from 2.6 to 4.1% over the 2-year study period


CMS/Premier HQID Project Participants Appropriate Care Score: Trend of Quarterly Median (5th Decile) by Clinical Focus Area

October 1, 2003 - June 30, 2007 (Year 1 and Year 2 Final Data, and Year 3 and Year 4 Preliminary)

70

.7%

30

.0%

22

.3%

34

.7%

27

.8%

72

.7%

34

.1%

28

.0%

43

.6%

34

.1%

75

.7%

45

.8%

34

.7%

50

.0%

41

.2%

80

.0%

48

.7%

39

.0%

53

.8%

53

.6%

80

.9%

68

.5%

43

.8%

58

.5% 63

.6%

80

.6%

77

.3%

44

.3%

62

.6%

72

.1%

85

.0%

82

.9%

50

.7%

64

.6%

78

.6%

87

.0%

84

.2%

53

.8%

68

.0%

81

.3%8

7.8

%

86

.6%

60

.9%

72

.3%

84

.7%

88

.2%

91

.9%

62

.8%

75

.8%

85

.2%

89

.6%

93

.3%

67

.6%

78

.1%

89

.5%

88

.6%

91

.7%

70

.3%

78

.3%

87

.2%

90

.0%

91

.7%

86

.3%

79

.2%

90

.0%

90

.0%

93

.3%

86

.9%

82

.5%

86

.4%92

.3%

94.3

%

90.1

%

85.2

%

86.4

%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

AMI CABG PN HF Hip and Knee

Clinical Focus Area

4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06 4Q06 1Q07 2Q07

More Patients Receive Evidence-based Care More Patients Receive Evidence-based Care

Avg. improvement in all clinical areas (15 quarters)

52.6%Clinical Area

Percent Improvement

AMI (Heart Attack)

21.6%

CABG (Coronary Bypass)

64.3%

Pneumonia 67.8%

Heart Failure 50.5%

Hip & Knee 58.6%

Ap

pro

pri

ate

Ca

re S

co

re

Source: Center for Medicare & Medicaid and Premier Inc. Hospital Quality Improvement Demonstration Project (HQID)

http://www.premierinc.com/quality-safety/tools-services/p4p/hqi/index.jsp


Government sponsored programs Government sponsored programs

Hospital Costs for Pneumonia Patients

6,000

8,000

10,000

0 to 50% 51 to 99% 100%A

vera

ge H

ospi

tal C

osts

Study demonstrates that when evidence-based care is reliably delivered, quality is higher and costs are lower (over 1.1 million patients).

Mortality Rate for CABG Patients (%)

0%

2%

4%

6%

0 to 49% 50 to 74% 75-100%

Mor

talit

y R

ate

(%)

Patient Process Measure Patient Process Measure

Study finds higher reliable care yields lower mortality rates for heart bypass surgery patients

Study finds higher reliable care yields lower hospital costs for patients with pneumonia

Source: Center for Medicare & Medicaid and Premier Inc. Hospital Quality Improvement Demonstration Project (HQID)


Findings from Government sponsored Findings from Government sponsored programs programs

● Financial incentives combined with public reporting of transparent data can drive significant improvement in quality

– Hospitals held the gains and continued to improve

● More patients are reliably receiving evidenced-based care

● Improved quality is associated with saving lives and reducing costs


Designation for quality recognition in physician directories, award certificates for office display, etc.

Recognition

Aligning incentives is a key driver for successful collaboration.

Physician Specialist IncentivesPhysician Specialist Incentives

Integration of American Board of Internal Medicine Practice Improvement Modules, or

Blue Cross Blue Shield quality based recognition programs, or

Special recommendations to patients to seek physicians and hospitals which have achieved high-quality, evidence-based care.

Reward


Evidence: Recognized physicians have Evidence: Recognized physicians have higher quality results!higher quality results!

Study 1 examined routine screening for a variety of patients:– Cancer screening

– Routine laboratory screening for diabetics

– Routine laboratory screening for heart disease patients

– Routine laboratory screening for hypertensive patients

Study 2 examined several dimensions of diabetic care:– Routine laboratory screening

– Eye exams

In two separate studies, it was demonstrated that recognized physicians score higher at essential elements of patient care.


When Primary Care Doctors Treat Patients… When Primary Care Doctors Treat Patients…

● Chronic diseases receive better care – Patients with congestive heart failure had 35% fewer hospital days;

– Patients with diabetes had significant reductions in cardiovascular risk;

– Asthma and diabetes patients were more likely to receive appropriate therapy.

● Access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially.

● If every American had access to comprehensive primary care, national health care expenditures would drop by 5.6% -- equal to national savings of at least $67 billion per year.


The Primary Care ModelThe Primary Care Model

● Trusted personal physician● Physician who provides, manages and facilitates

care● Care is coordinated or integrated across

healthcare system● More accessible practice with increased hours

and easier scheduling

● Enhanced payment that recognizes the added value of delivering care through the PCMH model

● Assistance to practices seeking transformation ● Support to practices adopting HIT for QI

Patient Personal Physician


The Primary Care ModelThe Primary Care Model

Changes in Clinician Incentives

Fee For Service• Fee for service

• Prospective payment

• Pay for outcomes

Blended Payment Improved Patient InteractionBetter Work Environment

• Team effort

• Increased responsibility for admin and clinicians

• More time for patients

• Better communication and access

• Case management

Personal Physician


Financial incentives lead to meaningful Financial incentives lead to meaningful outcomes improvements in primary careoutcomes improvements in primary care

0

10

20

30

40

50

60

70

80

90

100

Blood Pressure(Control)

HbA1c (Control) LDL (Control)

Clinical Measure

% C

om

pli

ance

w/

Nat

ion

al G

uid

elin

es

Jan-07

Dec-07


Sending the right message to physicians with Sending the right message to physicians with financial incentivesfinancial incentives

How do we provide the right incentives for physicians to deliver high quality, patient-centric, efficient care?

Problems with productivitySalarySalarySalarySalary

Problems with overuseFee-for-serviceFee-for-serviceFee-for-serviceFee-for-service

Problems with underuseCapitationCapitationCapitationCapitation

Problems with ignoring what’s not attached to additional paymentPay-for-QualityPay-for-QualityPay-for-QualityPay-for-Quality


Blue Distinction raises the level of care delivered across the country by focusing on evidence-based quality and outcomes that are reinforced through national incentives

Physician Controlled, Evidence Based

Blue Distinction VisionBlue Distinction Vision


National PresenceNational Presence

Blues achieve national presence, with over 800 Blue Distinction designations spanning 45 states

WA

OR

CA

AK

HI

TX

NMAZ

UTNV

ID

MT ND

SD

NE

WY

COKS

OKAR

LA

MSAL GA

FL

SC

NCTN

KYMO

IL

IA

MN

WIMI

INOH

WV VA

PA

NY

MEVT

NH

RIMA

CTNJDEMD

PR

Blue Distinction Centers for Cardiac CareSM

Blue Distinction Centers for Bariatric SurgerySM

Blue Distinction Centersfor TransplantsSM

Blue Distinction Centers Complex & Rare CancersSM


Outcomes from Clinical DataOutcomes from Clinical Data Inpatient MortalityInpatient Mortality

Cardiac BDCs demonstrate better overall outcomes

Inpatient Mortality Post Heart Attack

Statistically significant difference

Inpatient Mortality Post Bypass Surgery

*Risk-adjustedSource: 2005-06 Hospital RFI Data Submitted to the Blue Cross and Blue Shield Association

7%

9%

3%2%

Mean Mean*

BDC Other


Outcomes from Clinical DataOutcomes from Clinical Data

Blue Distinction Centers demonstrates better, more consistent overall outcomes

Source: Hospital RFI Data Submitted to the Blue Cross and Blue Shield Association

Inpatient MortalityPost Heart Attack

Mortality Rate One-year Post Heart Transplant

BDC Other

11%

19%

Mean

7% 9%

Mean


Happier DoctorsHappier Doctors

● Reward from medical practice: pride and peer approval

● Reward from payers: higher income based on better patient outcomes

● Reward from the nation: admiration and gratitude

● Reward from international colleagues: acceptance and integration of joint programs and initiatives


Healthier PatientsHealthier Patients

● Better clinical outcomes

● Consistent management of chronic illness

● Trust that there is a caring relationship with a healer

● Belief that someone with special knowledge cares for him or her

● Safety from ineffective or unnecessary care

● Security for families and individuals


Harmonious SocietyHarmonious Society

● Doctors and professional societies have aligned incentives

● Doctors, hospitals, and patients have aligned incentives

● Ministries and all healthcare stakeholders have aligned incentives

● Chinese patients deserve optimal health and productivity.

THE INCENTIVE: Doing the right thing right, the first time, based on the best available clinical evidence. This creates the opportunity for medical and financial security.


Contact InformationContact Information

Allan M. Korn, M.D., FACP

Senior Vice President Clinical Affairs

and Chief Medical Officer

Blue Cross Blue Shield Association

225 North Michigan Avenue

Chicago, Illinois 60601

312.297.6840

[email protected]

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Third Sino-U.S. Conference on Medical Professionalism Allan M. Korn M.D., FACP Blue Cross Blue...

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