1 an approach for caring for particular types of patients a presentation by chet burrell president...
TRANSCRIPT
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An Approach for Caring for Particular Types of Patients
A Presentation by Chet BurrellPresident and CEO
CareFirst BlueCross BlueShield
December 16, 2010
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
Participation
12 percentage points
upon enrollment
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* Incentives and reward increases apply to all medical services and exclude supplies and drugs.
PCMH: Designed to preserve and enhance PCPs’ ability to practice medicine the way they want to practice medicine –
while improving quality and reducing costs
12% fee schedule
increase
upon enrolling
12% fee schedule
increase
upon enrolling
New fees paid
for Care Plan
development
and follow-up
New fees paid
for Care Plan
development
and follow-up
Significant
rewards*
based on quality
and efficiency
Significant
rewards*
based on quality
and efficiency
Incentive IncentiveIncentive
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10 Essential Elements
1. Medical Care Panels are the central building blocks
2. Patients ‘attributed’ to panels
3. Calculating the illness burden score
4. Establishing global expected care costs and tracking experience
5. Referrals to specialists: patient authorization and consent
6. Enhanced focus on patients with chronic illnesses – care plans / teams
7. An online member health record (MHR)
8. Measuring quality of care
9. Annual settlement and calculation of incentive awards
10.Signing on and complying with program rules
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Focusing on High-Risk Patients
Targeted
Group
Wellness/Illness Burden Pyramid – PCMH & Employers
Example PCMH Panel Experience Example Employer ExperiencePercent of Population
Percent of Cost
3% 35%
7% 25%
21% 25%
19% 9%
50% 6%
Percent of Population
Percent of Cost
2% 31%
9% 29%
22% 20%
17% 15%
50% 5%
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