quadmed
DESCRIPTION
QuadMed. Innovations in Population Health Management – Delivered On-site. Raymond Zastrow, M.D . Chief Medical Officer QuadMed LLC West Allis, Wisconsin. We provide innovative, high-value health care solutions to companies, improving the overall health and productivity of their people. - PowerPoint PPT PresentationTRANSCRIPT
QuadMedInnovations in Population Health Management – Delivered On-site
Raymond Zastrow, M.D.Chief Medical OfficerQuadMed LLCWest Allis, Wisconsin
We provide innovative, high-value health care solutions to companies, improving the overall
health and productivity of their people.
QuadMed Clinic Locations
MillerCoors Brewing• Primary Care• Fitness Center• Occupational Med• Rehab
Briggs & StrattonHealth Center• Primary Care• Fitness Center• Occupational Med• Rehab
Northwestern MutualHealth Centers (2)•Primary Care•Occupational Med
Briggs & StrattonHealth CenterPoplar Bluff, MO• Primary Care• Rehab
QG Lomira, WI• Primary Care• EAP, AODA• Rehab • Fitness Center• Dental• Vision
QGWest Allis, WI• Primary Care• ENT• Orthopedics• Cardiology• Occupational Medicine• EAP, AODA• Rehab • Fitness Center• Dental• Vision Care
QG Sussex, WI• Primary Care• Surgery• EAP, AODA• Rehab • Fitness Center
QG Saratoga Springs, NY• Primary Care• EAP, AODA• Rehab • Fitness Center
QG Martinsburg, WV• Occupational Med• Primary Care• EAP / AODA• Fitness• Rehab
QuadMed Model• Onsite Employer-directed Primary
Care• Organized as PCMH• Self-funded / Self-administered• Value-based Benefit Design• Our Strategic Directives: Triple Aim /
Lean• Not Presently Serving Medicare /
Medicaid Populations
Care Improvement• Population Health Management
– From a Primary Care Platform• Proactive – Across the Care
Continuum– Incentivized Wellness– Coaching / Behavior Modification– Chronic Condition Management– Complex Case Management
Communications and Change Management
Integration across the Continuum
Inte
grat
ion
Population Health Management delivered from a Primary Care Platform
Population Care Continuum
Preventative Care
Short Term Acute ChronicGood
Health Complex Catastrophic
Fitness Centers
HRA
Wellness Programming
Chronic Condition Management
High Performance Network
Case Management
Patient Centered Primary Care (platform for managing population health )
Lifestyle Coaching
Cost Reduction• Specialty Care• Hospital Inpatient• Pharmaceutical • Emergency Department• Diagnostic Imaging
QuadMed Track Record
Average healthcare cost per employee
0123456789101112
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
$ Thousands
Midwest Quad/Graphics
Average Cost Trend 1999-2008: 5.6%
Regional Collaboration• WI Collaborative HC Quality• WI Health Information
Organization• WI Health Information Exchange
– ED Linking Project• PCMH (WAFP, Jackson Clinic)• IHI Triple Aim (Bellin)• Lean (Theda)
Accountable Community Partnerships• Value-based Contracting
– Terrific Whitepaper at CHVI site– http://www.vbhealth.org/wp-content/uploads/CHV_OBC-Cover_Text_REV8-30-10c.pdf
• Narrow, High-Performance Networks– Service Level Agreements
• QuadMed External to QG– Cost-Plus Contracting– Performance Guarantees
• Future: Risk-adjusted PMPM?
Payer
Providers
Risk-Adjusted PMPM Fee-For-Service
Pay for Performance
ACO RVUs Coding Accuracy Chart Completion
Schedule Efficiency EBM Patient SatisfactionSalary +
Current Challenges• Integration of Worldcolor into Quad
– Fighting for Transparency• e.g. Pharmacy Benefit Design
– Extending the QuadMed Model to multiple smaller legacy WC sites
• Consumer Health IT• Telemedicine
• Paying More for Care Under ACA– Understanding Ramifications of
Exchanges heading into 2014
Collaboration With CMMI• QuadMed has developed a healthcare
enterprise that has been successful in controlling cost and improving quality of care for Quad/Graphics and other employers with a focus on:– Accountable / Empowered Primary Care– Wellness and Prevention– Practice of Evidence Based Medicine– Outcomes-based Contracting
• QuadMed features are applicable to healthcare systems in general and can be successfully implemented at other large organizations with similar results.
Innovations in Health Care Delivery
Bruce Nash, M.D., M.B.A.Capital District Physicians’ Health Plan Senior VP, Chief Medical OfficerAlbany, NY
Who We Are•Not-for-profit network model health plan
•Physician-founded and guided for 27 years•350,000+ members in 29 counties in upstate New York •Top-ranked plan nationally for Commercial, Medicare Advantage and Managed Medicaid products
Practice Reform
Payment Reform
CDPHP Pilot
Patient Centered Medical Home Practices - Total Cost of Care Commercial Product Performance in Pilot and Core-4 CountiesYTD Third Quarter 2009 Compared to YTD Third Quarter 2008
n = member-months
$199.13 $202.59
$223.16 $219.04
$0.00
$50.00
$100.00
$150.00
$200.00
$250.00
$300.00
Core 4 Pilot
Cos
t of C
are
Allo
wed
Dol
lars
PM
PM
3Q YTD 2008 3Q YTD 2009
n = 1,220,189n = 1,286,065 n = 80,955 n = 77,726
Trend = + 12.07% Trend = + 8.12%