The MidAtlantic Business Group on Health Working Together to Improve Healthcare Value

1. The MidAtlantic Business Group on Health Working Together to Improve Healthcare Value David Johnson John Miller MidAtlantic Business Group on Health

2. Membership • Voting Members • Non-voting Corporate Members • Non-voting Individuals

3. Voting Membership

4. Corporate Membership

5. Geography • Maryland • Virginia • District of Columbia

6. Mission • Sharing and analyzing data • Education, coordination, solutions to health services issues • Cooperative, objective forum promoting affordable, high quality, and accessible health care • Meetings and conferences; publications

7. Data • Health Management Survey • Membership Information • eValue8

8. Education • Education Committee • Disparities in Health Care • Health Management Committee • Strategic Health Management • Legislative Committee • Legislative Updates

9. Objective Forum • MABGH History • (Maryland Health Care Coalition) • Practice of Hearing Both Sides

10. eValue8: A Coordinated Health Plan Quality Improvement Process

11. Premises: • MCOs Should Remain Employers “Lieutenants” • The Loudest “Plurality” Drives the System • Improving Processes Will Lower Cost • “Rising Tide Raises all Healthcare”

12. Method 1. Consolidate and Articulate Expectations: Example eValue8 Expectations: • Provider differentiation and reward • Clinical Guideline for Alcohol • Provider Education on CVD Risk Factors

13. Method 2. Measure Performance Against Expectations • Objectively as Possible • National Benchmarks of the “Possible”

14. Method 3. Open, 2-way Discussion of Results: WITH CLINICAL DECISION-MAKERS • eValue8 Scores • eValue8 Process • “How can we help you?”

15. Clinical Decision-Makers Aetna Attendance:- Chuck Cutler, MD (Head of National Quality Management)- Pat Mueller, MD (Regional Medical Director)- Rick Fornadel, MD (Local Medical Director- Tammie McGonigle, R Ph (Clinical Pharmacist)- Fran Grabosky (Quality Manager, Behavioral Health) - Sue Grauer (Product Manager, Disease Management)- Quincy Garfield (Product Head, Disease Management)- Mark Friedlander, MD (Medical Director, Behavioral Health)- Larry Nardozzi, MD (Medical Director, Magellan)- Sam Freeman (Sales Vice President)- Carol Rosebrook (Account Executive)- Mary Eller (Account Executive)

16. Method 4. Identify and Agree on Targets for Improvement

17. Our Four Goals: Across All MCOs Cardiovascular: Improving Practitioner Compliance with Guidelines Using Performance Data to Differentiate and Reward Providers Consolidate Diabetes “Registry” Alcohol Screening and Referral

18. Individual Plan Goals • PCP Alcohol Screening Initiative • Colorectal Cancer Screening • Depression Management (X 3) • Cultural Competency Program • 2 Hr. Web-based Program • Goal: 95% completed by 1 Qtr. 2004

19. Alcohol: Plan C

20. Local Results 2003

21. Local Results 2004

22. HIT Driving HIT: 2005 • Plan Structure and Organization • Community Collaboration • Standards • Practitioner Administrative Support Tools (Eligibility, Member Financial Requirements, Claims) • Practitioner Clinical Support Tools (Referrals, Electronic Ordering and Reporting) MHCC

23. HIT Driving HIT: 2005 • Outpatient Electronic Prescribing Tools • Member Provider Selection and Connectivity Tools • Electronic Personal Health Record (PHR) • Purchaser Cost and Utilization Management Tools MHCC

24. HIT Driving HIT: 2005 • Incentives for HIT • Performance Measurement MHCC

25. Overall Results • Employer:“This is what we expect: we’re watching, thank you for listening.” • MCOS:“We’re glad you’ve started to watch: together we can improve healthcare and all save money.” MHCC

26. MABGH Summary • Data • Education • Cooperative, objective forum • Meetings and conferences; publications • NETWORKING • Voting Member-to-Voting Member • Members-to-Vendors MHCC

28. The MidAtlantic Business Group on Health Working Together to Improve Healthcare Valuejohn.miller@mabgh.org301-552-4237