Monday, November 08, 2010

#WHIT The HealthPlan Innovators Panel inc.MaryAnn Stump(BCBSMN) and Chet Burrell (@carefirst) Roy Schoenberg American Well

More from WHIT:

1:45 pm -
2:45 pm
KEYNOTE PANEL DISCUSSION: Innovators Insight – How Forward Thinking Health Plans are Positioning for Tomorrow’s Marketplace
A panel of innovative health plan executives will evaluate market forces transforming the face of health care, share their vision of tomorrow’s health care landscape and identify necessary changes to stay ahead of (or even keep up with) an industry in transition.
  • Key trends impacting business strategy
  • Innovations in response to key trends
  • Opportunity on the horizon – re-engineering plans for 2011 and beyond
Chester Burrell
President and CEO
CareFirst BlueCross BlueShield 

 View Biography

Roy Schoenberg, MD, MPH
Chief Executive Officer
American Well Systems 

 View Biography

Panel Chair: MaryAnn Stump, RN
Senior VP & Chief Strategy and Innovation Officer; President, Consumer Aware
Blue Cross Blue Shield of Minnesota 

 View Biography

Reed V. Tuckson, MD, FACP
Executive Vice President and Chief of Medical Affairs
UnitedHealth Group 

 View Biography

Mary Ann Stump chaired this panel. Some fascinating views from the Blues and United Health with American Well as the non-payer Innovator.

 The topics look set to be wide ranging: Mary Ann has touched on Care Models, mHealth, Retail Clinics. 

Reed T:  Yes, cost and cost escalation is a concern.  Innovation requires effort to avoid waste. We need to solve the fragmentation problem. We need to deal with the contraction of Primary Care Services. We need innovation in care delivery. We need to get to the source of problems. Move Care Delivery from Hospital to Out Patient to the Doctors Office to the Home. Get involved earlier in the innovation and Research process.  Data and Analytics is key. We need better meaningful use criteria. Opportunities in Telemedicine and 24x7 access  using electronic devices and the Internet will be exciting if they can be implemented in a cost effective way.

We need performance measures and guidelines for use to make use of new innovations.

Roy S: Online Care aims to stimulate interaction between patients and doctors and other medical professionals. The patient's perception of value comes from connecting with a medical professional. Technology can remove barriers to that connection. American Well acts as a broker. Providers are willing and able to provide care. Patients are available and want to connect with a Provider. This is not a dumb connection. There is a match making process that works in real time. The Impact since introduction in 2009 is significant. Remove distance barriers. Time is a removed as a barrier. Mobility is no longer a barrier. From a provider prospective the system enables a virtual house visit. 

Chet B: CareFirst has 3.5M people who are served in the VA/MD/DC area. Cost is to healthcare as CO2 is to Global warming. 

Top 2% of patients in area cost 32% of total cost. The next 5% represent 33% of cost. The top 7% cost $3.5B (of $7B) in medical spending.

The Payer community has been focused on reviewing appropriate care. CareFirst challenged this approach. Primary Care Medical Care is being launched across 6,000 providers. Practitioners are being asked to group together in to virtual teams of 5-20 people. 100's have been formed and those program has only recently been launched.

These groups will look at members with Multiple Chronic diseases and get them to establish care plans. Provide incentives to have providers do this.
A gain share model. Each virtual panel serves about 3,000 patients. They are rewarded for paying attention to members.

Lots of technology comes in to play:
- Attribution data
- How to coordinate care plans between nurses and physicians.
- Can virtual consults happen in real time
- See a longitudinal Medical record over time

Creating a Member Health Record using claims data.
Enhancing this with medical data and lab results coming from Health Information Exchanges
All available 24x7

Without the technology it is difficult to achieve this.

Reward and information sharing based solution.

How does the patient understand their own status.
CareFirst will integrate with leading vendors to deliver this - not build it all themselves.

Mary Ann Stump: Newt Gingrich talked about the rules needing to change. Organizational change is needed. State  Licensing issues. 

Reed T: Some Medical Societies challenge innovation to protect their members. But this is countered by a growing band of Physician Entrepreneurs that "Get the new paradigm"

Chet B: It was against the law in Maryland to set up PCMH groups with an incentive based upon saving money. The law got changed. The technology to connect Nurse, patient, provider has been missing but it is available now.

CareFirst is looking for a 2-5% bend to the cost curve each year over multiple years. Much more is possible. In current model no one has incentive to track what is happening to the patient. PCMH gives that incentive to the Physician. 

Demand is driven by lifestyle. We have to connect the patient to the physician and give them both incentives to better manage their health.

Reed T:  Doctors can only do so much. Public Health has accountability. Doctors can't cure obesity or tobacco use on their own. They need public health support.

Roy S: Online care doesn't change the decision making and the decision makers. It simply removes the barriers to those people being able to come together to make the necessary decisions.

Accountability - Getting the Patient to "do the right thing" sounds simple - but what is the right thing. Once it has been decided what the right thing is to do. Then we have to get information to the person that can make the right thing happen but we also have to make it EASIER and More Convenient for the Patient to comply.

Chet B: Behavioral change  through incentives and information to address lifestyle driven diseases. HMOs were the first attempt but they didn't have the technology to connect everything and attempted to limit choice.

Reed T: The physician is the person that the patient trusts. We have to find a way to engage physicians in the redesign of plans and services. 

Roy S: Healthcare used to be patronizing. People are becoming more decisive. They are open to shopping around. 

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