Friday, March 18, 2011

#whchpi Experience in aligning incentives at Lovelace in New Mexico

More from the Health Plan Innovation Conference in Orlando, FL

CASE STUDY: How Lovelace Health Plan is Effectively Using Incentives – An Employer and Plan Perspective
Learn how Lovelace is using incentives to engage their employees and their customers in better health; and to engage their providers in better quality care.
  • Evaluating the ACO and patient centered medical home models
  • Aligning incentives for the provider, the member and the patient
  • ‘Re-culturing’ to sustain the programs
  • Results to date
John Cruickshank, MD
Chief Medical Officer
Lovelace Health Plan 

 View Biography

Seeking to align Incentives amongst Physicians, Hospitals and Health Plan.

Quality and Efficiency of Care. Fixing the Reward v Effort balance.

Long term contractual relationships. 

Multiple lines of business: Commercial, Medicaid and Medicare. 6 medical groups in New Mexico each with more than 500 covered lives.

Medical Loss Ratio is the initial basis for calculation of program efficiency.

PCP Attribution model to assign membership.
Incremental MLR margin generated through medical expenses will be gain-shared equally.

Focus is on improved quality (NCQA, HEDIS, Stars program etc.) No access to gain share without quality improvements.

- Care Management
- Pharmacy Measures
- Appointment Measures
- Member Satisfaction/Experience.
- Access
- Effectiveness of Care

35 measures. Focus on 10-12 in first year. Add more each year.

MedAI predictive modeling has been embedded in TriZetto at the Health Plan and information is shared with providers.

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