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Published September 22, 2012, 11:30 PM

BCBS push to improve care, curb costs sees results

FARGO – Check out these health system vital signs: Fewer hospital admissions. Emergency room visits down significantly. Better diabetes control and coronary artery disease management.

By: Patrick Springer, INFORUM

FARGO – Check out these health system vital signs: Fewer hospital admissions. Emergency room visits down significantly. Better diabetes control and coronary artery disease management.

By combining sophisticated data tracking, reducing payments for hospital admissions resulting in complications, and more intensively managing patients with chronic diseases, Blue Cross Blue Shield of North Dakota and health providers across the state are seeing results from an initiative launched three years ago.

The financial bottom line: Every dollar spent on the MediQHome quality initiative has saved $2.50, Blue Cross Blue Shield of North Dakota figures show.

Another indication that cost-containment efforts appear to be working: Medical inflation, which had averaged 8 percent a year over a recent 10-year period, dropped to 4 to 5 percent.

The program, which applies to three of every four Blue Cross Blue Shield members in the state, is highlighted as an example of efforts to simultaneously improve the quality of care and reduce spiraling costs.

“I’m extremely proud of what North Dakota is doing,” said Dr. Paul Grundy, a physician and global director of health care transformation for IBM.

“It’s showing us it can be done across the entire state,” Grundy said, noting that almost all physicians in the state are participating, and all major health systems are on board.

Grundy will be speaking Tuesday in Fargo, when Blue Cross Blue Shield will be awarding North Dakota health providers for noteworthy achievements in improving the quality of care and lowering costs.

By using financial incentives, both rewards and penalties, Blue Cross Blue Shield of North Dakota has aggressively pushed participation in the initiative, he said.

Measurable results from the “medical home” approach, involving more intensive medical management, include:

E The number of diabetics who received optimal diabetic care increased by 227 percent.

E Colorectal cancer screening jumped by 123 percent.

E Tobacco use among patients with coronary artery disease dropped by 43 percent.

Dr. David Hanekom is chief medical officer of MD Datacor, a firm affiliated with Blue Cross Blue Shield of North Dakota that developed medical tracking software used in the initiative.

In a two-year-period, 2010 and 2011, the initiative saved “tens of millions of dollars,” said Hanekom, formerly the North Dakota Blues’ chief medical officer.

“There’s actually a cost savings to the membership of Blue Cross Blue Shield through this program,” he said.

The payback has come sooner than expected, but Hanekom wants to see the savings sustained for another two or three years before declaring a definite trend.

Significantly, he said, the savings resulted from additional investments. For instance, patients with chronic diseases such as diabetes, hypertension or asthma often receive more medication, but get results.

Those results include fewer heart attacks, cardiac bypass procedures or expensive imaging tests.

The benefits can be profound on a human level, Grundy said, noting that better control of diabetes can avoid serious complications, including loss of a limb or eyesight.

As measured in dollars and cents, the savings come from keeping patients out of the hospital by avoiding complications from poorly controlled diabetes, for example, Hanekom said.

“Most of the credit,” he said, “should go to the doctors and nurses in the health care systems,” for their improved care coordination efforts.

To tame rising health care costs – which all agree are unsustainable – critical elements, all at play in North Dakota, must come together, Grundy said.

They include data tracking to guide better patient management, payment reform to reward outcomes instead of merely paying for procedures, and much better communications between providers and patients.

Cellphone messages informing patients about an immunization or health screening is just one example Grundy offered.

Using those approaches, health costs will come under control, he said.

“I’m very optimistic,” Grundy said. “It works.”

The MediQHome model has been adopted by Blue Cross Blue Shield plans in nine other states, Hanekom said.

“What we’re learning in North Dakota can be applied elsewhere,” he said. “We’re actively helping thousands of physicians in multiple states. We are on a journey to spread what I think of as the North Dakota common sense and cooperative spirit.”

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Readers can reach Forum reporter Patrick Springer at (701) 241-5522