Better Data Improving Health Care, Cutting Costs for West Michigan Provider Organization
In February, Holland Physician Hospital Organization joined Blue Cross Blue Shield of Michigan’s innovative risk-sharing payment model, designed to balance the financial responsibility for managing the cost and quality of health care between providers and Blue Cross.
In March, health care drastically changed in the face of the COVID-19 pandemic, but even with the unforeseen hurdles to care delivery, officials at Holland Hospital and HPHO, a partnership between lakeshore community physicians and the hospital, say joining Blue Cross’ Blueprint for Affordability efforts is helping them more clearly see the big picture.
Data helping drive decisions
Terry Steele, senior vice president and CFO, Holland Hospital and Paul Clippinger, executive director, HPHO said increased data sharing through the Blueprint partnership is improving HPHO’s approach to the “Triple Aim” – goals health care organizations set related to improving individual care, improving population health and reducing cost.
“Access to more complete and timely data assists us in decision making with regard to strategic priorities centered around the Triple Aim,” Clippinger said. “Consistency across our network with regard to superior quality and utilization performance favorably impacts our community improving the health of the entire population we serve.”
Both Clippinger and Steele say greater access to data is akin to having more pieces of a complicated puzzle they’re trying to solve. Working closely with Blue Cross analysts and medical leadership in West Michigan, Blueprint is helping HPHO find more efficiencies in care and cost drivers, such as how to rein in drug costs through a more comprehensive look at pharmacy data.
“We’ve been extremely impressed with the dedicated resources we’ve had,” Clippinger said. “That’s really helped us get deeper into what our performance looks like and where the opportunities for improvement are.”
As a health care system that was already high-performing and efficient before Blueprint, Steele said the bigger picture view the payment model supplies is helping the organization uncover new opportunities to cut costs and improve care.
“Due to our strong performance on a per member, per month basis, we have been challenged at times in identifying additional opportunities to further bend the cost curve,” Steele said. “We are hopeful that initiatives like Blueprint will provide the data to guide our path.”
Steele said he appreciates that HPHO’s performance as it relates to Blueprint is measured on a trended basis compared to the rest of the state – that aspect of the program is designed to not penalize high-performing systems who might find it difficult to increase performance rates year over year if they’re already performing at near optimal levels.
Charting a new course, together
Even before Blueprint, HPHO was moving toward coordinated care. All the primary care physician offices associated with HPHO ensure patients have access to care managers to help coordinate services and navigate a health care system that can be confusing. HPHO offices are also designated as patient-centered medical homes, a Blue Cross-backed quality distinction, and many have been integrating pharmacists and behavioral health providers into primary care settings.
With Blueprint, the non-profit has found more ways to improve care. Education for physicians focuses on lower-cost medication options and the cost effectiveness of where care is delivered so doctors can help patients make less costly choices when it comes to their health care. HPHO is also implementing a risk stratification tool that can help them better identify patients in need of extra support.
Being able to see the spending patterns of their patient population through Blue Cross data is helping to more effectively manage health at a population level. Steele said the type of collaboration exemplified through Blueprint is a model for how health insurers and health care systems will increasingly have to follow.
“I think generally employers and patients really want us to work together on their behalf and do the right thing and I think Blueprint moves us in that direction,” Steele said.
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Photos courtesy of Holland Hospital