BCBSND President and CEO Mike Unhjem was in Washington, D.C., earlier this year to help unveil the Blue Cross and Blue Shield Association's (BCBSA) new five-point plan to improve health care quality, rein in costs and expand coverage to all Americans.
The plan, titled "The Pathway to Covering America," builds on the employer-based health insurance system, which currently provides coverage to more than 60 percent of the population. The plan lays out detailed recommendations to change the incentives in today's delivery system to assure high quality, affordable care and offers solutions to expand access to coverage.
For each of the five action steps, the proposal outlines what BCBS plans are doing in their local communities and the necessary actions that should be undertaken by the government.
Unhjem spoke at the January briefing at BCBSA in Washington and mentioned U.S. Sen. Kent Conrad's (D-N.D.) interest in helping the government establish an independent comparative effectiveness research institute. Unhjem also discussed BCBSND's successful disease management and care coordination programs. Other speakers at the briefing were Daniel Loepp, president and CEO of BCBS of Michigan, and Scott Serota, president and CEO of BCBSA.
Unhjem, who was chairman of the BCBSA Board of Directors in 2001 and 2002, is now chairman of the BCBSA board's Health Policy Committee, which develops the association's key health care public policy and legislation issues. He has served on that committee for five years. As Health Policy Committee chairman, Unhjem helped draft the Pathway document's five steps. The table below shows the steps and tells what the Blues are doing and what the government should do.
| Pathway to Covering America steps | What the Blues are doing | What the government should do |
|---|---|---|
| 1. Encourage research on what works. America needs an independent institute to support research comparing the relative effectiveness of new and existing medical procedures, drugs, devices and biologics. | Spearheading evidence-based assessments through its Technology Evaluation Center Creating the nation's largest health care database, Blue Health Intelligence |
Create an independent institute to support research on the effectiveness of procedures, drugs and devices. |
| 2. Change incentives to promote better care. The incentives in our system must be changed to advance the best possible care, instead of simply paying for more services that might be ineffective, redundant or even harmful. | Designating Blue Distinction Centers
Using incentives to encourage quality care Promoting great use of generic drugs Piloting Patient Centered Medical Homes |
Incorporate pay-for-quality incentives in Medicare Promoted management of chronic illness through Medicare Advantage Increase access to generic drugs Enact effective medical liability reform |
| 3. Empower consumers and providers. We must give consumers and providers the information and tools they need to make informed decisions. This starts with information systems to manage personal health records. In addition, consumers need to know how much they are paying and what they are getting for it. | Providing easy-to-understand information on quality and cost Giving consumers improved access to their health information and helping providers adopt health IT Offering all members a personal health record (PHR) by the end of 2008 Offering savings and payment options through Blue Healthcare Bank |
Promote greater quality and cost transparency Encourage adoption of health information technology |
| 4. Promote health and wellness. The costs of treating chronic conditions are estimated to account for 75 percent of health care spending. We must promote healthy lifestyles to prevent chronic illness and work aggressively to help patients with chronic illnesses manage their own health. | Partnering with employers and consumers through Engaging Consumers@Work Offering specialized disease management and care coordination programs |
Encourage employee wellness programs Educate children on healthy lifestyles Provide incentives and education and nutrition and health |
| 5. Foster public-private coverage solutions.We need to tailor our coverage plans to capture the diversity of the uninsured population so no one gets "squeezed out" by cost, "misses out" on available government assistance or "opts out" because they do not think they need coverage. | Offering more affordable products for low-income individuals Educating consumers on federal and state assistance programs Designing innovative coverage plans Developing consumer-friendly tools |
Provide four new tax credits Extend public coverage to everyone up to the federal poverty level Require all states to have high-risk pools or other mechanisms to assure access Help states enroll Medicaid/SCHIP eligibles Launch a public-private educational campaign |
"To help advance this proposal, in 2008 BCBSA and its member plans will engage in a multi-pronged campaign-both nationally and in all 50 states-to inform consumers, small businesses, large employers, policymakers, presidential campaigns and others about the value of the employer-based system and our vision for improving the health care delivery system," Unhjem said at the briefing.
Unhjem and the other BCBSA legislative committee members will be working on the introduction and passage of the Pathway proposals. BCBSND's will work with providers, employers and our congressional delegation to promote the plan, Unhjem said.
BCBSA employees are working with Conrad and his staff to prepare legislation that would establish the research institute, which Serota says would be "insulated from political pressures and funded by all payers-public and private."
North Dakota Blue's successes
Below are Unhjem's comments at the briefing regarding BCBSND's disease management and care coordination programs.
"As the CEO of BCBS of North Dakota, I am especially pleased to share some of our successes. We offer disease management and care coordination programs that demonstrate improvements in the health and well-being of chronically ill patients while also reducing costs.
"Working collaboratively with a subset of the largest medical group in the state, we have piloted a diabetes management program, which assigns chronic disease management nurses to patients through a medical practice that serves as the patient's 'medical home.'
"The medical home model ensures that a medical practice commits to acting as the patient advocate-helping patients navigate the complexities of the health care system. The medical home provides evidence-based coordinated care to best meet the patient needs. In turn, physicians receive payment incentives.
"Through this coordinated effort, instead of a physician having to search their memory for the correct guidelines to follow and combing through a paper record, lab reports, X-ray reports and other data, the interoperable data exchange can provide the physician, at the point of service, with critical information about the patient's condition, recent and past tests, guidelines and compliance with guidelines and other preventive recommendations.
"Information about past and needed educational activities can also be handy for the physician and patient interaction. The physician provides better service and is more comfortable in the interaction and the patient receives better services and higher quality of care.
"Our results show impressive increases in several key metrics. For example, we've seen:
- Fewer emergency room visits
- Fewer inpatient admissions
- More completed tests/screenings
- Higher patient satisfaction
- Lower expenses per member. For our state that translates to $500 per patient per year through reduced emergency room use and hospitalizations.
"These efforts are just a part of our overall strategy to improve care to the people in North Dakota. We are also collaborating across the health care community to make payment improvements and develop other tools to help enhance clinical decision-making -especially for doctors in rural areas," Unhjem says.
