Mary Carol Todd vice president of medical management for the 38 hospital CHW

Mary carol todd vice president of medical management

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Mary Carol Todd, vice president of medical management for the 38 hospital-CHW, said the effort has targeted costs from overuse of surgery, avoidable hospital readmissions and patients who seek care outside the managed-care network in their effort to hold spending at about $400 per member per month in 2010. The effort stemmed from a year of talks among the partners to identify ways to improve quality and patient satisfaction and reduce costs, Todd said. Each had data without which others could not readily identify waste or errors that drove spending. Unexpected results Results of the analysis produced some unexpected results, Todd said. A major source of overuse proved to be knee surgery and hysterectomies, rather than treatment for asthma, diabetes or pneumonia. Meanwhile, IT proved to be a barrier as the partners sought to improve quality. Hill Physicians and CHW sought to improve communication to prevent avoidable return trips to the hospital, but not all clinics have electronic health records, Todd said. Nurses with Hill Physicians now access patient records at CHW hospitals for clinic case managers, after vetting the process to protect patient privacy, she said. Juan Davila, senior vice president for network management at Blue Shield of California, said costs the prior year rose roughly 8% to 10% and the flat spending amounts to savings of roughly $15 million. Davila contends the savings offers the network a competitive advantage among plans offered to California employees, which benefits the partners, he said. The insurer also
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P a g e | 6 guaranteed growth in members for CHW network and referrals for certain services to the system's hospitals, which stand to lose business under the cost-control efforts, he said. The partners also agreed to share losses should spending exceed the target, but the payment did not tie incentives to specific quality measures in the first year, Davila said. However, the partners separately report quality measures for California employees in the accountable care network to the state to monitor and ensure quality performance, he said. At least 16 health systems are expected to announce this week plans to separately launch accountable care networks through an initiative by the group-purchasing and quality- improvement organization Premier. The Charlotte, N.C.-based company, which is owned by health systems that contract for its purchasing services, said accountable care networks will seek to cut costs by 10% per capita over two years. Wes Champion, senior vice president of Premier Consulting Solutions, said he believes the private-market push ahead of federal regulations represents "a huge opportunity" to influence federal policy. Premier is expected this week to unveil the organization's push to promote the model with a two-tiered network of hospitals and health systems seeking to create such arrangements.
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  • Fall '15
  • PatriciaRiley
  • healthcare costs, accountable care organizations, accountable care

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