The Leapfrog Group
2007 Health Plan Users Group
Scorecard
ANTHEM NATIONAL ACCOUNTS RESPONSES
PART 2 OF 2
April 30, 2007
Anthem National Accounts (referred to herein as “Anthem”) represents fourteen Blue
Cross and/or Blue Shield plans, all under the same parent company, in the following
states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine,
Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin.
The Anthem National Accounts business unit serves members of the Blue Cross
licensee for California; the Blue Cross and Blue Shield licensee for Colorado,
Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in
the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue
Shield in 10 New York City metropolitan counties and as Blue Cross or Blue Cross
Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern
Virginia suburbs of Washington, D.C.) and Wisconsin. Anthem Blue Cross and Blue
Shield is the trade name for the following: In Connecticut: Anthem Health Plans, Inc.
In Colorado, Rocky Mountain Hospital and Medical Service, Inc. In Indiana: Anthem
Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky. In Maine:
Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and
Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire,
Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of
Virginia, Inc. In Missouri: RightCHOICE® Managed Care, Inc. (RIT), Healthy
Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and
certain affiliates administer non-HMO benefits underwritten by HALIC and HMO
benefits underwritten by HMO Missouri, Inc. Life and disability products are
underwritten by Anthem Life Insurance Company (ALIC). RIT and certain affiliates
only provide administrative services for self-funded plans and do not underwrite
benefits. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites
or administers the PPO and indemnity policies; Compcare Health Services Insurance
Corporation ("Compcare") underwrites or administers the HMO policies; and
Compcare and BCBSWi collectively underwrite or administer the POS policies.
Independent licensees of the Blue Cross and Blue Shield Association. ® Registered
Marks Blue Cross and Blue Shield Association.
2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
2nd Pillar: Standardized Measurement and Practices
No. 2007 Goal
Fully Met
4
Evaluate hospitals based on standard efficiency
and/or cost measures and link such performance data
to information on provider quality measures for
which adequate denominator volumes exist.
Best practice:
Efficiency measures should meet Leapfrog/BTE
efficiency measure guidelines available at
http://www.regence.com/research/
Efficiency is defined as the cost and quantity of
services (i.e., total resources used) for the episode of
care. For additional information, see "Measuring
Provider Efficiency Version 1.0" available at
http://www.regence.com/research/docs/measuringPr
oviderEfficiency.pdf
The plan meets all of the following criteria:
i.
The plan collects and publicly
publishes hospital data for
efficiency and/or cost measures for
its entire book of business, across
all geographic areas, and links such
data with data on quality measures
at the hospital level.
ii.
The plan evaluates efficiency
and/or cost measures for hospitals
that account for at least 75% of the
plan’s acute care hospital
admissions or payments in each
market.
iii.
The plan communicates provider
performance on efficiency
measures to hospitals in the
markets at least annually and offers
outlier hospitals an opportunity to
discuss results.
Partially Met
Not
Met
The plan meets all of the following criteria:
i.
The plan commits to evaluate
hospital data based on efficiency
and/or cost measures for its entire
book of business, across at least 10
metropolitan areas and to link such
data with data on quality measures
at the hospital level in 2007.
ii.
The plan commits to evaluate
efficiency and/or cost measures for
hospitals that account for at least
75% of the plan’s acute care
hospital admissions or payments in
the market in 2007.
iii.
The plan commits to communicate
provider performance on efficiency
measures to hospitals in the market
at least annually and offer outlier
hospitals an opportunity to discuss
results.
The plan utilizes hospital cost and efficiency
measurement: methodological approaches at
http://www.pbgh.org/programs/documents/PBGHHo
spEfficiencyMeas_01-2006_22p.pdf
Anthem Care Comparison is a proprietary tool that displays total cost estimates for an episode of care using Anthem’s contracted rates for 39 medical
procedures (inpatient and outpatient), diagnostic tests, and common office visits. The information is at the facility level. Currently, data for the Dayton, OH
market is available to approximately 2 million members, but planning is underway to expand the pilot to Cincinnati, OH; Columbus, OH; Indianapolis, IN;
Louisville, KY; and Lexington, KY in 2007. In addition to expanding to additional geographic areas, planned future enhancements include tying in quality
metrics. This pilot is being highlighted as a “best practice” and model for other Blue plans by the Blue Cross and Blue Shield Association. See the “Anthem
Care Comparison Screens” document for screen prints.
Consumer-directed health plan members have access to quality and cost information about specific providers and facilities through the online provider
directory. Members can view provider- and hospital-specific quality information, such as NCQA designations, disciplinary actions, and safety ratings
(Leapfrog metrics). They can also view cost estimates (discounted and undiscounted) for 8-10 high-volume services for the given specialty. Planned future
enhancements include expanding the features to other product lines. See “Lumenos Provider Finder Screens” for screen prints.
Anthem offers members across all books of business a suite of online decision-support tools administered by Subimo (WebMD), including Healthcare
AdvisorSM. Through that tool, members have the ability to view quality information, as well as estimated treatment costs for specific services, tests,
physician visits, and medications. For example, members can select from a number of common inpatient procedures, and then enter their age group, gender,
and zip code to view the total estimated cost before insurance benefits for the procedure. The typical estimated cost ranges for the procedure at an innetwork facility and at an out-of-network facility are provided. Typical costs are calculated from the average fees for each type of service at the average
3 of 20
2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
2nd Pillar: Standardized Measurement and Practices
No. 2007 Goal
Fully Met
Partially Met
Not
Met
rates charged, and they represent the total cost for the service. The data is provided by third party sources and is not hospital-specific. See “Anthem 2007
HPUG Response Supplement – Screen Prints” document to view sample screen prints.
Enhanced inpatient cost information is available to Anthem Blue Cross and Blue Shield members in Virginia through the “Find and Compare Hospitals”
tool within Healthcare Advisor. The Virginia hospitals are rated as below average, average, or above average in cost on 23 common inpatient procedures.
PPO contract reimbursements are used to calculate the average costs.
We do not currently evaluate efficiency and/or cost measures for hospitals that account for at least 75% of acute care hospital admissions or payments in
each market.
Anthem does not currently communicate provider performance on efficiency measures to hospitals.
C:\PPU\External
C:\PPU\External
Organizations\Leapfrog\Score
Organizations\Leapfrog\Score
Sheet 2007\ResponseSheet
Supplements\Anthem
2007\Response Supplements\Lumenos
Care Comparison Screens.ppt
Provider Finder Screens.ppt
*Please contact Anthem or Leapfrog staff for additional information.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
2nd Pillar: Standardized Measurement and Practices
No. 2007 Goal
Fully Met
5
Evaluate physicians based on standard efficiency
measures and/or cost measures and link such
performance data to information on provider
quality measures for which adequate denominator
volumes exist.
Best practice:
Efficiency measures should meet Leapfrog/BTE
efficiency measure guidelines available at
http://www.regence.com/research/
Efficiency is defined as the cost and quantity of
services (i.e., total resources used) for the episode
of care. For additional information, see
"Measuring Provider Efficiency Version 1.0"
available at
http://www.regence.com/research/docs/measuring
ProviderEfficiency.pdf
See "Advancing Physician Performance
Measurement: Using Administrative Data to
Assess Physician Quality and Efficiency" available
at
http://www.pbgh.org/programs/PhysicianPerforma
nce.asp
PARTIALLY MET
The plan meets all of the following criteria:
i.
The plan collects and publicly
publishes physician data for
efficiency measures for its entire
book of business, across all
geographic areas, and links such data
with data on quality measures at the
physician or medical group level.
ii.
The plan evaluates efficiency and
quality measures for physicians that
account for at least 75% of the plan’s
payments to physicians in each
market.
iii.
The plan communicates provider
performance on efficiency and
quality measures to physicians in the
markets at least annually and offers
outlier providers an opportunity to
discuss results .
Partially Met
Not
Met
The plan meets all of the following criteria:
i.
The plan commits to evaluate
physician data based on efficiency
measures for its entire book of
business, across at least 10
metropolitan markets, and to link
such data with data on quality
measures at the physician or
medical group level.
ii.
The plan commits to evaluate
efficiency and quality measures for
physicians that account for at least
75% of the plan’s payments to
physicians in the market in 2007.
iii.
The plan commits to communicate
provider performance on efficiency
and quality measures with
physicians in the market at least
annually and to offer outlier
provider an opportunity to discuss
results.
Anthem offers members across all books of business a suite of online decision-support tools administered by Subimo (WebMD), including Healthcare
AdvisorSM. Through that tool, members have the ability to view quality information, as well as estimated treatment costs for specific services, tests,
physician visits, and medications. For example, members can select from a number of common outpatient procedures, and then enter their age group,
gender, and zip code to view the total estimated cost before insurance benefits for the procedure. The typical estimated cost ranges for the procedure at an
in-network provider and at an out-of-network provider are provided. Typical costs are calculated from the average fees for each type of service at the
average rates charged, and they represent the total cost for the service. The data is provided by third party sources and is not provider-specific. See “Anthem
2007 HPUG Response Supplement – Screen Prints” document to view sample screen prints.
Anthem Care Comparison is a proprietary tool that displays total cost estimates for an episode of care using Anthem’s contracted rates for 39 medical
5 of 20
2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
2nd Pillar: Standardized Measurement and Practices
No. 2007 Goal
Fully Met
Partially Met
Not
Met
procedures (inpatient and outpatient), diagnostic tests, and common office visits. The information is at the facility level. Currently, data for the Dayton, OH
market is available to approximately 2 million members, but planning is underway to expand the pilot to Cincinnati, OH; Columbus, OH; Indianapolis, IN;
Louisville, KY; and Lexington, KY in 2007. In addition to expanding to additional geographic areas, planned future enhancements include tying in quality
metrics. This pilot is being highlighted as a “best practice” and model for other Blue plans by the Blue Cross and Blue Shield Association. See the “Anthem
Care Comparison Screens” document for screen prints.
Consumer-directed health plan members have access to quality and cost information about specific providers and facilities through the online provider
directory. Members can view provider- and hospital-specific quality information, such as NCQA designations, disciplinary actions, and safety ratings
(Leapfrog metrics). They can also view cost estimates (discounted and undiscounted) for 8-10 high-volume services for the given specialty. Planned future
enhancements include expanding the features to other product lines. See “Lumenos Provider Finder Screens” for screen prints.
Our physician pay-for-performance programs in certain California and Missouri markets include cost metrics, in addition to clinical quality metrics, in
evaluating physicians. In California, we estimate that at least 75% of Blue Cross of California plan payments to physicians are for physicians evaluated on
efficiency and quality.
All providers participating in our pay-for-performance programs receive annual performance reports related to the quality and, where in use, efficiency
metrics employed in the program. We are available to meet with any provider to discuss options, and, in many cases, actively reach out to underperforming
providers.
Anthem’s strategy to evaluate physician performance is to utilize metrics endorsed by national quality organizations. Given the availability of such metrics
for primary care, and the importance of primary care in the health care delivery system, half of Anthem’s physician pay-for-performance programs are
currently targeted at PCPs; the balance are targeted at specific specialty types for which national metrics are available. Therefore, Anthem does not
generally target physicians for pay-for-performance programs based on the percentage of plan payments they account for in the market. Rather, Anthem’s
goal is to engage as many eligible providers as possible into pay-for-performance programs in order to drive positive health outcomes and increased patient
safety.
Anthem’s enterprise Blue Precision networks are high performance networks composed of cost-efficient specialists identified using an Episode Treatment
Group (ETG) methodology to stratify performance. These networks give members the choice of selecting a physician at a lower overall cost to them and to
their employer through tiered benefit designs. To view Blue Precision providers, members can visit the Blue Cross and Blue Shield Association website
(http://www.bcbs.com/healthtravel/finder.html). The display of Blue Precision specialists in the online provider directories is under development. We are
developing quality designations for selected specialists in the Blue Precision network, to be rolled out in 2008. Similar to the approach taken in our pay-forperformance programs, metrics that are endorsed by national quality organizations are being utilized. The leaders in this arena are the National Committee
for Quality Assurance (NCQA), the National Quality Forum, (NQF), the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), the
AQA (formerly Ambulatory Care Quality Alliance) and the American Medical Association’s Physician Consortium for Performance Improvement (AMAPCPI). A number of national organizations with an interest in a specific disease or specialty areas have also developed measures. For example the American
College of Cardiology (ACC) and the Society of Thoracic Surgeons (STS) have each defined process and outcome measures and have additionally set up
disease registries to which data on these metrics are reported for participating physicians. The level of involvement of other specialty societies in developing
and promoting quality metrics is variable. In instances where no or limited metrics are available for a given specialty, Anthem is working with the relevant
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
2nd Pillar: Standardized Measurement and Practices
No. 2007 Goal
Fully Met
Partially Met
Not
Met
national specialty societies to promote the development of measures or to obtain endorsement of measures proposed. Given the limited metrics that are
currently available for specialists, our approach is to roll out the quality component sequentially over several years.
C:\PPU\External
C:\PPU\External
Organizations\Leapfrog\Score
Organizations\Leapfrog\Score
Sheet 2007\ResponseSheet
Supplements\Anthem
2007\Response Supplements\Lumenos
Care Comparison Screens.ppt
Provider Finder Screens.ppt
*Please contact Anthem or Leapfrog staff for additional information.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
3rd Pillar: Incentives and Rewards
No. 2007 Goal
Exceeded
1
Design and implement a 2007
hospital incentive and reward
(I&R) strategy1 based on a
standardized set of measures
and lessons learned from I&R
programs.
Best Practice:
Incentives and Rewards Best
Practices Primer: Lessons
Learned from Early Pilots,
July 2006 (with support from
Robert Wood Johnson
Foundation and California
Health Care Foundation).
Find pdf of report at
www.leapfroggroup.org or
www.chcf.org
For information regarding
non-financial incentives, see:
http://www.academyhealth.or
g/nhcpi/models.pdf
In addition to meeting the fully met
criteria, the plan:
i.
calculates return-oninvestment for its I&R
program(s) in ten
metropolitan markets, and
ii.
documents statistically
significant improvement
on at least three quality
measures and one
efficiency (or cost)
performance measure
targeted by incentives over
two years in at least three
metropolitan markets.
Plans using steerage strategies for
their I&R programs should
calculate % achieved savings
compared to other plan benefit
designs, in lieu of ROI.
Fully Met
Partially Met
Not
Met
In at least ten metropolitan markets,
the plan has either licensed and
implemented the Leapfrog Hospital
Rewards Program or implemented
another hospital I&R program.
In at least one metropolitan market,
the plan has either licensed and
implemented the Leapfrog Hospital
Rewards Program or implemented
another hospital I&R program.
The plan’s I&R program meets all
of the following criteria:
i.
targets network hospitals
that account for at least
50% of plan admissions in
each market;
ii.
uses standardized
measures of hospital
performance;
iii.
includes non-financial
incentives (e.g., published
performance ratings)
related to hospital
performance on targeted
measures, and
iv.
includes financial
incentives that annually
equate to at least 2% of
annual plan payments to
I&R-participating
hospitals.2
The plan’s I&R program meets all
of the following criteria:
i.
targets network hospitals
that account for at least
50% of plan admissions in
the market;
ii.
uses standardized
measures of hospital
performance;
iii.
includes non-financial
incentives (e.g., published
performance ratings)
related to hospital
performance on targeted
measures, and
iv.
includes financial
incentives that annually
equate to at least 2% of
annual plan payments to
I&R-participating
hospitals.
PARTIALLY MET
Anthem uses standardized, nationally endorsed hospital performance metrics across its programs, including metrics endorsed by organizations like the
National Quality Forum (NQF), the Hospital Quality Alliance (HQA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and
“Steerage strategies” using quality-based benefit design products are considered to represent one possible I&R strategy that insurers can employ to address this
goal.
2
For quality-based benefit design products, performance relative to the 2% criterion should be evaluated within 24 months of introduction in each market. For
all other I&R strategies, performance relative to the 2% criterion should be evaluated within 18 months of introduction in each market.
1
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
3rd Pillar: Incentives and Rewards
No. 2007 Goal
Exceeded
Fully Met
Partially Met
Not
Met
others.
Our hospital pay-for-performance programs include over 500 facilities in twelve states. Most widespread is the Anthem Quality-In-Sights®: Hospital
Incentive Program (Q-HIPSM) in six states.
Anthem does not generally target hospitals for I&R programs based on volume of admissions. Anthem’s goal is to engage as many eligible providers as
possible into pay-for-performance programs to drive positive health outcomes and increased patient safety. In the Virginia, California, Colorado, Indiana,
Ohio, Missouri, and Kentucky markets, however, an estimated 50% or more of plan admissions do come from participating hospitals.
Anthem Blue Cross and Blue Shield plans in the Indiana, Kentucky, Ohio, and Missouri markets hold annual educational conferences in each state.
National quality improvement speakers attend, hospitals share best practices, and Anthem “Successful Practice” award winners are showcased at these
conferences. Each year, hospitals are asked to submit abstracts on performance improvement projects they instituted at their facilities. The abstracts are
reviewed by Anthem Medical Directors and three hospitals in each state are publicly recognized with awards at the annual educational conference.
In addition, displaying performance across the quality metrics included in Anthem Blue Cross and Blue Shield in Virginia’s Quality-In-Sights®: Hospital
Incentive Program (Q-HIPSM) for hospitals with ‘above-average’ scores is under development. This data would be displayed within the Anthem.com site
and be available to all members and all commercial product lines. As of now, members can view which Virginia hospitals are participating in the program
via an indicator displayed in the provider directory on the Anthem.com website.
Whether the financial incentives provided under Anthem’s hospital I&R programs annually equate to at least 2% of annual plan payments to those
hospitals cannot be evaluated at this time. Many of the programs are very new (2006 or 2007 rollouts) and others vary by individual hospital contracting
arrangement. Program incentives are negotiated with the participating hospitals. In aggregate, Anthem paid out approximately $49 million in financial
incentives in 2006 to hospitals participating in its pay-for-performance programs enterprise-wide.
Anthem is building methodologies to appropriately and consistently calculate return-on-investment for pay-for-performance programs enterprise-wide and
to quantify program results.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
3rd Pillar: Incentives and Rewards
No. 2007 Goal
Exceeded
2
Design and implement an
outpatient physician
recognition strategy3 based
on a standardized set of
measures and lessons learned
from I&R programs.
Best Practice:
Incentives and Rewards Best
Practices Primer: Lessons
Learned from Early Pilots,
July 2006 (with support from
Robert Wood Johnson
Foundation and California
Health Care Foundation).
Find pdf of report at
www.leapfroggroup.org or
www.chcf.org
In addition to meeting the fully met
criteria, the plan meets all of the
following criteria:
i.
calculates return-oninvestment for the I&R
program(s) in all ten
metropolitan markets, and
ii.
documents statistically
significant improvement
on at least three quality
measures and one
efficiency (or cost)
performance measure
targeted by incentives in at
least three metropolitan
markets.
Plans using steerage strategies for
their I&R programs should
calculate % achieved savings
compared to other plan benefit
designs, in lieu of ROI
Fully Met
Partially Met
In at least ten metropolitan markets,
plan has licensed and implemented
one or more components of the
Bridges to Excellence Program
and/or has implemented another
physician I&R program.
In at least one metropolitan market,
the plan has licensed and
implemented one or more
components of the Bridges to
Excellence Program and/or has
implemented a physician I&R
program.
The plan’s I&R program meets all
of the following criteria:
i.
targets network physicians
that account for at least
50% of plan physician
payments in each market;
ii.
uses standardized
measures of physician
performance;
iii.
includes multiple
reinforcing incentives,
including non-financial
incentives (e.g., published
performance ratings)
related to targeted
physician performance,
and
iv.
includes financial
incentives that annually
equate to at least 2% of
annual plan payments to
I&R-participating
physicians. 4
Not
Met
The plan’s physician I&R program
meets all of the following criteria:
i.
targets network physicians
that account for at least
50% of plan physician
payments in each market;
ii.
uses standardized
measures of physician
performance;
iii.
includes multiple
reinforcing incentives,
including non-financial
incentives (e.g., published
performance ratings)
related to targeted
physician performance,
and
iv.
includes financial
incentives that annually
equate to at least 2% of
annual plan payments to
I&R-participating
physicians.
FULLY MET
“Steerage strategies” using quality-based benefit design products are considered to represent one possible I&R strategy that insurers can employ to address this
goal.
4
For quality-based benefit design products, performance relative to the 2% criterion should be evaluated within 24 months of introduction in each market. For
all other I&R strategies, performance relative to the 2% criterion should be evaluated within 18 months of introduction in each market.
3
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
3rd Pillar: Incentives and Rewards
No. 2007 Goal
Exceeded
Fully Met
Partially Met
Not
Met
Anthem is building methodologies to appropriately and consistently calculate return-on-investment for pay-for-performance programs enterprise-wide and
to quantify program results.
Anthem does not generally target physicians for I&R programs based on the percentage of plan payments they account for. Participation in pay-forperformance programs is voluntary and is offered to the physician types being targeted (e.g. primary care physicians, OB/GYNs, cardiologists, etc.) by the
program who meet minimum eligibility thresholds, not the entire network. Physicians who are interested in working with Anthem to improve quality as
part of a contracting strategy are targeted. Anthem also looks for groups that are interested in working together on an ongoing basis to keep the measures
fresh and continually evolve the P4P program. Anthem’s goal is to engage as many eligible providers as possible into pay-for-performance programs to
drive positive health outcomes and increased patient safety. Given that half of our physician pay-for-performance programs are targeted at primary care
physicians, and most of the others are targeted at specific specialty types, it is difficult to achieve the 50% of plan payments in the market threshold. In the
Indiana, Missouri, and Ohio markets, however, it is estimated that this threshold is met.
We use standardized, nationally endorsed physician performance metrics across our programs, including those metrics endorsed by organizations like the
National Quality Forum (NQF), the AQA (formerly Ambulatory Care Quality Alliance), the National Committee for Quality Assurance (NCQA), and
others, in areas for which endorsed measures are available. However, for a number of medical specialties and diseases, there are no nationally endorsed
quality metrics. Anthem’s approach to identify metrics for these diseases and specialties is to work directly with national medical specialty societies to
promote the development of performance metrics.
Performance scorecards for medical groups participating in our pay-for-performance Physician Quality Incentive Program (PQIP) through the statewide
Integrated Healthcare Association (IHA) collaborative in California are available publicly on Blue Cross of California’s website. Members can view and
compare results across medical groups. The reported information includes: clinical measures (an aggregate measure of screening, immunization, and
chronic disease management measures); service satisfaction; and complaint resolution. See
http://www.bluecrossca.com/wps/portal/chpmemberbcc?content_path=shared/noapplication/medcalparticipants/nosecondary/notertiary/pw_a087005.htm
&label=Physician/Medical%20Group%20Quality.
In addition, BlueCross BlueShield of Georgia plans to review administrative requirements for physician groups participating in the pay-for-performance
program there that have the highest scores, in an effort to streamline, simplify, and/or eliminate appropriate requirements (“goldcarding”).
The financial incentives provided under Anthem’s physician I&R programs in California are estimated to represent at least 2% of annual plan payments to
participating providers. In aggregate, we paid out approximately $96 million in financial incentives in 2006 to physicians participating in our pay-forperformance programs enterprise-wide.
Anthem signed an enterprise licensing agreement with Bridges to Excellence (BTE) in September 2006. Anthem plans to continue its existing regional
initiative in Georgia, and to expand to additional geographies across the enterprise, likely beginning with Ohio and Kentucky. We will also integrate BTE
components into pay-for-performance programs and enhance online provider directories to indicate BTE designations.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
No.
2007 Goal
Fully Met
Partially Met
3
Support Leapfrog’s Never Events Policy
The plan meets both of the following criteria:
i.
The plan documents support of this
Leapfrog goal.
ii.
The plan actively encourages its
contracted hospitals to implement
Leapfrog’s Never Events Policy.
The plan documents support of Leapfrog’s
Hospital Policy (See the Leapfrog Hospital
Quality and Safety Survey)
The following states required public
reporting of Never Events as of February
2007:
htww.pstoolbox.org/_docdisp_page.cfm?
LID=6BC2AB7D-6F1E-4DF2AD20DAE18001147B
Not
Met
Best practice:
HealthPartners (MN) stipulates that
contracted hospitals must report Never
Events that occur to plan members and
that the hospital will not pay for costs
associated with Never Events.
FULLY MET
Anthem is in full support of the Never Events policy. We have finalized boiler plate language related to Never Events for the enterprise hospital
agreement templates. See the “Never Events Hospital Agreement_4-5-07” supplemental document. As hospital agreements come up for renewal, we will
begin to include this language as part of the standard contract. It is expected that his language will be incorporated into the majority of hospital
agreements within the next three years.
C:\PPU\External
Organizations\Leapfrog\Score Sheet 2007\Response Supplements\Never Events Hospital Agreement_4-5-07.doc
4
Encourage physicians to employ
electronic prescribing technology.
The plan meets both of the following criteria:
i.
The plan utilizes incentives to
encourage and assist physician
practices to employ electronic
prescribing technology in at least 10
metropolitan markets.
ii.
The plan reports that in at least two
metropolitan markets, 25 percent or
more network physicians are employing
electronic prescribing technology
The plan utilizes incentives to encourage and
assist physician practices to employ electronic
prescribing technology in at least 10
metropolitan markets.
PARTIALLY MET
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
No.
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Electronic prescribing is a component of several physician pay-for-performance programs. Anthem Blue Cross and Blue Shield plans in Connecticut,
Maine, and New Hampshire include e-prescribing in the Technology/Structure section of their program scorecards. Provider groups can earn points by
having electronic prescribing installed and in use by the end of the measurement period. Anthem Blue Cross and Blue Shield in Virginia rewards PCPs
participating in its statewide pay-for-performance program that have electronic medical records that meet certain criteria, including decision support tools
using evidence-based medicine for pharmacy management – this includes electronic prescribing technology. Blue Cross of California’s pay-forperformance program allocates 20% of the overall score for medical groups to information technology measures, which include electronic prescribing.
The physician pay-for-performance program in Greater Cincinnati and Dayton, OH evaluates and scores use of electronic medical records. Both
components of the EMR metric must be met to receive credit: (1) the system must be able to store prescription information which allows the system to
identify allergies and potential drug interactions, and (2) the system must be able to identify patients with chronic diseases and specific disease
management requirements (e.g. HgbA1c in diabetics, flu vaccine in asthmatics, etc.).
Anthem Blue and Cross Blue Shield in Ohio has begun a pilot e-prescribing initiative with General Motors. It will involve 100 physicians and benefit
thousands of patients in Dayton, Ohio. The pilot will equip the participating physicians with computer hardware and software that provide instant access
to health plan formularies and patient medical histories. It will allow them to send prescriptions electronically to retail and mail order pharmacies.
Specifically, the targeted physicians have been offered free use of software needed for e-prescribing through MedPlus, a subsidiary of Quest Diagnostics,
as well as a $1,000 subsidy on the purchase price of a specific computer for use in the pilot. All groups that are also participating in the local Anthem payfor-performance program can also earn financial incentives by adopting and utilizing e-prescribing. The program is still too new to evaluate utilization of
e-prescribing by the physicians. We are committed to e-prescribing as a mechanism for reducing medication errors and providing more affordable care.
This e-prescribing pilot will be rolled out to additional markets. We will also be conducting studies to evaluate the impact on patient safety from eprescribing (e.g. reductions in drug-drug interactions). See “ePrescribing recruitment letter – Dayton – 7 21 06 All” document for a sample of the letter
that went out to physicians introducing the pilot.
In comparing results across plans, we caution that criteria (ii) can be evaluated differently by different plans. For example, should a physician that used eprescribing for just one script out of, say, a thousand count as a physician utilizing e-prescribing and be counted towards the 25% target?
We announced participation and collaboration with RxHub in February 2007, further demonstrating our support of e-prescribing. Anthem is also a partner
in the National E-Prescribing Patient Safety Initiative (NEPSI), a new coalition of technology companies, health care companies, and physician groups
that is dedicated to improving patient safety and eliminating medication errors by providing access to free electronic prescribing for every physician in
America. Anthem will play a key role in funding this program.
*Please contact Anthem or Leapfrog staff for additional information.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
4th Pillar: Opportunity Rate
No. 2007 Goal
1
Calculate and share the plan’s opportunity
rate on both an aggregate and employerspecific basis using the Leapfrog
methodology.
Fully Met
Partially Met
Not
Met
The plan meets all of the following criteria:
i.
The plan calculated and submitted to
Medstat the plan’s opportunity rate
using the Leapfrog Group methodology
https://leapfrog.medstat.com/or/
ii.
The plan shares the plan’s current
opportunity rate score with employers.
iii.
The plan shows 10% improvement over
the Leapfrog overall opportunity rate
reported by the plan in 2005/2006.
The plan meets each of the following criteria:
i.
The plan calculated and submitted to
Medstat the plan’s opportunity rate
using the Leapfrog Group methodology
https://leapfrog.medstat.com/or/
ii.
The plan either shares the plan’s
current opportunity rate score with
employers OR the plan shows 5%
improvement over the Leapfrog overall
opportunity rate the plan reported in
2005/2006.
PARTIALLY MET
Anthem has been working very closely with Medstat over the past several weeks to calculate the opportunity rate. We will report our opportunity rate
score when it is available. 2007 will serve as our baseline year.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
5th Pillar: External Collaboration
No. 2007 Goal
1
Define an implementation strategy to
work collaboratively with the 31
Leapfrog Group Regional Roll-Out leads
to increase hospital reporting of the
Leapfrog hospital survey and increase
implementation of the Leapfrog patient
safety and quality practices.
Fully Met
Partially Met
Not
Met
The plan meets all of the following criteria:
i.
The plan has designated an employee in
each of the 31 defined Leapfrog Group
Regional Roll-Out (RRO) areas where
the plan has covered lives to act as a
RRO liaison and coordinate efforts to
increase hospital reporting and
implementation of the Leapfrog patient
safety and quality practices5.
ii.
The plan has contacted each of the
RROs and offered to develop a
collaborative strategy designed to
increase survey reporting and
implementation of leaps.
iii.
The plan liaison with each RRO
actively participates in at least 50% of
RRO meetings and calls as requested
by the RRO and has submitted the
attached tracking sheet to reflect
achievement of this metric.
The plan meets both of the following criteria:
i.
The plan has designated an employee in
each of the 31 defined Leapfrog Group
Regional Roll-Out (RRO) areas where
the plan has covered lives to act as a
RRO liaison and coordinate efforts to
increase hospital reporting and
implementation of the patient safety
and quality practices.
ii.
The plan has contacted each of the
RROs and offered to develop a
collaborative strategy designed to
increase survey reporting and
implementation of leaps.
FULLY MET
Fourteen Regional Roll-Outs covering eleven states overlap markets in which Anthem has commercial business. See “RRO_List0207_Anthem Overlap”
to see those RROs and their leaders. We have identified individual contacts to actively participate in each of the RROs.
Though not formally participating in the RROs to date, Anthem has been involved in local activities to increase Leapfrog survey reporting and
implementation of the Leaps. For example, Anthem Blue Cross and Blue Shield in Ohio worked with Barbara Belovich of the Health Action Council,
and RRO lead in Northeast Ohio, to send out a letter signed by health plans and employers to all hospitals that have not yet reported to the survey in
April 2007. Similarly, Blue Cross of California’s Chief Medical Officer signed a letter coordinated by the Pacific Business Group on Health that was
distributed to hospitals encouraging them to participate (see “PBGH CA letter” file). In addition, Dennis Matheis, President of Anthem Blue Cross and
Blue Shield in Missouri joined the St. Louis Area Business Health Coalition, for which Louis Probst (the St. Louis RRO lead) is Executive Director, in
signing a statement supporting the "cornerstones of value-driven health care" at a March 2, 2007 press conference led by Missouri Gov. Matt Blunt and
U.S. Department of Health and Human Services Secretary Mike Leavitt.
5
Scorecard criteria relating to Regional Roll Outs apply only to RRO areas where the plan has covered lives.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
5th Pillar: External Collaboration
No. 2007 Goal
Fully Met
Partially Met
Not
Met
Blue Cross of California also sent out its own letter to hospitals (see “2006_ltr to CA Hospitals” file). Anthem Blue Cross and Blue Shield in Colorado
mailed a letter to hospitals (see “2006 CO Letter to Hospitals – Final” file). BlueCross BlueShield of Georgia annually mails a letter to network hospitals
encouraging them to participate in the Leapfrog Survey (see “Leapfrog letter06 GA” file). This letter is sent to all participating hospitals in the Atlanta
and Savannah areas that have not submitted Leapfrog Survey data.
C:\PPU\External
C:\PPU\External
C:\PPU\External
C:\PPU\External
Organizations\Leapfrog\Score
Organizations\Leapfrog\Score
Sheet 2007\Response
Organizations\Leapfrog\Score
Sheet
Supplements\PBGH
2007\Response
Organizations\Leapfrog\Score
CA
Sheet
Supplements\2006_ltr
letter.pdf
2007\ResponseSheet
Supplements\2006
to CA
2007\Response
hospitals.doc
COSupplements\Leapfrog
Letter to Hospitals - Final.doc
letter06 GA.doc
2
*Please contact Anthem or Leapfrog staff for additional information.
Participate in coordinated hospital
The plan participates in at least two of the
performance measurement initiatives with following in a coordinated measurement
other plans and/or with purchasers.
initiative with other plans or with purchasers:
i.
standardized measures of hospital
Best practice:
performance,
The Wisconsin Collaborative for
ii.
standardized measures for hospital
Healthcare Quality is working to develop
incentives, and/or
iii.
pooling data with other plan(s) to
verifiable measures for public reporting.
measure and report hospital
http://www.wisconsinhealthreports.org/
performance.
FULLY MET
The plan participates in at least one of the
following in a coordinated measurement
initiative with other plans or with purchasers:
i. standardized measures of hospital
performance,
ii. standardized measures for hospital
incentives, and/or
iii. pooling data with other plan(s) to measure
and report hospital performance.
The California Hospital Assessment and Reporting Taskforce (CHART): Implementation date: 2007; Pools data for hospital feedback, benchmarking,
consumer rewards and payment rewards. CHART is a voluntary collaboration among hospitals and health plans in California. CHART has defined more
than 50 hospital performance indicators that include process and outcome measures in specific clinical areas such as cardiac care, maternity, pneumonia
treatment, and intensive care. They also include hospital-wide outcomes in areas such as patient experience, nursing-sensitive measures, and
appropriateness of cardiac procedures. The measures are aligned with national initiatives such as the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) and the National Quality Forum (NQF). More than 200 hospitals, representing 70% of all hospital admissions in California,
agreed to participate in the voluntary effort. The major health plans working in California [Blue Cross of California, Blue Shield of California, Health
Net, and PacifiCare] have agreed to use the data as the basis for quality reporting and have committed to providing some financial support. Government
and regulatory agencies are actively supporting the effort, including the California Office of Statewide Health Planning and Development (OSHPD) and
JCAHO, as well as the PBGH and CalPERS. Program details can be viewed at http://www.chcf.org/topics/hospitals/index.cfm?itemID=111065.
The Colorado Health and Hospital Association (CHA) Performance and Quality Group is a collaborative effort by twelve major health care, business,
and governmental organizations. Participants include Colorado Hospitals Quality Managers, Colorado Business Group on Health, Colorado Medical
Society, Centers for Medicare and Medicaid Services, Colorado Foundation for Medical Care, COPIC, Business Council on Health Care Competition,
Physician Health Partners, Colorado Health Institute, Colorado Association of Health Plans, and the Colorado Department of Public Health and
Environment. Anthem Blue Cross and Blue Shield in Colorado is part of this collaborative. This group has selected quality indicators, and encouraged
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
5th Pillar: External Collaboration
No. 2007 Goal
Fully Met
Partially Met
Not
Met
Colorado hospitals to voluntarily release these quality indicators to the public. The group has overseen the development and publication of the data. This
website provides additional information: http://www.hospitalquality.org/.
Care Focused Purchasing (CFP) is a Mercer-led initiative to aggregate claims data from participating health plans (Anthem, Aetna, CIGNA,
FiservHealth, Humana, Preferred Care, and Regence BlueShield) and self-insured claims data from participating employers. The data will be housed in a
repository and be available to measure quality and efficiency at the provider level. Priorities include: 1) standardized performance measures of quality
and efficiency for hospitals and physicians; 2) produce detailed information request to measure quality and efficiency; 3) share provider performance
measures; 4) open and accessible information about hospital and physician performance.
Blue Health Intelligence (BHI) is another data pooling initiative Anthem is participating in. There are 20 Blues plans participating covering 79+ million
members in the Blues system. This will be the deepest data repository available when completed.
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
5th Pillar: External Collaboration
No. 2007 Goal
3
Participate in coordinated physician
performance measurement initiatives with
other plans and/or with purchasers.
Fully Met
The plan participates in at least two of the
following in a formally coordinated initiative
with other plans/purchasers:
i. standardized measures of physician
Best practice:
performance,
Massachusetts Health Quality Partners is ii. standardized measures for physician
a broad-based health care coalition to
incentives, and/or
promote valid, comparable measures to
iii. pooling data with other plan(s) to measure
drive quality improvement.
and report physician performance.
www.mhqp.org/default.asp?nav=010000
FULLY MET
Partially Met
Not
Met
The plan participates in at least one of the
following in a formally coordinated initiative
with other plans/purchasers:
i. standardized measures of physician
performance,
ii. standardized measures for physician
incentives, and/or
iii. pooling data with other plan(s) to measure
and report physician performance.
California Pay for Performance Program, Integrated Healthcare Association (IHA): Implementation date: 2004; Pools data for physician feedback,
benchmarking, consumer reporting and payment rewards. Participants: Integrated Healthcare Association; California Health Plans: Aetna, Blue Cross of
California, Blue Shield of California, CIGNA, Health Net, PacifiCare, Western Health Advantage; 225 Physician organizations representing 35,000
California Physicians. Measures include: appropriate long-term medication use for people with asthma, cardiac hyperlipidemia (LDL controlled <130
mg/dL & lipid management), diabetes (A1c test annually, A1c poorly controlled, LDL controlled <130 mg/dL, and nephropathy monitoring), preventive
care for children (immunization status), preventive care for women (breast cancer, cervical and Chlamydia screenings), and the appropriate use of
antibiotics in children with URI.
Improving Performance in Practice (IPIP) Program, Colorado Clinical Guidelines Collaborative. Implementation Date: 2006; Integrates quality
improvement and data collection methods into practices; pools data from multiple sources into disease management registry for physician feedback,
benchmarking and (in the long-term) consumer reporting. It also prepares physicians to participate in local P4P programs. Participants include (currently
have over 50 participants): Colorado Clinical Guidelines Collaborative; Colorado Health Plans: Anthem Blue Cross and Blue Shield in Colorado, Aetna,
CIGNA, Colorado Access, Kaiser Permanente, UnitedHealthcare, and other, smaller plans; Medical Groups: Exempla Physician Group, MedSouth, New
West Physicians, Physician Health Partners, University Physicians, and others; Medical Societies: Colorado Medical Society, American Academy of
Family Physicians, American Academy of Pediatrics, American Cancer Society, and others; Employer participants: Colorado Business Group on Health;
Hospital Systems: Exempla, HCA, The Children’s Hospital and University of Colorado Health Sciences Center. Measures include: diabetes (A1c testing
& control, eye exam, blood pressure, LDL and LDL control, foot exam, smoking status, etc.) and asthma (medication management, influenza
vaccinations, documented action plan, smoking assessment and cessation counseling).
Quality Health 1st of Indiana program, Indiana Health Information Exchange (IHIE): Implementation date: 2007; Pools data from multiple payer sources
for physician feedback, benchmarking, consumer reporting and payment rewards. Participants: Indiana Health Information Exchange; Indiana Health
Plans: Anthem Blue Cross and Blue Shield in Indiana, M-Plan, MDwise, Medicare, UnitedHealthcare, and Humana; Medical Groups: Clarian Health
Partners, Community Physicians of Indiana, IU Medical Group, Methodist Medical Group, St. Francis Medical Group, St. Vincent Physician Network,
The Care Group and American Health Network. Measures include: children’s health (strep testing, URI), women’s health (breast, cervical and
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2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
5th Pillar: External Collaboration
No. 2007 Goal
Fully Met
Partially Met
Not
Met
Chlamydia screenings), diabetes (A1c testing and control, lipid profile and control, nephropathy) and appropriate medications for people with asthma.
There is an initiative in Maine run through the Maine Health Management Coalition (MHMC) called Pathways to Excellence (PTE). There are over 40
members, including employers (e.g. Hannaford Bros. and Maine State Employees), doctors, hospitals, and health plans [including Anthem Blue Cross
and Blue Shield in Maine, Aetna, CIGNA, and Harvard Pilgrim]. The MHMC does obtain all payer data for their analysis and reporting, but this is not a
pay for performance program. This is a reporting and information vehicle as they have listed this information online for consumers to access. Some of the
other health plans in the area have rewarded the physicians based on the number of ribbons they receive from PTE, but that is entirely separate from the
MHMC. Anthem submits monthly data feeds to the Maine Health Information Center (MHIC) who collects the data for the Maine Health Data
Organization (MHDO). The file feeds consist of: eligibility, medical claims and prescription drug claims for fully insured and ASO business across all
product lines; and line level detail for medical claims and prescription drugs. Per the state mandate, we submit data for Maine residents that are insured
by Anthem. Per a separate agreement, we submit data for the Coalition firms' out of state members. Anthem has worked closely with the MHMC to
utilize their technology survey so the physicians, when applicable, would not have to enter two surveys. We receive that data back from the MHMC and
feed it into our existing P4P program. However, that is only one component of our existing P4P program and the only piece of information we currently
use from the MHMC. More information on the MHMC can be found at: http://www.mhmc.info.
Care Focused Purchasing (CFP) is a Mercer-led initiative to aggregate claims data from participating health plans (Anthem, Aetna, CIGNA,
FiservHealth, Humana, Preferred Care, and Regence BlueShield) and self-insured claims data from participating employers. The data will be housed in a
repository and be available to measure quality and efficiency at the provider level. Priorities include: 1) standardized performance measures of quality
and efficiency for hospitals and physicians; 2) produce detailed information request to measure quality and efficiency; 3) share provider performance
measures; 4) open and accessible information about hospital and physician performance.
4
Blue Health Intelligence (BHI) is another data pooling initiative Anthem is participating in. There are 20 Blues plans participating covering 79+ million
members in the Blues system. This will be the deepest data repository available when completed.
Support hospital participation in the IHI’s The plan creates incentives and rewards for
The plan creates incentives and rewards for
5 Million Lives campaign to encourage
facilities to succeed in the 5M lives Campaign
facilities to succeed in the 5 Million lives
hospital progress towards patient safety
Lives Campaign by doing at least three of the
campaign by doing at least two of the following:
and quality
following:
i.
publicly recognizing hospitals
i.
publicly recognizing hospitals
participating in IHI 5 Million Lives
http://www.ihi.org/IHI/Programs/Campai
participating in IHI 5 Million Lives
campaign.
gn/
campaign.
ii.
financially rewarding effective
ii.
financially rewarding effective
organization-wide introduction of the
organization-wide introduction of the
Campaign interventions.
Campaign interventions.
iii.
supporting hospital participation by
iii.
supporting hospital participation by
offering financial assistance for related
offering financial assistance for related
improvement work or by subsidizing
improvement work or by subsidizing
facilities to take part in Campaign
facilities to take part in Campaign
education sessions or meetings.
education sessions or meetings.
iv.
hosting an expert-led learning session
19 of 20
2007 Health Plan Users Group Scorecard – 2-14-07 DRAFT
5th Pillar: External Collaboration
No. 2007 Goal
Fully Met
iv.
hosting an expert-led learning session
on 5 Million Lives Campaign
interventions and on the quality
improvement methods known to drive
change.
Partially Met
Not
Met
on 5 Million Lives Campaign
interventions and on the quality
improvement methods known to drive
change.
PARTIALLY MET
Anthem’s hospital pay-for-performance programs already allocate points towards implementation of the interventions included in IHI’s 100,000 Lives
Campaign (e.g. deployment of rapid response teams). In addition, some of the individual metrics within the new 5 Million Lives Campaign intervention
domains are included in existing hospital P4P programs (e.g. ACEI/ARB for LVSD, D2B time for primary PCI, and discharge instructions rate for heart
failure). The enterprise Hospital Measures Workgroup is discussing how to pull additional interventions and indicators into P4P programs.
Anthem has initiated discussions with hospitals participating in the Quality-In-Sights®: Hospital Incentive Program (Q-HIPSM) in Connecticut, Maine,
New Hampshire, Virginia, Georgia, and New York regarding the inclusion of 5M Lives Campaign interventions into the program.
Anthem Blue Cross and Blue Shield in Indiana, Ohio, Missouri, and Kentucky are asking network hospitals if they have signed up for the 5M Lives
Campaign. Several of the Campaign indicators will be added to the 2007 hospital RFI in those states (e.g. VTE prophylaxis and treatment, infection
control guidelines for MRSA, conducting active surveillance cultures on all admitted patients, reducing pressure ulcer occurrence, some SCIP measures,
and some of the CHF measures).
An article on the 5M Lives Campaign is being included in upcoming plan newsletters to providers across all Anthem plans enterprise-wide, giving
information on the Campaign and encouraging hospitals to participate. See “IHI 5M article_Template” document for the template article used by each
plan.
The Blue Cross and Blue Shield Association gave $5 million to IHI, a significant portion of which came from Anthem, to help get the 5M Lives
Campaign off the ground and demonstrate support for the initiative.
C:\PPU\External
Organizations\Leapfrog\Score Sheet 2007\Response Supplements\IHI 5M article_Template.doc
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