Quality Initiatives are a part of Blue Cross Blue Shield of Michigan’s (BCBSM) Physician Group Incentive Program (PGIP), which promotes information sharing about today’s health care issues. Each initiative is designed to improve the health care system within the state of Michigan. Mercy Physician Community Physician Hospital Organization of Port Huron implements these programs as an approach to achieving comprehensive primary and specialist care with associated patients.
Advance Care Planning
Advanced Care Planning (ACP) is an initiative of Blue Cross Blue Shield of Michigan (BCBSM) as part of their Physician Group Incentive Program (PGIP). ACP addresses the management of end-of-life issues and concerns, and, is designed to help improve the quality of care for patients. LHMC PHO uses ACP to help their practice units monitor how end-of-life medical decisions can impact the quality of a patient’s final days of life. Physician awareness gives our members the ability to educate their patients regarding care options near the end of life. Essentially, promoting awareness to physicians while increasing knowledge for patients allows for an Advanced Care Plan to be established in an appropriate manner well before a life threatening event occurs. An additional goal of LHMC PHO is to increase awareness throughout the community so that ACP can be talked about comfortably in other avenues such as community service agencies.
The Lake Huron Medical Center PHO target of providing first-rate Cardiac Care begins with the Blue Cross Blue Shield of Michigan’s (BCBSM) Cardiac Care Initiative (CCI). The main objective is to ensure optimal efficiency and quality of services provided to cardiac patients. Actively engaged cardiac specialists within our PHO who are enrolled in BCBSM’s Physician Group Incentive Program (PGIP) have become involved with instituting specific criteria to meet the CCI requirements. Each practice is responsible for managing the use of services, optimizing quality of care, and working collaboratively with primary care physicians to develop an improved shared process of care. The initiative is designed to reduce the use of unnecessary diagnostic procedures to control cost while enhancing cardiac care provided to patients.
Electronic Prescribing Initiative
Since Blue Cross Blue Shield of Michigan (BCBSM) began its Electronic Prescribing Initiative (E-Prescribing), the state of Michigan has become a national leader in the movement. LHMC PHO has adopted the E-Prescribing Initiative, where our physicians can directly send their prescription to their patient’s pharmacist through a secure Web portal, in an accurate and legible manner. The efficiency of this concept emphasizes providing patient safety. Physicians are able to see the list of medications prescribed to their patient, including drug allergies, dosing, and even possible issues regarding drug combinations. As with each incentive within BCBSM’s Physician Group Incentive Program (PGIP), E-Prescribing is essential to improving the efficiency regarding a physician’s delivery of care to their patients. E-Prescribing cuts down on paper waste in addition to minimizing time taken between pharmacists and doctor offices trying to sort out orders properly.
Emergency Room Initiative
In 2009, the Emergency Department Utilization (EDU) Initiative was introduced by Blue Cross Blue Shield of Michigan. The EDU initiative focuses on creating an impact on primary care sensitive emergency department use rates and associated costs With the data that can be provided, physicians are able to identify conditions related to primary care sensitive emergency department use. By developing the capability to identify related conditions in addition to increasing physician participation, LHMC PHO’s goal is to reduce the emergency room use rate. In preventing the emergency department from becoming occupied with non-emergency issues, health care costs can decrease. Lake Huron Medical Center PHO provides its Primary Care physicians daily reporting of patients who have been discharged from the local hospitals’ ED, allowing practices to reach out to patients for timely follow up appointments. Monthly ED tracking reports are shared with the PHO’s Quality Committee and periodically with PCPs.
Evidence Based Care Reporting Initiative
Evidenced Based Care Reporting (EBCR) encourages the adoption of evidence-based guidelines to improve the quality of care provided by physician organizations. The resources providing the evidence come from performance reports produced by the Physician Group Incentive Program. Physicians are able to identify opportunities for improvement by analyzing data, resulting in better outcomes due to more effective delivery of care. Engaged physicians within Mercy PHO are encouraged to use available data, providing consistency throughout the EBCR program. Continual performance reviews based on EBCR will contribute annually to the improvement of Mercy PHO’s commitment to quality care.
Generic Dispense Initiative
Lake Huron Medical Center PHO has been actively promoting increasing the use of Generic Drugs. Where medically appropriate, LHMC PHO physicians prescribe the generic equivalent as opposed to the more expensive brand name drug. This method plays a role in accomplishing a measurable improvement in cost, which contributes to our ongoing effort to reduce health care costs. Blue Cross Blue Shield of Michigan (BCBSM) has provided initiative and leadership for collaborative efforts to occur throughout LHMC PHO by including the Generic Dispense Initiative as a part of their Physician Group Incentive Program. Continual improvements regarding the process of care will come from sharing successful techniques from other practices on how to improve generic dispense rate. Our PHO has added pharmacists to their team to help physicians identify opportunities in increasing their generic use rate.
The Obstetrics and Gynecology (OB/Gyn) Initiative provides an opportunity for the Lake Huron Medical Center PHO OB/Gyn physicians to use Blue Cross Blue Shield of Michigan provided data and improved care processes. In addition, there are quality improvement efforts to encourage evidence-based utilization of hysterectomy and labor induction.
Radiology Management Initiative
The Radiology Management Initiative deals with the concept of radiation exposure from diagnostic imaging. With the increased usage of screening machines in recent years, a heightened awareness regarding this issue has become apparent. By increasing physician knowledge regarding radiation exposure, the Radiology Management Initiative plans to develop a patient understanding as well. Using reports to measure cumulative radiation exposure for each attributed member can provide additional perspective on how to approach this subject moving forward. Besides examining the radiation exposure dangers, LHMC PHO strives at developing ways to reduce duplication of radiology services, by increasing secured health information exchanges. Along with reducing duplication, the promotion of the “Choosing Wisely” evidence-based guidelines to encourage the “right radiology at the right time” is a cornerstone of the LHMC PHO’s radiology program that can provide education to patients on appropriate times for use of radiology.
Transitions in Care
Transitions in Care places the responsibility for improvement of care transition on hospitals and ambulatory based physicians. As an initiative of Blue Cross Blue Shield Michigan’s Physician Group Incentive Program, physicians are expected to improve the transition from the hospital to home or to an on-going care setting. Currently, gaps in care transition are preventing effective patient transferring from each level of care. The Transitions in Care incentive aims to minimize wasteful healthcare utilization that results from poor communication, processes, and procedures. Moving forward, the Transitions in Care incentive will become an essential step towards providing not only smarter, but high quality of care. Making sure that patients have a clear understanding of their medical condition and what to expect after discharge is essential for their well being – especially understanding their medications at discharge. With good transitions in care, patients will benefit from the peace of mind knowing their care is being well-coordinated between the hospital and their primary care provider.