physician practices for quality improve- ments. Blue Cross and Blue Shield of Texas has had success using medical home models to coordinate care, reduce costs, and improve the health of its com- mercial patients by providing practices with resources like care coordinators. The Blues plan is working with the state to apply those strategies to Med- icaid. “But the Medicaid population is more challenging from a financial and administrative perspective,” Blues ex- ecutive Scott Albosta says. For instance, Medicaid patients typically require more outreach but can enroll and disenroll on a monthly basis, making it difficult to track and coordinate their care. Mr. Albosta, vice president of network performance management, says the Blues plan is responding to the state’s call to find a solution, including working with other carriers on common quality metrics and models. “It’s really going to take trial and error. But not unlike what we did in the commercial population, we evolved as we went and got better.” Ms. Ghahremani acknowledged that
reducing costs by cutting payment rates “does not do us proud and does nothing to improve quality,” but says physicians and health plans must do their part. Overuse of certain services, for ex-
ample, remains an obstacle to reducing costs. She pointed to new guidelines cutting back the frequency of recom- mended mammogram screenings that she described as largely ignored. “And if we really want to make change … pay- ers need to talk to each other.” Dr. Chassay added that the state “hopes to align with quality measures that are already out there” to help minimize the burden on physicians and others. “All stakeholders have to come together to decide how much improve- ment we have to make, but we have to continue moving the needle.” Considering the challenges, Dr. Pe- terson says, physicians and health plans have already made significant progress since the move to managed care. Texas exceeds the national average, for in- stance, on quality measures related to immunizations, well-child visits, and asthma care. “And there are bright spots that we
need to replicate, like the low caesar- ean section rates in some of our teach- ing hospitals,” she said. While those are good places to start, the next step will be finding “those elements that are already working, and the two or three things we want to concentrate on improving in the
state of Texas that we [payers and pro- viders] can all agree on,” which will take time. n
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
CALL FOR POSTERS
Applications due Feb. 28
The TMA Council on Health Care Quality and TMF Health Quality Institute are excited to host the second annual TexMed Quality Poster Session.
All TMA member physicians and their practices are encouraged to apply. This is a great opportunity to share patient-care quality improvement successes and best practices for quality patient care.
• Winners will receive special recognition at TexMed 2014.
• Texas Medicine magazine will list all selected submissions.
• Selected submitters who exhibit will receive a $100 travel voucher.
Attendees may earn 1 AMA PRA Category I Credit TM
with ethics. The TexMed 2013
poster session, with 23 submissions, was one of the best-attended programs and received excellent reviews.
TEXMED 2014 QUALITY CME
POSTER SESSION WHERE: Fort Worth
Convention Center WHEN:
TexMed 2014
Saturday, May 3, 2014 HOW:
Contact
posters@texmed.org for more information and an application packet.
December 2013 TEXAS MEDICINE 61
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68