By: Rick Murdock
MAHP’s Pinnacle Awards are always one of the high points of the year for our association – and for me, personally.
Yes, I’m an association executive, and I know that we need to keep a focus on the bottom line. But I’m also a firm believer in the ability of our members to do well by doing good – and the Pinnacle awards are proof that we put improving the health of Michigan as a high priority, and in doing so, help out the bottom line.
The Pinnacle Awards we issued on Sept. 16 at the Kellogg Hotel and Conference Center in East Lansing recognize innovation in delivering better health care, more efficiently. This year, one of the trends I saw was more health plans using data to pinpoint their members who use high levels of service, and trying to figure out how to serve them in a way that will reduce their needs – and therefore, the overall costs of serving them.
We are all aware of the 80-20 rule of thumb. In our industry, it can sometimes be more like 90-10 – 90 percent of the costs of health care are involved in caring for 10 percent of the population. Those can be complex cases, people with multiple conditions and needs. It can be the elderly – dual eligibles, in our case, seniors who are also quite poor. It can be children born with special needs. It can be people who live in “medical deserts,” rural areas with few service provides or in some urban areas when clinics move to suburban locations and transportation is a challenge.
We saw several Pinnacles go to health plans figuring out how to deliver services to these special needs populations.
- HealthPlus of Michigan partnered with Flint’s Hurley Medical Center to open a clinic to care for a relative handful of patients who were using a very high level of services, especially emergency room and inpatient services. Examining data, Health Plus decided to put a special clinic aimed at better serving 100 members and $100,000. Year one saw 33 members served, a cost savings of $334,287 and a 78 percent reduction in non-emergent ER utilization.
- Priority Health set up a way that members with less serious conditions can jump on the phone or online with board-certified doctors to get advice on how to care for their conditions – keeping people out of the ER, and giving them access to the health care services they need right at home.
- Molina Healthcare developed a system of bringing post partum the visits to the women’s homes. The visits included a postpartum assessment, education for the mother and a postpartum depression screening. Molina’s Healthcare Effectiveness Data and Information Set (HEDIS) rate increased from 64.10 percent in 2012 (25th percentile) to 72.79 percent in 2014 (75th percentile).
These are a just a few examples of great ideas to serve people better. You can read hereabout all the great submissions we received this year.
Our mission at MAHP is “to provide leadership for the promotion and advocacy of high quality, affordable, accessible health care for the citizens of Michigan.” Our members are providing that leadership, every day, and the Pinnacle Awards makes some of their great ideas a little more visible.