Population Health Management Texas Medicine February 2018

The Power of Physician Leaders

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Commentary — February 2018

Tex Med. 2018;114(2):12-13.

By Esteban López, MD, MBA

Since the practice of medicine began, the role of physicians in preventing and treating disease and fostering overall well-being has been irreplaceable. Even as we fast-forward to 21st-century medicine ― with cutting-edge technologies, global connectivity, advances in medical practices, and state-of-the-art diagnostic and treatment tools ― the simple act of laying a trained physician’s hands on a patient remains at the core of today’s health sector.

Today, Blue Cross and Blue Shield of Texas (BCBSTX) operates as a physician-led health insurance provider, and this is not an accident. Our company remains centered on fulfilling our promise of “doing everything in our power to stand with our members, in sickness and in health.” We know that doctors bring a unique and indispensable perspective that enhances our accountability to our more than 5 million members.

Population health management is but one example of where this leadership structure provides our company with insight and subject-matter expertise. Delivering on the promise of population health management and value-based care is an expression of the purpose we’ve had since day one. As a customer-owned insurer ― where shareholders and short-term dividend targets have no place in our decisionmaking ― members rely on us to be responsible stewards not only of the health care they access, but also of the cost to their pocketbooks in receiving it.

To advance public health, and the health of our members, we are committed to championing a new mindset within the health care sector ― moving from a fee-for-service to a fee-for-value payment model. Influencing our sector in such a way will take time and will require a new cultural mindset. Value-based care presents an opportunity to deliver smarter care for better health. At this critical tipping-point moment in health care, many players are stepping up with creative solutions that raise expectations and shift industry focus from paying for services to delivering better health outcomes.

BCBSTX’s physician-led, value-based care initiatives include accountable care organizations (ACOs), such as those crafted through TMA PracticeEdge ― a joint effort with the Texas Medical Association. Many ACOs are constrained by their ties to a specific hospital system. TMA PracticeEdge eliminates this dependency and helps connect independent physicians centered on the needs of their specific patients by offering them the means to provide coordinated collaborative care, including prevention and management of chronic disease. Results take time, and TMA PracticeEdge is still in its infancy. However, our other ACOs already are showing promise: Claims data show a 19-percent reduction in emergency department visits and an 8.9-percent reduction in the average length of a hospital stay for acute inpatients. 

At BCBSTX, we’re confident that coupling client insights with a physician-led mindset will deliver new and improved ways to manage a population’s health. For example, BCBSTX now offers employers a proprietary methodology for identifying high-risk, high-cost members. Using this methodology, we can predict the care-seeking behaviors of an employer’s workforce using member segmentation, allowing for proactive clinical action to help improve quality of care. This paves the way for early identification of members who may meet or exceed high-cost thresholds and can lead to targeted interventions that improve health outcomes while lowering costs. 

As a statewide health insurance company, BCBSTX is uniquely positioned to address health and wellness issues on a much larger scale, not just for our members. The physician-led mindset prompted BCBSTX to focus community investment resources on a more focused, long-term effort in hopes of yielding notable improvements in two specific disease states. We will help raise awareness around the prevention and early detection of diabetes-related chronic kidney disease and chronic obstructive pulmonary disease (COPD). 

Our claims data show that these two health issues greatly impact health care costs, as well as the life span, productivity, and quality of life of millions of Texans. Last year, BCBSTX claims data showed a 107-percent increase in diabetes with chronic conditions. In 1982, diabetes accounted for 27 percent of patients with kidney failure. By 2012, that percentage had nearly doubled to 47 percent. Data show higher incidence of diabetes in the southern regions of Texas, largely affecting Latinos and African-Americans. In northern Texas, Caucasians are predominately affected by COPD, with the highest morbidity and mortality affecting white women.

Under the guidance of a physician leader, our teams can study claims data to identify trends that impact the health of a mass of people ― whether it’s a specific workplace, a specific community, or a specific patient population. At the end of the day, health information is only helpful when it is meaningful information.

Esteban López, MD, MBA, is chief medical officer for Blue Cross and Blue Shield of Texas.

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Last Updated On

April 19, 2018

Originally Published On

January 19, 2018

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