pennsylvania healthcare cost containment council seeing is believing francis s. soistman president...

Pennsylvania HealthCareCost Containment Council

Seeing is Believing

Francis S. SoistmanPresident and CEO

June 4, 2003

• Subsidiary of Coventry Health Care, Inc.

• HealthAmerica & HealthAssurance

• Regional health plan founded in 1975• Over 650,000 members• 132 hospitals & 17,000 doctors• Over $1.3 billion in revenue run rate• Full product spectrum• Highly experienced leadership team

HealthAmericaOverview

Service Area

• Never compromise quality–HEDIS®--highest quality ratings in the region and above national averages

• Customer-driven• Efficiency through

technology• Innovative in medical

management and products

Our Approach

• Shows how we compare against our peers & state averages

• HealthAmerica and/or HealthAssurance:–Surpassed competitors in 10 of 15 measures for preventive care

–Surpassed state and national averages in all but1of 15 measures

Utilization of PHC4

HEDIS Scores

HEDIS Scores

HEDIS Scores

HEDIS Scores

HEDIS Scores

• Gives ideas for new initiatives for improving–Always room for improvement–Diabetic incentive program to improve outcomes

We are well organized to supply data–HEDIS –Data warehouse

Utilization of PHC4

Quality Improvement

•Identify issue•Collect data

•Analyze data for concern

Baseline

Improvement

•Draw conclusion•Formulate action plan

•Implement plan•Remeasure

•Modify as needed

Utilization PHC4

• Quality comparative information about health care is minimal

• Heath care decisions can be the most important of an individual’s life

• Plethora of subjective, erroneous, and biased information

• Comparative information can be of help

Filling the Void

• To make educated decisions, unbiased information is needed

• PHC4 fills part of the void

• Useful to those who emphasize quality

• Cost of care is still important

• The available information serves as a good foundation

Managed Care

• Focus on competitive differences• Optimize outcome• Stimulates plans with lower scores to

improve• Plans with higher scores still focused on

improvement• Size of plan doesn’t matter• Health of community is improved

Future

• Help foster discussion between all players

• Set the stage for collaboration

• Best health care system in the world

• Solutions exist

Solutions

Solutions

Solutions

Future

• Accountability by all

• We’re in this together

• Courage to make change