Provider Reimbursement Enhancement and the Advanved Medical Home-results of a Pilot Study.

1. Advancing Primary Care through Changing Reimbursement: Provider Based Disease Management and the Advanced Medical Home. David S Hanekom, M.D. Medical Director Blue Cross Blue Shield of North Dakota The National Healthcare Incentives Institute October 21, 2008 Washington, DC

5. Diabetes Clinical Outcomes

6. CAD Clinical Outcomes

7. HTN Clinical Outcomes

8. ER and Inpatient Admissions

9. Global Costs: Actual vs. Expected 2.46% -7.79% -6.06% Blue Cross Blue Shield Contributed Dollars Member Contributed Dollars Sept 06 – Sept 07 Sept 07 – Sept 08 Average Cost Trend 10%

10. Pharmacy Claims

11. Professional Claims 7.41% 6.25% 6.47% Average Cost Trend 10%

12. Institutional Claims -6.26% -21.4% -20.34% Average cost trend 10%

13. ROI

18. MediQhome Information Technology