Healthcare that Works: - LiveWell Colorado

Anthem Blue Cross of CaliforniaTake Charge of Your Health – Self-Care InitiativeThe aim of the Anthem Blue Cross of California Self-Care Initiative is to redirect plan membersfrom emergency room (ER) care to their primary care physician (PCP), encourage self-care whenappropriate and provide members with health education resources. The primary targets of theprogram are high ER utilizers – plan members with three or more ER visits within a 12-monthrolling time period. Program resources are allocated by risk category. All members enrolled in theSelf-Care Initiative receive health information and the Healthwise Handbook: A Self-Care Guidefor You by mail.An outreach call is made to provide information about PCP appointment scheduling,transportation options, community resource referrals, and nurse or social worker caremanagement pre-screening. In addition to these outreach efforts, those members considered athighest risk are offered help with pain management, complex care coordination and prescreeningfor entry into disease-management programs or nurse care management. Data arecollected about barriers to PCP care in order to proactively address those which might becontributing to ER overuse (e.g., appointment availability and access to after hours care).Though start-up and administration costs of the program are considerable, the monetary andnon-monetary return on investment are significant in terms of decreased ER utilization,improved hospital relations, better access to care—and most importantly, improved individualhealth.Results• In a population of 12,525 members enrolled in the program, there was a 51 percentdecrease in ER usage in the 12 months following the program compared to the 12 monthsprior;• Of those enrolled members without a PCP or specialist visit in the past 12 months, over 34percent had such a visit in the 12 months following the initiative, indicating that theprogram was encouraging or facilitating PCP-based care;• Of the 12,252 members enrolled there were $7.8 million less in paid claims for the 12-month period following the intervention compared to the 12 months prior to theintervention.***For further information, please visit, http://www.anthem.com/.Anthem Blue Cross of California, Blue Cross and Blue Shield ofGeorgia and Anthem Blue Cross and Blue Shield of MissouriGenericSelectGenericSelect was launched to reduce escalating prescription drug cost without compromisingthe quality of care. The program teaches consumers, doctors and pharmacists about the safetyand cost-effectiveness of generic drugs.GenericSelect targets drugs used to treat depression, high cholesterol, acid reflux, high bloodpressure, diabetes and arthritis pain. The list of GenericSelect drugs are among the mostcommonly prescribed medications available, accounting for 35 percent of prescriptionexpenditures. The drugs covered by the GenericSelect program were chosen because theycontinue to provide significant medical value and are considered by physicians and pharmaciststo be just as safe and effective as their brand name counterparts. As the FDA continues to

approve new generic medications, other drugs may be added. Members who participate can havethe co-pay for their first prescription waived or discounted up to $10.Studies show that a one percent increase in generic drugs for the selected classes in this programsaves as much as $5 million a year.Results• After introducing GenericSelect in December 2002, Anthem Blue Cross of Californiarealized an 18 percent increase in the use of generics in the first two years with nodecrease in the quality of care.***For further information, please visit, http://www.anthem.com/.Bank of AmericaBank of America is one of the world’s largest financial institutions and employs more than178,000 associates in the United States. When Bank of America and Fleet Boston Financialmerged on April 1, 2004, the new company’s leaders leveraged the best wellness practices of bothorganizations. With an associate population of 42,000, Fleet had offered creative,comprehensive, wellness and prevention initiatives for over 20 years. Bank of America’s use ofSix Sigma methodology and its experience with wellness and health management provided newinsights into program strategy and design.The goals of the Bank of America program include educating and motivating employees tooptimally manage their personal, family, health and safety needs. This is accomplished through: Health risk assessments – available to all employees through the Internet; Fitness – on site fitness centers, walking initiatives, home workout kits, discountedfitness programs; Nutrition – online resources to help associates set and attain nutrition and exercisegoals, “At Work” Weight Watchers Program, Healthier Food Choices Program, sitespecific nutrition lectures and cooking demonstrations, healthy food offerings incafeteria; Smoking cessation program – covered 100 percent by the company, a 50 percentpharmacy subsidy for pharmacotherapy and telephonic/ online coaching; Health advocate program – dedicated case managers through two nationalhealthcare insurers that work with bank employees and dependents to help them withcatastrophic and complicated cases; Disease management program: two national insurance companies; insurancecompanies use predictive modeling and physician referral system to recruit certainpatients for the program.Bank of America uses health risk appraisals, surveys, facility assessments, health fairs, wellnessprogram enrollment and medical claims data to analyze population demographics and improveprogram design. The analysis helps the bank achieve operating plan goals and allows it tomeasure associate health and satisfaction and to demonstrate return on investment. Bank ofAmerica uses insurance claims data and Voice of the Customer (VOC) research to improve itshealth programs. VOC involves regular surveying of associates about health and wellnessinitiatives.Results

Bank of America’s health promotion program reduced insurance claims on average by$164 per-participant per-year compared to an average increase of $15 per-year for thecontrol group that did not participate in the program;Bank of America saved $6 for each dollar invested in its wellness program;The disease management program is showing a high percentage of identification, withclose to 6 percent identification of diabetics (close to overall U.S. benchmark of diabetesprevalence);The smoking cessation program resulted in a 31 percent quit rate over a 12-month period.***For further information, please visit, https://www.bankofamerica.com/index.jsp.Blue Cross and Blue ShieldPrevention Minnesota (Smoking Cessation)Blue Cross and Blue Shield of Minnesota’s comprehensive approach to reducing tobacco use andexposure to secondhand smoke employs policy and community support, along with clinical,worksite and individual interventions. Phone-based cessation support is available at no charge toall Blue Cross members. A fax referral program also makes it easy for physicians, pharmacists anddental professionals to refer patients for quitting assistance. The plan rewards provider groups ifthey ask every patient about tobacco use and offer quitting assistance to anyone who says yes. Anational best practices package encourages employers to cover the cost of quit medications foremployees.Results• Tobacco use among members has declined significantly from 14.7 percent in 1999 to 12.4percent in 2003 to 10.9 percent in 2007 (p

The company provides members with tailored obesity prevention and self-management programmaterials based on member risk factors and readiness to change. BCBSNC also launched OnlineHealthy Living Programs – online modules offering members access to a series of self-directedprograms to help manage fitness, nutrition, weight loss and smoking cessation efforts. It alsooffers physician toolkits with patient materials and office support tools, including tear sheets forhealthy weight and pre-diabetes patient education.Results• To date, 47 percent of program participants have lost weight, with an average weight lossof 9.5 pounds;• 70 percent of program participants reported better eating habits and 59 percent reportedbecoming more active;• 76 percent of enrolled members lowered their category of high blood pressure or pre-highblood pressure.***For further information, please visit, http://www.bcbsnc.com.Bridges to ExcellenceBridges to Excellence (BTE) is a multi-state, multi-employer coalition developed by employers,physicians, healthcare services researchers and other industry experts to reward quality acrossthe healthcare system. Key objectives of the program include:• Encourage and reward healthcare providers who demonstrate that they deliver safe,timely, effective, efficient and patient-centered care;• Encourage patients to seek evidence-based care;• Reward patients with chronic diseases who take an active role in managing their own careand achieve target goals aimed at improving their health.One major focus of BTE is diabetes care. Diabetes is the sixth leading cause of death in the UnitedStates, and 20.8 million Americans have the disease. Data shows that diabetics only receiveappropriate treatment 50 percent of the time. Public awareness about the seriousness of thedisease and the importance of its management is low, and unless changes occur, the Centers forDisease Control (CDC) estimates 1 of 3 Americans born in 2000 may develop diabetes. Based ondata for the year 2002, the economic cost of diabetes was $132 billion: $92 billion in directmedical costs and $40 billion in indirect costs such as lost workdays and restricted activity.To combat these perilous trends, BTE created the Diabetes Care Link (DCL) program to improvethe quality of care for patients with diabetes. It offers a suite of products and tools to help diabeticpatients get engaged in their care, achieve better outcomes and identify local physicians that meethigh performance measures. Additionally, physicians who demonstrate they are top performersin diabetes care, including following best clinical practices, can earn up to $200 for each diabeticpatient covered by a participating health plan and/or employer. Participants fund these incentivesfrom the savings they achieve through lower healthcare costs and increased individualproductivity that results from delivery of higher quality diabetes care. Therefore, DCL is a winwin-winsituation for physicians, plans, employers and patients.Results• Independent studies conducted by three national health plans found that physiciansparticipating in the DCL program offered care that was substantially more consistent withbest practice guidelines than physicians not participating;

• Additionally, these physicians delivered care at a 10 percent to 15 percent lower cost thannon-BTE physicians (Approximately $350 per patient in the initial study year). Themajority of the savings came from fewer hospitalizations and fewer trips to the emergencyroom;• An analysis by Towers Perrin of the DCL module estimated a maximum savings of up to$1,059 per patient per year when blood pressure, HbA1c and LDL control measures aremet.*** Submitted by François de Brantes, CEO, Bridges To Excellence,Francois.deBrantes@bridgestoexcellence.orgCaterpillarHealthy BalanceLocated in Peoria and Aurora, Illinois, Caterpillar is a leading manufacturer of construction andmining equipment, diesel and natural gas engines and industrial gas turbines with over 77,000employees worldwide and revenues of $30 billion per year. With healthcare costs at Caterpillarrising at double digit rates in the 1990s, and projected to exceed $1 billion by 2000, Caterpillarinitiated a core program called Healthy Balance to provide consistency, direction andmeasurements in evaluating the effectiveness of healthcare interventions offered. The objectivesof the Healthy Balance program were to reduce healthcare costs, improve the health of employeesand to urge self-responsibility for health amongst employees.Healthy Balance uses strong incentives to reward participants, including a reduction of $600 inemployee health premium contributions. The program also utilizes health risk assessments;disease management programs, including personal counseling service provided by registerednurses and dieticians for participants with diabetes and heart disease; health fairs, medicaldepartments staffed with physicians and registered nurses; smoking cessation programs; fitnessand exercise programs; quarterly newsletters; and healthy food choices in the cafeteria andvending machines.Results:• The Healthy Balance program retained 93 percent of incented employees and 62 percentof spouses in 2003;• Over an eight-year period, Caterpillar achieved a 400 percent to 500 percent return oninvestment;• Average claims of participants were $700 lower than non-participants;• Projected net savings from medical expenses of $700 million by 2015;• Incidence of chronic and acute disease among employees, retirees, and dependents hasdeclined;• More than 1,100 participants have quit smoking since the program began;• More than 4,700 participants have lost weight since the program began.***For further information, please visit http://cathealthbenefits.cat.com.Cincinnati Children’s Hospital Medical CenterEvery Child Succeeds/CincinnatiEvery Child Succeeds (ECS) is a partnership of Cincinnati Children’s Hospital Medical Center,United Way of Greater Cincinnati and Cincinnati–Hamilton County Community Action Agency,and 16 provider agencies. The program involves regular home visits to first-time, at-risk mothersfrom the time of pregnancy to the child’s third birthday. Nurses, social workers and child-

development specialists provide interventions and assessments designed to achieve good healthand psychosocial adjustment, with the ultimate goals of optimizing early brain development andreadying the child for school.The average Every Child Succeeds mother is 20 years old at the time of enrollment; more than 90percent are unmarried; most have low incomes; and nearly one-third have received late,inadequate or no prenatal care. Those factors put their children at higher risk for a host of longtermproblems, including delayed development, abuse, neglect and poor academic achievement.An array of indexes measuring health and safety, learning and development, nurturing andeffective parenting and physiological development indicate that it is making a difference.Arguably the most significant outcome is a lower rate of infant mortality. Among ECS families,the rate is 4.7 per 1,000 live births, compared with 17.4 per 1,000 in Cincinnati and 8.3 per 1,000for the state of Ohio. Every Child Succeeds achieves those outcomes by thoroughly researchingdevelopmentally appropriate interventions and assessments, developing a comprehensivecurriculum with easy-to-access resources and extensively training the more than 120professionals providing in-home visits.The close relationship of participating organizations is another success factor. Home visitors areemployed by the 16 provider agencies, which all operate off well-articulated protocols, programdeliverables and a common training curriculum. About 40 percent of the budget comes fromprivate sources; the United Way of Greater Cincinnati contributes approximately $2.5 millionannually. Medicaid and other state programs are the source of public funding.Results:• The program has provided approximately 250,000 visits to 13,000 families since 1999;• Lower infant mortality among participants, 4.7 per 1,000 live births versus 13.9 per 1,000in Hamilton County and 17.4 per 1,000 in Cincinnati;• 90 percent of ECS kids have safe play environments;• 92 percent of parents support active learning;• 87 percent of moms are more nurturing and meet kids’ emotional needs.***For further information, please visit, http://www.cincinnatichildrens.org/svc/alpha/e/everychild/default.htmCMS Premier Hospital Quality Demonstration ProjectThe Centers for Medicare and Medicaid Services (CMS) Premier Inc. Healthcare Alliance HospitalQuality Incentive Demonstration (HQID) project is the first national pay-for-performance projectto measure hospital performance and offer additional Medicare payment to hospitals for topquality care. The demonstration, which began October 1, 2003, involves a CMS partnership withPremier, a nationwide healthcare quality and cost improvement alliance of more than 2,100 notfor-profithospitals. During the demo, CMS rewarded the top performing hospitals – in terms ofimproved coordination of care for chronically ill and high-cost beneficiaries – by increasing theirpayment for Medicare patients.The program is voluntary and uses 34 measures, drawn largely from the National Quality Forumendorsed hospital performance measures set, as a basis of examining and rating each hospital.Five clinical focus areas or groups (CFGs) are the evidence-based quality measures used as thebasis for hospital top performers:• Acute myocardial infraction (AMI)• Congestive heart failure• Pneumonia• Coronary artery bypass graft

• Hip and knee replacementsFor each CFG, Premier collects data from each participating hospital for a number of processmeasures, such as the timely administration of antibiotics and outcome measures, such asmortality. The scores for each measure are blended to create a Composite Quality Score, anaggregate of all quality measures within each clinical area, for each CFG. A composite qualityscore is calculated annually for each demonstration hospital with a minimum sample of 30 casesin a measured clinical quality area. Hospitals receive separate scores for each clinical condition by“rolling-up” individual process and outcome measures into an overall quality score. CMS thencategorizes the distribution of hospital quality scores into deciles to identify top performers foreach condition. For each condition, all of the hospitals in the top quality 50 percent of hospitalsare publicly reported on CMS’ website.Bonuses are given based on top performers for each condition. Top 2 deciles are given a 1-2percent bonus of their Medicare DRG payments for that condition. If the performance in yearthree does not exceed baseline, the hospital will receive a payment penalty as a cut of 1-2 percentlower DRG payments for conditions below the 9 th or 10 th percent baseline level.Results:• For hospitals participating in the HQID project, the average Composite Quality Scoreimproved by 4.4 percent between the project’s second and third year for total gains of15.8 percent over the project’s first three years:o From 87.5 percent to 96.1 percent for patients with AMI;o From 84.8 percent to 97.4 percent for patients with coronary artery bypass graft;o From 64.5 percent to 88.7 percent for patients with heart failure;o From 69.3 percent to 90.5 percent for patients with pneumonia;o From 84.6 percent to 96.9 percent for patients with hip and knee replacement.• The cost of the incentive bonuses to Medicare for the first three years was about $24.5million;• The bonus incentive payments ranged from $900 to $847,000 across the first three yearsof the project with an average payment of $70,000;• 182 providers have received an incentive payment in at least one clinical area over thethree years;• Premier estimates that approximately 2,500 lives were saved in the care of heart attackpatients alone across the first three years of the project;• In addition, patients received approximately 300,000 additional recommended evidencebasedclinical quality measures, such as smoking cessation, discharge instructions andpneumococcal vaccination, during that same timeframe; CMS extended the project for three additional years to test the effectiveness of newincentive models and ways to improve patient care. The extension will continue to trackhospital performance in the clinical areas of pneumonia, heart bypass, heart attack (acutemyocardial infarction), heart failure, and hip and knee replacement. New measures suchas the AHRQ PSI Composite measure, length of stay, and complications will be tested inthese clinical areas. In addition, new areas will be added for testing such as Surgical CareImprovement Project SCIP and Ischemic Stroke. The extension will also allow the testingof new payment models.***Submitted Eugene Kroch, Ph.D., VP - Chief Scientist, Premier, Inc., Eugene_Kroch@PremierInc.comConAgra FoodsConAgra Foods is a retail, food service and food ingredient company that has more than 40different brands and serves consumer grocery retailers, restaurants and other foodserviceestablishments. ConAgra first introduced the Wellness Committee in December 1990, as part of a

new initiative to help employees take control of their own health and fitness needs. In 2004-2005,ConAgra expanded on this original initiative by implementing worksite health screens at all of itsfacilities.Program objectives include engaging employees in their own health decisions to reduce risk andprovide baseline health measurements; improving individual well-being that leads toorganizational benefits of increased morale, higher productivity, reduced absenteeism and lowerhealthcare costs; maintaining and enhancing the productivity of employees by helping themmanage their health, fitness and work-life balance; and finally, creating a financial managementtool for employee healthcare costs.ConAgra has incorporated numerous wellness programs into their workplace at no cost toparticipants. These programs include:• Preventive health screenings including annual biometric health screenings, completeprostate exams and mammograms, lipid profiles, immunizations and fitness testing;• Customized health risk appraisals (HRA) offered semi-annually to allow for maximumbehavior modification throughout the year;• Health fairs held semi-annually and include a lipid profile (cholesterol, HDL, LDL,triglyceride levels), blood pressure, height/weight and body fat testing, gait analysis andnutritional counseling. Participants receive results and interpretation of resultsimmediately so that they can take action to improve their health;• Fitness facilities and incentives gives all employees access to worksite fitness facilities andcreates an incentives structure where participants record their activity in a web-basedprogram and receive incentives to reward their efforts;• Healthcare workshops/communication provide luncheon sessions, support groups,information sessions, and group email broadcasts to allow for extended informationgatheringand repeated reinforcement on a topic;• Incentive program encourages employees to create a healthier lifestyle. Employees havethe opportunity to receive awards for participation and yearly monetary rewards forsatisfactory or better screening results;• Disease management helps control and monitor at-risk population, especially those withacute and chronic diseases;• Healthy lifestyle bonus: Yearly tiered monetary rewards based on exercise adherence,body composition and lipid profile values;• Smoking cessation aids and classes.Results:• Based on the average cost/benefit ratio, it is estimated that gross savings in 2001 wereapproximately $730,000;• 48 percent of eligible employees completed the HRA in 2002;• Estimated savings of approximately $20,000 to $25,000 in healthcare costs by detectingearly cancer cases through their cancer screening program;• Evaluation of the program determined that the potential to realize a cost savings return ofbetween $5 and $9 for every dollar spent on the program is clearly achievable;• The total direct cost of the program in 2001 was $243,321, which is equal to a cost of$113.06 per eligible ConAgra employee for the year. In comparison to other corporatehealth promotion programs, this cost represents modest per-person expenditures for amulti-level, activity-based health promotion program.***For further information, please visit, www.conagrafoods.comCouncil for Affordable Quality Healthcare (CAQH)CORE

CAQH is a non-profit alliance of health plans, networks and industry trade associations thatdevelops and implements collaborative, public-private initiatives to simplify and streamlinehealthcare administration. CAQH’s Committee on Operating Rules for Information Exchange(CORE) initiative makes it possible for any provider to access consistent and reliable insurancecoverage and payment information from any health plan electronically, using the technology ofthe provider’s choice.Through this national, all-payer, vendor-neutral solution, providers and health plans areaccelerating the use of HIPAA transactions and other standards. They are also resolving dataexchange challenges, such as patient identification, that impact all health IT efforts. Since itslaunch of initial rules in 2006, providers across the U.S. can now access health planadministrative data in real-time for over 63 million Americans, resulting in significantadministrative cost savings. For eligibility alone, providers may reduce labor costs associated withverifying insurance coverage as much as 50 percent, and health plans avoid phone calls byincreasing the use of automated transactions.Results• Blue Cross Blue Shield of North Carolina (BCBSNC) was one of the first CORE-certifiedhealth plans. They experienced a three-fold increase in the use of electronic eligibility andbenefits verification transactions within 12 months of implementing the CORE rules, withthe percentage of real-time transactions increasing from 20 percent to over 90 percent;• Many of BCBSNC’s 44,000 providers have expressed satisfaction in this change giveneasier and faster access to patient coverage information in real-time;• BCBSNC has seen faster implementations of electronic data exchange with provider andvendor trading partners due to more straightforward implementation oftelecommunications, testing and data content;• BCBSBNC is now requiring all of its vendor partners to become CORE-certified.***Submitted by Gwendolyn Lohse, CORE Director, CAQH, glohse@caqh.orgCouncil for Affordable Quality Healthcare (CAQH)Universal Provider DatasourceCAQH is a non-profit alliance of health plans, networks and industry trade associations thatdevelops and implements collaborative, public-private initiatives to simplify and streamlinehealthcare administration.Universal Provider Datasource® (UPD) was developed by CAQH to streamline the credentialingapplication requirements of healthcare organizations. UPD is used by more than 640,000physicians and other healthcare professionals to post the credentialing and demographic dataelements required by health plans, hospitals and other healthcare organizations to a secure,national database; posting occurs once and then updates are made as needed.Previously, each provider practice spent countless hours and thousands of dollars annually tocomplete multiple credentialing applications. Given the results of UPD, many prominentprovider and quality organizations such as the AMA, ACP, AAFP, NCQA and URAC have beenactive in promoting the adoption of UPD. Additionally, certain states are looking at otheropportunities to improve the quality of their provider data, such as emergency responderinformation, and are considering how the critical mass of providers participating in UPD couldassist those efforts.Results

• CAQH estimates that UPD is reducing provider administrative costs by nearly $100million per year and has eliminated more than 2.5 million legacy paper applications todate.***Submitted by Gwendolyn Lohse, CORE Director, CAQH, glohse@caqh.orgDMAA: The Care Continuum AllianceAPS Healthcare & The Georgia Enhanced Care ProgramAPS Healthcare, one of the country’s leading specialty healthcare companies, was selected in2005 to implement and operate the Georgia Enhanced Care (GEC) program, a comprehensivedisease management program that serves more than 39,000 Medicaid aged, blind and disabled(ABD) members in northern Georgia regardless of their chronic condition. The purpose of GEC isto provide continuity of care and medical services in the most appropriate setting to managecertain chronic conditions.More than 85 percent of the members have multiple chronic and co-morbid conditions, coupledwith complex psychosocial and socioeconomic issues; 50 percent have a co-occurring mentalillness. APS was chosen for this contract based on their unique approach for implementing adisease management program which emphasizes:Identification of and intervention with individuals using a holistic approach to comorbidities;then merges behavioral and medical interventions to optimize outcomes;Placement of RN/Health Coaches in high volume federally qualified health centers whichhelp reach patients where they seek care.APS’ partnership with the National Center for Primary Care (NCPC) at the Morehouse School ofMedicine aligns two of the foremost Medicaid thought leaders to design and implement theprogram, which earned a designation in 2006 from Health Industries Research Companies(HIRC) and Disease Management Purchasing Consortium (DMPC) as one of the “Most EffectiveMedicaid DM” programs in the nation.Results• APS showed more than $80 million cost avoidance in their GEC program’s performanceyear one (May 1, 2006 to April 30, 2007) as validated by Mercer.• The GEC program earned a designation in 2006 from Health Industries ResearchCompanies and Disease Management Purchasing Consortium as one of the “MostEffective Medicaid DM” programs in the nation.• In the Spring of 2007, APS was granted another contract from the state for the GeorgiaMedicaid Management Program, to service more than 200,000 members of the ABDpopulation that were not covered by the GEC program.***Submitted by Carl Graziano, Vice President, Strategic Communications, DMAA: The Care ContinuumAlliance, CGraziano@dmaa.orgDMAA: The Care Continuum AllianceHealth DialogHealth Dialog, headquartered in Boston, Massachusetts, is a care management firm and whollyownedsubsidiary of Bupa, a global provider of healthcare services, which serves 24 millionindividuals. Health Dialog supports Shared Decision-Making® support tools as a best practice inhealthcare.

Best Practice Resources – access to information on a variety of health topics,including internet/intranet sites, community resource contacts, brochures and self-helpguides;Various On-site Resources and Programs – Site-specific offerings may include onsitedieticians, fitness centers and massage;Incentives Bonus Programo Pays performance bonuses to its medical staff based, in part, on whether Dowemployees meet goals aimed at improving their health in areas such as weight loss,smoking cessation, exercise, and reduced stress;o Health staffers in each of 13 regions develop at least two goals for employee healthfrom six categories such as weight, exercise and tobacco use;o Bonuses depend on both the performance of a single group as well as theperformance of all the groups.Results:• Dow expects to save up to $100 million in healthcare costs over the next decade;• 42 percent of North American employees who are members of the fitness centers areregular users;• 43 percent of North American employees participate in health promotion activitiesbesides those in fitness centers;• 83 percent of North American employees voluntarily participate in their scheduledHealth Surveillance and Screening Exam.***For further information, please visit, www.dow.com.Duke UniversityLive for LifeLive For Life is Duke University's employee health promotion program and a contracted serviceavailable to most Duke employees. The program’s objective is to optimize the health, well-beingand productivity of Duke employees, while achieving excellence in customer satisfactionThe program is broken into separate offerings with some benefits available to all full-time Dukeemployees, while others require that the participants be eligible for health insurance through theuniversity. All full-time Duke employees benefit from special request programs and classes,including a variety of health, fitness, ergonomic and injury prevention classes; a health resourcelibrary, which provides access to health-related books, tapes and videos; and special events,healthy challenges, contests and health screenings offered throughout the year. Duke employees,faculty and staff who are eligible for health insurance through Duke may also choose toparticipate in “HealthCheck,” a free, confidential health assessment including blood pressure,cholesterol, height, weight, Body Mass Index, all of which can be sent to the employee’s physician;health education classes; personal health counseling; personal consultations in nutrition and/orfitness; a “Steps to Health” incentive program, which focuses primarily on helping the participantachieve measurable health results and rewards participants with “Live for Life Dollars” forachieving health goals. Participants have the potential to earn up to $1,000 Live For Life dollarswhich can be used to purchase merchandise from the Live For Life storeResults• A 2001 study of employees with high cholesterol and high blood pressure found that themajority of those who participated in the Live For Life program decreased their healthrisks.• 54 percent of the 194 participants with high cholesterol eliminated their risk factors.• Duke estimated that it saved $124,800 on its health-insurance costs as a result.

***For further information, please visit http://www.hr.duke.edu/eohs/livelife/index.html.EmdeonEmdeon is a leading provider of revenue and payment cycle solutions that connect payers,providers and patients to integrate and automate key business and administrative functionsthroughout the patient encounter. Through the use of Emdeon's comprehensive suite of productsand services, its customers are able to improve efficiency, reduce costs, increase cash flow andmore efficiently manage the complex revenue and payment cycle process.Emdeon also provides Coordination of Benefits (COB) and Third Party Liability (TPL) services tostate Medicaid Agencies and other public entities and is a sub-contractor to primary TPL/COBvendors in 38 states. Emdeon processes 15 million real-time validations annually for bothretrospective recoupment and prospective cost avoidance, generating billions of dollars inMedicaid savings nationwide. Its network of national insurance eligibility and roster informationdetermines other coverage and assists Medicaid Agencies with recoupment and cost avoidancestrategies to recover or avoid claims where Medicaid is secondary. Medicaid ManagementInformation Systems (MMIS) TPL Segments are updated with coverage detail to allow providersto bill payers appropriately.The combination of historic roster searching and real-time data access is more effective thanother recovery and cost avoidance techniques that rely upon periodic batch updates provided bycommercial insurers. Emdeon uses real-time eligibility transactions to ensure that verified policesare placed in the state TPL file for immediate cost avoidance. The enhanced pre-claim benefitinformation allows Medicaid to avoid paying claims for which they are not responsible.Through partnership with major credit bureaus and data vendors, Emdeon can also determinecurrent income, family size and address information, allowing the provider to identify recipientswho may no longer be eligible for Medicaid.Results• Emdeon’s experience with 38 state Medicaid agencies suggests savings potential of up to5 percent of total Medicaid spending through enhanced COB and TPL transactions;• In large states, even a single percentage point reduction in the Medicaid spend can putmillions of dollars back into state coffers.***Submitted by Susanne Powell, Director, Corporate Communications, Emdeon, spowell@emdeon.comEmdeon and TennCare YouthEmdeon, in collaboration with TennCare's eHealth Initiative and Shared Health, has worked todevelop a system to alert providers on the healthcare screening status for Tennessee children andyoung adults covered under Medicaid.The new process gives providers enhanced eligibility information at the point of care indicatingwhether the required Early Periodic Screening Diagnosis and Treatment (EPSDT) screen has beencompleted according to protocol for patients 22 years old and younger. The protocol is designedto help improve health and save money by preventing disease and reducing hospital stays andemergency room visits.Emdeon developed a transaction workflow within its real-time switching infrastructure that can

prompt a clinical message when an Eligibility and Benefits Inquiry (270) transaction is launched.When the provider enters the patient's date of birth, the system simultaneously sends aneligibility inquiry to the payer and a clinical message search to a data analytics partner. Emdeonreceives both the payer response on eligibility and the clinical result and creates an enhancedoutbound Eligibility and Benefits Response (271) transaction with the appropriate messaging thatgoes to the provider.Results• Since the program went live on November 20, 2008, TennCare is averaging nearly1,400 EPSDT screening look-ups per day. That translates into 28,000 opportunities everymonth for children and young adults to get needed preventive care that might otherwiseget overlooked – inside the provider's existing workflow and technology.***Submitted by Susanne Powell, Director, Corporate Communications, Emdeon, spowell@emdeon.comFedExHealth Risk Reduction and Cost Reduction ProgramFedEx Corporation, the premier world-wide provider of transportation, logistics, e-commerce andsupply chain management services, is a global enterprise with over 200,000 employees andannual revenues of $19 billion. Rising healthcare costs, a tight labor market and the need toincrease productivity led to the design of innovative health promotion, injury prevention anddisability management efforts within FedEx as part of the FedEx Express-Health Risk Reductionand Cost Reduction Program. Program objectives include: managing and controlling risinghealthcare costs; increasing employee productivity; minimizing the utilization of inappropriateand unnecessary medical services by employees; educating employees on managing their own useof healthcare; and improving employee satisfaction with employer healthcare benefits.FedEx offers a variety of Human Capital Management (HCM) programs to its employees as partof the FedEx Express-Health Risk Reduction and Cost Reduction Program. A number of differentinternal organizations contribute to the program including: Safety and Risk Management, Healthand Wellness, Disability and Human Resources Services and Operations. Its varied programsinclude: Safety Above All Initiative: This component is effective in preventing injuries andprovides for safety to be included in corporate strategies and business planning. Includedin this initiative are: safety metrics for measurement of injuries, safety goal setting at thecorporate level, management bonus pay that incorporates safety objectives and goals,recognition awards for safety, a safety rating factor in performance reviews of allemployees, safety continuous improvement teams (SCIT), required management andemployee safety training, and a chargeback system to local budgets for injuries. Health and Wellness Centers: FedEx provides on-site wellness facilities at themajority of their facilities and offers employees without on-site facilities access to theFedEx Fitness Network. Medical Leave of Absence Management: HCMP’s manage employees on medicalleave of absence in order to keep disability claim duration lower than the transportationindustry average. FedEx Temporary Return to Work (TRW) Policy: Allows employees to return towork and remain productive during a partial disability. Employees work in a temporaryassignment and perform duties within temporary restrictions specified by the physician. Demand Management (part of FedEx Employee Benefits): These services are designedto minimize the utilization of inappropriate and unnecessary medical services byempowering employees to make medical decisions based on a consideration of benefitsand risks. It includes a toll free 24-hour telephone counseling service provided by CIGNAand United Healthcare. The goals of the program are the following: to teach employees

how to handle common illnesses at home and to determine when to consult a physician,teach efficient use of time spent with healthcare providers, help control costs byeliminating inappropriate visits to the emergency room or a physician’s office andimprove employee satisfaction with employer healthcare benefits.Utilization Management (part of FedEx Employee Benefits): These programs areincluded in all employee medical options.Catastrophic Case Management (part of FedEx Employee Benefits): These programsdeal with specific, severe illnesses in order to facilitate continuity of care and providepatient education in order to enhance the consumer knowledge and give support whenneeded most.Disease State Management: This program provides early intervention along thehealthcare continuum. It uses a systematic, proactive case management model toencourage patients to actively participate in managing their disease and maintain theiroptimum state of health.Lifeworks Program: Improves the health and quality of life of FedEx employees byproviding stress reduction, work/life support, resource and referral for childcare, eldercare, self-care and employee education and counseling.Employee Assistance Program: This program allows pre-paid short term counselingservices to employees, dependents and household members experiencing quality of lifeproblems.Maternity Education Programs.Smoking Cessation Program.Results:• FedEx’s programs resulted in a cumulative five-year medical benefit cost savings of about$579 million;• Six year cumulative cost savings related to decreases in medical-related lost time fromwork were estimated at approximately $479 million;• Average duration for a FedEx disability claim is 61 days, compared to 107 days for thetransportation industry;• Disability duration at FedEx was also nearly 75 percent below the average disabilityduration of other transportation industry employers;• Total disability claims have decreased 28 percent since FY94 and 7.2 percent betweenFY99 and FY00• Disability claims costs have decreased by 2.5 percent in the five fiscal years from FY96 toFY00, even as employment has increased by 20,000 in the same time period;• Since 1997, the Leave of Absence Days/100 Employees has been reduced by 28.4 days,while TRW utilization has increased from 32.4 percent to 54.9 percent;• FedEx Fitness Program participants reduced their overall benefit costs from $1,210 to$1,021 (16 percent savings) in the year following program enrollment, while nonparticipants’total benefits decreased from $2,104 to $1,947;• Safety Above All initiatives have resulted in a 47 percent improvement in injury ratesbetween FY96 and FY01;***For further information, please visit, http://healthproject.stanford.edu/koop/Federalpercent20Express/description.htmlGE HealthcareCardiology Consultants of PhiladelphiaCardiology Consultants of Philadelphia (CCP) is the second largest single specialty cardiologypractice in the United States. Their practice has 21 office locations in the greater Philadelphiametropolitan area and specializes in providing comprehensive cardiology care.

Beginning in 2002, the CCP Board of Directors began discussing the idea of adopting anelectronic health record (EHR). Expectations included an improvement in patient care, ability toparticipate in pay-for-performance, a marked reduction in filing and transcription costs, areduction in malpractice exposure and costs and an ability to analyze individual and grouppractice patterns.EHR deployment was guided by an EHR committee which was composed of several physicians,an executive director, an EHR project manager and all IT and EHR related staff. The EHRcommittee provided overall direction for the EHR project. Global questions such as workflows,needed changes to clinical content or how much material from existing paper charts should bescanned were resolved at this committee level. The EHR project manager was responsible for theday-to-day decisions regarding EHR rollout, as well as the deployment of her staff, and the overalltiming of the EHR rollout schedule. The physicians themselves determined the order with whichoffices transitioned to EHR.CCP planned EHR rollout to occur at the rate of one office each four to eight weeks with eachoffice being trained by an EHR trainer. Each site knew well in advance when go-live would occurat that site. Physician office schedules were reduced, initially to 50 percent of pre-EHR levels,gradually increasing until pre-EHR levels were achieved within two to six weeks after physiciango-live. Basic Centricity® navigation training was conducted both in live groups by employeefunction and through WebEx sessions for general staff. In order to simulate office visits, thephysicians and clinical staff were given user accounts in Centricity® Network Training, a trainingand development environment otherwise identical to the production system.The CCP EHR system makes extensive use of real-time quality checking algorithms. Before thepatient can be dismissed, deviations from defined quality measures are identified and presentedto the provider. This gives the provider the opportunity either to correct the quality deficiency, orto provide an explanation for deviation. The EHR presents the evidence for the appropriatequality indicator. It is not possible for providers to bypass these quality checks. Examples ofcardiology quality indicators include anti-platelet therapy use for patients with coronary arterydisease, beta-blocker therapy for patients with prior myocardial infarctions, ACE inhibitor orangiotensin receptor blocker use for patients with systolic congestive heart failure or leftventricular dysfunction, prophylactic ICD implantation in appropriate patients and smokingcessation advice.Now that all CCP providers have been on EHR for more than one year, CCP has begun to collectaggregate quality data, grouped by provider, for use in internal quality improvement andeventually for pay-for-performance contracts. CCP has also created custom interfaces with threemanufactures of implantable cardiac devices. Device interrogation data from patients enrolled inremote defibrillator and pacemaker-monitoring system is forwarded to CCP’s EHR using HL7messages and appear as lab results in the EHR system.Results• Transcription costs have been reduced to under $100,000 from a pre-EHR cost of$800,000—a reduction of 88 percent;• Filing clerk positions have been cut in half for a $350,000 savings;• CCP has received a 3.5 percent reduction in malpractice insurance expense representing a$70,000 savings;• Since creating a customized encounter form for warfarin management, CCP has been ableto run weekly reports indicating which patients are overdue for their blood tests. CCPfound patients overdue as much as six to twelve months through this process. Nurses cannow contact these individuals to facilitate their compliance with anticoagulationmonitoring;• CCP has been able to negotiate materially better rates of payment for cardiology serviceswith most of their insurers simply because of the presence of an EHR system;• CCP has entered into pay-for-performance arrangements with several larger insurers,increasing our reimbursement for clinical services.

***Submitted by Jenn Francis, Public Relations, GE Healthcare IT, jennifer.n.francis@ge.comGE HealthcareCoxHealthCoxHealth, based in Springfield, Missouri, which has been recognized as a Top 100 integratedhealth system by Hospitals & Health Networks magazine, is comprised of all major specialtiesand subspecialties. Care is provided through a network of clinics, physician practices and threeowned hospitals.To serve a growing patient population, CoxHealth is continually making strategic investments incapital expansions, new clinical services and additional providers and administrative staff. Onekey strategy is through technology. Today, the organization is using GE’s Centricity® ElectronicMedical Record (EMR) from GE Healthcare in its hospitals and 38 clinics. In addition it is movingrapidly to deploy the full set of features available in GE Healthcare’s Centricity GroupManagement system for revenue optimization.Using Centricity, CoxHealth has become a virtually paperless entity. Records are universallyavailable – at hospitals, physician offices and their homes. Centricity presents Cox physicianswith an accurate, readable medication list that is accessible from a single location in the record. Itis continuously updated as drugs are added or removed. Further, it advises the physician when aprescribed drug combination is likely to produce adverse reactions, thus reducing unnecessarypharmacy call-backs and repeat documentation that would consume hours of physician, nurseand staff time. The EMR’s reporting feature enables in-depth scorecarding on all providers. Inminutes it’s possible to see how every clinician stacks up against HEDIS and ORYX1 benchmarksfor patient actions taken across a spectrum of disease states. Having to do this manually wouldentail untold FTE time and cost.Centricity Group Management has proven features for billing, scheduling, electronic datainterchange and more. A key benefit of the tool is the ability to have charge information tieddirectly to an appointment. When a patient bill is created, three quarters of the fields alreadypopulated automatically from the appointment. This not only decreases data entry time, butmakes for more accurate posting as well. The system schedules the workload for collection staffby automatically pulling accounts that are past due into action queues. An auto-letter capabilitydelivers high value by eliminating the need to generate collection letters manually. This capabilitysaves between five to ten minutes per collection letter. Additionally, Centricity’s insurance setscapability enables CoxHealth to readily manage billing for patients with multiple coverage. Thefeature accommodates eight different payer types and automatically ties charges to theappropriate payer.ResultsOne clinic in the CoxHealth network, Cox Family Medicine Associates, has seen the followingresults: Centricity EMR eliminates the need to handle more than 150 charts each day and thededication of two full time employees; Patient phone calls that would typically require a chart pull, delivery to the physician’sdesk for a manual note entry and physical re-filing, are now handled almost instantly byemail to nurses, with subsequent online documentation and orders by physicians; Multiple users can work in a patient’s chart at the same time. Nurse and physician canenter their respective inputs simultaneously (e.g., vital signs and orders). This hasincreased the speed of workflow; Charts required for quarterly audits can be pulled in seconds for every physician; thisprocess would take five times as long in a paper-based environment.

Tests and procedures are ordered from within the EMR and are pre-populated withpatient data, diagnosis and physician authorization, and electronically transmitted;Nearly 80 percent of referrals are electronic. Specialists are armed with full informationabout a patient, including history, problems, medications and lab results.***Submitted by Jenn Francis, Public Relations, GE Healthcare IT, jennifer.n.francis@ge.comGE HealthcareEvans Medical Group, P.C.Evans Medical Group, a primary-care and pediatrics practice in Augusta, Georgia, includes fourphysicians who care for more than 1,500 patients each month. In order to improve efficiency andpatient quality, the medical group purchased GE’s Centricity® Electronic Medical Record.After more than a decade of using the program, Centricity EMR is an integral part of the dailyroutine at Evans Medical Group. The providers use a mix of desktops, thin-client workstationsand laptops on a wireless LAN to access information from anywhere. They can dial in to thesystem over a secure VPN, allowing them to look up a patient’s history from home or hospital inthe middle of the night. The EMR imports demographic data from the practice managementsystem. When the front desk makes an appointment for a new client, Centricity EMR uses thatdata to create a patient chart without anyone having to type in information. The system alsointerfaces with their primary lab, so results are automatically imported into patient charts.Providers enter encounter data in several ways. First, the nurses input data from questionnairesthat the patients fill out. The physicians also enter data directly into the EMR, either by typing inthe exam room while the patient talks, using the dropdown lists or radio buttons to select choices,or typing their findings after the visit. Evans has not used a transcriptionist in nearly six years.Writing prescriptions is easier and safer with Centricity EMR. The software checks for druginteractions and counter indications, flagging the provider if there’s a potential problem. Beingable to print prescriptions from the system also eliminates handwriting errors. The orders featureof Centricity EMR simplifies lab and radiology tests. The local providers accept Evans MedicalGroup’s printed form as a lab requisition, which lets the practice link problems on the patient’sproblem list with the ordered test, simplifying authorization. Even handling patient phone calls iseasier with Centricity EMR. This practice developed a custom form with its own protocols, whichallows nursing staff to handle most phone calls without physician approval. The chart is alwaysavailable, and the patient’s medication list is always complete and up-to-date.In addition to cost savings, Centricy has allowed for greater patient care, including diseasemanagement. The system uses graphs to illustrate to patients how important certain tests andmedication management are in controlling their conditions. In addition to disease management,Centricity EMR’s database search capabilities make it easy to provide better care to entirepopulations. Because almost half of their practice is pediatrics, Evans Medical Group’s businessfalls off dramatically during the summer. The medical group decided it would be a great time tocatch everyone up on their routine check-ups, so they created staff incentives for finding patientswho needed to come in. With a quick search in Centricity EMR, the practice was able to find allthe diabetics who hadn’t been seen in six months; all the people with hypertension who hadn’thad a check-up in nine months; all the infants more than three months old who hadn’t had theirfirst DTaP shot. The staff then contacted these patients (or their parents) and encouraged them toset up appointments, making last June one of the practice’s busiest months ever.Results• Evans estimates that the group saves approximately $183,000 per year in staff time andother efficiencies;• Vaccination rates are up, insurance chart audits consistently get the highest ratingspossible, and patient volume and quality of care have both increased;

• Evans Medical Group uses the Centricity system so effectively that it won the prestigious2003 Davies Award of Excellence, given by the Healthcare Information and ManagementSystems Society (HIMSS) to recognize the effective use of technology for improvinghealthcare.***Submitted by Jenn Francis, Public Relations, GE Healthcare IT, jennifer.n.francis@ge.comGE HealthcareThe Westchester Medical GroupThe Westchester Medical Group, a multi-specialty, physician-owned medical group based inWhite Plains, New York is one of the most automated and efficient practices in the nation. Uponimplementing GE Healthcare’s Centricity® Practice Management (PM) and Electronic MedicalRecord (EMR) solutions, Westchester Medical Group saw an immediate positive return on theirinvestment. They believe they more than paid for the system in the first year just by the reductionin the number of people who handled paper.After “going live” all incoming external documents such as lab tests, x-ray reports, and dictationwas stored in an EMR. The effect was a reduction in the number of necessary FTEs handlingmedical records from 23 to 6. In implementing technology to achieve efficiency, it was importantto preserve physician autonomy as physicians were relieved of some decisions. The programs didnot increase physician workload by one minute. In addition, the average training time atWestchester Medical for complete CPOE (computerized physician order entry) was less than 30minutes.In 2004, the practice was awarded the Certificate of Recognition from the American DiabetesAssociation (ADA) and the National Committee for Quality Assurance (NCQA) Diabetes PhysicianRecognition Program. The Group notes that Centricity EMR’s structured data entry approach is acrucial enabler of the ability to participate in these quality outcomes initiatives.Results• After five years, the Group has gone from five FTE’s per physician to 3.2. At their currentsize, the Group is saving the equivalent of approximately 180 FTEs. Since the averageFTE salary cost is $40,000, that represents over $6 million dollars in savings each year;• Transcription costs are now less than $20,000 a year, which before, at half their currentsize, were over $300,000. In current dollars, the group is saving more than $500,000 peryear in transcription costs alone;• Gaining revenue-generating space has also been beneficial. A former medical recordsdepartment in their main facility – 3,000 square feet – is now a GI department includingendoscopy labs;• In a recent AMGA survey, The Westchester Medical Group finished in the 98th percentilefor physician satisfaction.***Submitted by Jenn Francis, Public Relations, GE Healthcare IT, jennifer.n.francis@ge.comGulfstream Aerospace: “Partners in Quality” (PIQ)In 2003, Gulfstream Aerospace Corporation partnered with Memorial University Medical Centerto create a program called “Partners in Quality” (PIQ), a quality improvement initiative forMemorial’s network of primary care physicians who were delivering care to Gulfstreamemployees.

After analyzing claims data, Gulfstream realized the majority of participating physicians were notfollowing best practice protocol. This often resulted in increased medical costs due to follow-upvisits and/or the onset of chronic disease co-morbidities with possible hospitalizations. The focusof the PIQ program’s measurement process became greater attention to proper, evidence-basedtreatment protocols for key disease groups: diabetes, breast cancer, cervical cancer andpharmaceutical management.Gulfstream engaged program participants by offering: lower healthcare costs and increasedemployee wellness to participating companies; financial incentives and public recognition toparticipating physician who followed best practice protocols; and the possibility of lower co-paysto employees whose physicians were designated a “Distinguished Quality Physician” (DQP).To measure program outcomes, Memorial Hospital’s Physician’s Quality Committee defined keymeasures for each disease group. The measures were then placed on a balanced scorecard whichassessed each physician’s performance against each targeted area for improvement. If thephysician’s average score was 70 percent or higher, he or she was designated a DQP. After the firstset of performance data was distributed only 10 percent of physicians qualified as DQPs.In 2006, to further reduce costs and increase the health of Gulfstream employees, the companychanged its pharmaceutical program to promote the use of generic drugs. It also initiated acompanywide, voluntary Health Risk Assessment (HRA) program which helped employees detectpreviously undiagnosed medical situations. Through this program, Gulfstream’s benefitsdepartment has been able to clearly identify what major health risks exist within the organizationand has adjusted their healthcare programs to help address those exposures. For example, thedecision of the types of drugs to be included in their free generic drug program was greatlyinfluenced by the findings from the HRA summary data.Results (2004 – 2008) The percent of primary care physicians qualified as “Distinguished Quality Physicians”went from 10 percent to 44 percent, which represents a 340 percent quality improvementor an increase from 18 to 80 doctors in Savannah; The percent of women age 40 and above receiving annual mammograms went from 44percent to 51 percent, a quality improvement of 16 percent;The percent of diabetics getting two or more HbA1c tests per year went from 39 percentto 61 percent, a quality improvement of 56 percent; The percentage of diabetics getting an annual lipid profile went from 57 percent to 80percent, a quality improvement of 40 percent; The percentage of diabetics who received an annual dilated pupil eye exam went from 32percent to 56 percent, a quality improvement of 75 percent; The percentage of women age 21 and above receiving an annual PAP test went from 37percent to 63 percent, a quality improvement of 70 percent;The generic drug dispensing rate went from 33 percent to 54 percent, a qualityimprovement of 64 percent;There was a 21 percent reduction in average medical cost per diabetic;There was a 2 percent reduction in diabetic patients with renal failure;There was a 43.3 percent increase in average drug cost per diabetic;Gulfstream’s four-year healthcare cost trend was an increase of only 4.3 percent, farbelow the national average; Gulfstream’s programs have generated an annual healthcare cost avoidance of $5 to $6million.***Submitted by Bob Holben, Director, Compensation & Benefits Gulfstream Aerospace,bob.holben@gulfstream.com

Gundersen LutheranConnected CareGundersen Lutheran Health System, headquartered in La Crosse, Wisconsin, has created“Connected Care,” a national model for efficient, high-quality, end-of-life care. This modelincorporates all elements of the health system’s advance care directives program to provide thebest possible care for patients nearing the end of life. The program has been named ConnectedCare because the health system uses an electronic medical record to connect patient informationon the care planning process, goals, treatment plans, compliance, outcomes and patientsatisfaction—regardless of treatment setting.Connected Care is designed for patients with terminal chronic conditions. Rather than focusingon disease management, this system is designed to efficiently help patients live as well as possiblein their last two years of life. Gundersen also incorporates a palliative care program which helpspatients with advanced diseases and their families through the physical, psychosocial andspiritual aspects of aging and dying.Gundersen Lutheran is currently presenting their Connected Care program as a demonstration tothe Centers for Medicare and Medicaid Services, as this model may be one answer to the issues ofaccess and cost associated with the retirement of the Baby Boomers.Results• The initial findings of the Connected Care program have shown a decrease in utilizationof services resulting in decreased costs, increased patient satisfaction and increasedaccess to services for others that may need more acute or specialty care;• Gundersen’s palliative care program significantly reduces hospital costs, approximately$3,500 per patient in billed costs. It also increased admissions to hospice care by 32percent since 2007 and reduced hospital readmission rates 6 percent, versus 18 percentin a control population;• Studies at Gundersen Lutheran have shown that patients with advance directives usedabout $2,000 less in physician and hospital services in the last six months of life;• The Connected Care model could nationally reduce associated healthcare costs by 25 to50 percent;• In 2008, a study published by The Dartmouth Atlas, which analyzed the care of patientswith severe chronic illness, including Medicare spending per patient in the last two yearsof life, Gundersen was recognized as one of three hospital referral regions in thecountry—out of 306—to achieve the lowest per patient spending. The study alsoconcluded that Medicare spending could have declined by 25 percent if all U.S. regionssafely adopted the practice patterns of the most efficient regions.*** Submitted by Joan Curran, Chief of Government Relations and External Affairs, Gundersen LutheranHealth System, jlcurran@gundluth.orgGundersen LutheranEmployee Wellness ProgramGundersen Lutheran in La Crosse, Wisconsin realizes that the health of a workforce has a directimpact on the cost of healthcare for businesses. The health system recognized the opportunity in

their employees and developed wellness programs that target key risk factors which contribute tothe rising cost of care.Gundersen’s wellness program, which has seen year-over-year decreases in several health riskindicators, contributes its success to several components including:• A tobacco cessation program;• A 12-week lifestyle modification program which helps participants with weight loss;• A healthy eating program that helps participants choose eating selections that arecontrolled in fat and calories at more than 40 food retailers;• A unique partnership with a local vending company which allows for smarter snackchoices;• A variety of options for employees to incorporate physical activity before or after theirworkday or during their lunch break, including exercise classes and onsite fitness centers.Results• The percentage of employees with three or more health risks has declined from 14.7percent in 2005 to 11.3;• Data from 2006-07 has shown that 78 percent of employees enrolled in a smokingcessation program quit successfully, while only 43 percent of employees not enrolled inthe program had the same result;• Weight loss participants lose an average of 10 to 12 pounds during the 12-week weightloss course and more than 50 percent of participants report engaging in exercise four tofive days a week;• More than 1,400 participants attended Gundersen exercise classes in 2007, while theonsite fitness centers were used more than 7,100 times;• Gundersen Lutheran received the Wellness Councils of America Gold Well Workplaceaward in 2008 and is one of the only 19 companies in Wisconsin to have received theaward since 1991;• Gundersen Lutheran is one of only four Wisconsin employers to receive the GoldGovernor’s Worksite Wellness Award from the Wisconsin Governor’s Council onPhysical Fitness & Health. As of November 1, 2008, Gundersen had the highest totalscore of all companies to receive the award;• The American Heart Association recognized Gundersen Lutheran’s commitment topromoting exercise and good nutrition in the workplace with its Start! Fit Friendly GoldAward in 2008.*** Submitted by Joan Curran, Chief of Government Relations and External Affairs, Gundersen LutheranHealth System, jlcurran@gundluth.orgGundersen LutheranTransforming Breast Cancer CareGundersen Lutheran Health System, headquartered in La Crosse, Wisconsin is taking a uniqueapproach to breast cancer care. The health system believes that detection and diagnosis of breastcancer at the earliest possible stage is key to increasing survival and quality of care, whilelowering the cost of breast cancer.Gundersen’s approach starts with screening mammography—particularly for women age 40 andolder because it can detect a cancerous tumor up to four years before it can be felt. When detectedearly and at a small size, a woman has a 92 percent chance of being alive in five years. Whendetected late, that rate drops to seven percent and costs soar. Gundersen Lutheran has takenseveral steps to increase mammography use among Wisconsin residents, including a mobilemammography unit that travels to sites in 19 counties throughout its rural service area. This isaided by an outreach program entitled “Stayin’ in the Pink” which spreads the message of the

importance of screening mammograms. Those who have a mammogram as a result of theprogram are entered into quarterly prize drawings.But no matter where or how a woman has a screening mammogram in Gundersen Lutheran’sthree-state service area, it is evaluated by a Gundersen Lutheran radiologist who sub-specializesin breast care at its headquarters. Because Gundersen Lutheran limits the number of radiologistswho read mammograms, they have more experience detecting very small tumors and can detectlumps sooner.When breast cancer is detected, having multiple departments available to provide breast care—the traditional approach to care—isn’t enough. The best care is provided by an interdisciplinaryteam, which allows the right care to begin as quickly as possible. Gundersen Lutheran’s breastcare team bridges the boundaries of traditional medicine with medical and support staff fromclinical breast radiology, pathology, surgery, medical oncology, radiation oncology and plasticsurgery. Weekly breast conferences among Center for Breast Care team members allow them todiscuss and agree on what treatment plan is best for each individual patient and to scheduleservices—ranging from lumpectomy and mastectomy to radiation, chemotherapy and hormonaltherapy—as quickly as possible. As the woman meets with those involved in her care, every effortis made to bring the specialists to her, rather than having her move to various physical locations.Gundersen Lutheran’s model can be replicated on a national scale, improving clinical outcomeswhile providing significant financial savings in national healthcare costs.Results• 97 percent of women treated at Gundersen Lutheran have their cancers detected at Stage0 or Stage 1;• 75 percent of women at Gundersen Lutheran who need biopsies are able to undergo lessinvasive, needle-guided biopsies;• Only 5 percent of women at Gundersen Lutheran must undergo surgery for their biopsycompared to the 50 percent nationally;• The Norma J. Vinger Center for Breast Care interdisciplinary model has the potential tosave an estimated $4.15 billion dollars in national healthcare costs if implemented on anational scale;• Gundersen Lutheran is one of only two healthcare organizations nationwide that hasattained every breast care-related accreditation offered.*** Submitted by Joan Curran, Chief of Government Relations and External Affairs, Gundersen LutheranHealth System, jlcurran@gundluth.orgH. Lee Moffitt Cancer Center & Research InstituteThe H. Lee Moffitt Cancer Center is committed to the prevention and cure of cancer, workingtirelessly in the areas of patient care, research and education to advance one step further infighting this disease. As part of an elite group of 39 National Cancer Institute (NCI)–designatedComprehensive Cancer Centers, Moffitt focuses on the development of early stage translationalresearch aimed at the rapid translation of scientific discoveries to benefit patient care.As a national leader in cancer care, Moffitt recently implemented a revolutionary programdesigned to assist researchers and clinicians in creating personalized cancer treatments based onthe proven efficacy of various therapies administered to patients with specific genetic profiles.The anticipated result is significantly improved outcomes for patients suffering from a wide rangeof cancers.Called the Total Cancer Care (TCC) Initiative, this program is highly dependent upon asophisticated technology platform, which has transformed Moffitt’s data collection processes and

provides far-reaching administrative, clinical and research benefits. The goals of the TCCInitiative include: reduce staff time spent collecting, entering and distributing patient data; collectmost current demographic, emergency contact, insurance and external physician information onfile for each patient; eliminate the need for patients to complete lengthy medical historyquestionnaires multiple times; fulfill mission to conduct scientific research that leads to bettercare and improved outcomes for greater numbers of patients.A significant component of the platform was the automated kiosks and wireless computer tabletsthat streamline patient check-in and standardize the data collection process, which greatlyenhances the consistency and quality of research data. These tools streamlined the facility’spatient check-in and registration process and yielded great dividends in operational efficiency andpatient satisfaction. Clinical staff, supported by IT analysts and the vendor, even created a clinicalrollout training manual, accompanied by a comprehensive training process to optimize successfulimplementation of the self-service platform with minimal disruption to the every-day treatmentflow of patients.Results• In one month alone, more than 1,000 multi-page forms were captured electronically andinterfaced directly into an EMR system;• Patients appreciate the convenience of the kiosks, the reduced wait times and minimizedpaperwork. The data intake process is tailored to each patient’s stage within thetreatment cycle so they need to provide information only once;• Streamlined data collection speeds patient flow throughout the facility, enabling clinicalpersonnel to treat more patients in the same amount of time;• Availability of 800 discrete data elements that are self-reported by the patient improvesthe quality of scientific/clinical research and analysis;• Use of the kiosks reduces printing paper and storage expenses;• Accurate patient identification at check-in eliminates the potential for error and ensuresregulatory compliance.***Submitted by Edward Martinez, Vice President and Chief Information Officer &William Dalton, Chief Executive Officer, Moffitt Cancer Center.Health Performance Improvement (HPI)Healthcare Performance Improvement (HPI) provides healthcare organizations with methods toimprove safety and quality while lowering costs. The HPI approach and methods, currently beingimplemented at over 100 hospitals across the country, are based on the knowledge, learning, andbest practices of high-reliability organizations such as nuclear power, aviation andmanufacturing.While healthcare has historically focused on traditional process improvement as a means to betteroutcomes, high-reliability organizations recognize that optimizing outcomes requires aconcurrent focus on and integration of process design and human behavior accountability.Building behavior accountability is as complex, and perhaps more challenging, than processdesign improvement. While process design focuses on detecting and correcting weaknesses insystems, behavior accountability focuses on the prevention of initiating human errors that canlead to events of harm or untoward outcomes.The HPI approach is a highly structured methodology that defines actions by staff, physicians,hospital administration and medical staff leadership to minimize error and profoundly changeculture. Based on an in-depth safety culture diagnostic assessment interventions are tailored tothe individual organization. These strategies include several complementary efforts:

Leadership Method – Learn adopt and practice proven leadership skills for buildingand sustaining a reliable and safe culture that results in performance excellence. Forexample, daily check-in, walking rounds and pre-task briefs.Error Prevention – Implement safety behaviors and error prevention techniques forphysicians and staff targeted at common causes of previous performance problems. Forexample, team member checking and coaching, self-checking using STAR, and formalizedcommunication and handoff techniquesRoot Cause and Common Cause Analysis – Implement state of the art causeanalysis capabilities to identify and resolve root causes of avoidable events and establishan early warning system by identifying common causes of precursor and near missevents.Lessons Learned – Implement a transparent and robust process to learn from serioussafety events, success stories and best practices from other industries.Safety Metrics – Establish a comprehensive performance monitoring system thatemploys leading, real time and lagging indicators.A strong accountability system drives individual compliance across the organization and to thefront-line depths of each department. Elements of accountability systems include aligning goals,metrics, and performance incentives to reinforce behavior changes; ensuring an environment offairness that reinforces behavior expectations without punishing people for unintended errorsand other programmatic reinforcements such as front-line safety coach programs, sharing ofsafety success stories, and creation of visible reminders of behavior expectations such as badgecards, newsletter articles, and department posters.The process of building and sustaining a culture of reliability is sometimes described as a longdistance marathon. Each of the following healthcare organizations is at different stages in theirjourney of transformation and recognizes that these improvements are an early sign of successthat nonetheless requires continued application of the methodology described above to continueto sustain those gains.Results:• HPI organizations have achieved up to a 91 percent reduction in the rate of preventableserious safety events that harm patients, while at the same time result in significantpositive financial benefits – up to a $21 million savings in three years.• Sentara Healthcare, an integrated healthcare system in southeastern Virginia, hasreduced the number of serious events of harm to patients (Serious Safety Event Rate) byover 60 percent. Through December 2008, SNGH has demonstrated an 80 percentreduction in serious events of harm since it began its efforts in November 2003. Therehas also been a 90 percent reduction in ventilator associated pneumonia and a 70 percentreduction in blood stream infections.• Community Health Network, a four-hospital system in Indianapolis, realized a 70percent decrease in the Serious Safety Event Rate, and in early January celebrated 365days since their last Serious Safety Event.• WellStar Health System, an integrated healthcare system located in the northwestmetro Atlanta area and a recent HPI client, has already seen the near elimination ofventilator associated pneumonia and central line blood stream infections.***Submitted by Shannon M. Sayles, RN, MS, MA, Consultant, HPI, shannon@hpiresults.comHighmark BlueCross BlueShieldEmployee Wellness ProgramHighmark offered a comprehensive health promotion program to all its employees beginning inthe summer of 2002. The program offered health risk assessments (HRAs), online programs in

nutrition, weight management and stress management, tobacco cessation programs, on-sitenutrition and stress classes, and various promotional campaigns to increase fitness participationand awareness of disease prevention strategies.Results• The program yielded a return on investment of $1.65 for every dollar spent on theprogram;• Four-year expenditures were $808,403 and savings were $1,225,524;• Healthcare expenses per person per year were $176 lower for participants and inpatientexpenses were lower by $182.***For further information, please visit, https://www.highmark.com/hmk2/index.shtml.InterComponentWare, Inc. (ICW)eHealth InfrastructureInterComponentWare Inc.’s ehealth infrastructure, a highly secure and fully interoperabletechnology platform, enables access to aggregated health data to authorized patients, providersand payers.ICW’s international implementation of the ehealth infrastructure has laid the foundation for theBulgarian Ministry of Health to launch a National Health Portal and electronic personalambulatory books (ePAB), two initiatives aimed at increasing patient access to services andimproving wellness through greater personal responsibility. The Bulgarians have thoroughlytested the secure identification feature of the infrastructure and are successfully using it foreprescribing with an initial group of 40,000 state employees.In the German state of Baden Wurttenberg, the platform’s security and interoperability of theICW ehealth infrastructure support the insurer AOK’s enhanced health plan that providesphysicians with incentives for offering expanded office hours and for optimally treating a patient’scondition on the first visit (measured by rate of repeat visits). Patient access, cost reductions andimproved quality of care are the drivers of this effort.In the United States, ICW is partnering with SureScripts-RxHub to enable bi-directionalcommunications between prescribers and pharmacies to deliver the next-generation ofprescription health information exchange. The enhanced communication and expanded messagetypes, made possible by the ICW ehealth infrastructure, allow for a focus on medication history.Over 8,000 physicians and clinics are involved in the first phase of this effort with a full nationalrollout scheduled for 2009.Results• It is anticipated that over 100,000,000 prescriptions will be filled electronically in 2008with complete health information available.• It is also predicted that medication error rates and the number of redundantprescriptions will drop.***Submitted by Anne Marie Heil, ICW, amheil@amheil.comInterComponentWare, Inc. (ICW)Coventry HealthCare - Chronic Disease ManagementInterComponentWare, Inc. is providing the ICW ehealth infrastructure and telemonitoringconnectivity to Coventry HealthCare, one of the leading insurance providers in the U.S. The

Coventry project focuses on 650 Chronic Heart Failure (CHF) patients living within the KansasCity area. Patients utilize monitoring devices in their homes that are connected to a centralizedsource of specialized care providers. The program is designed to align member, physician andhealth plan incentives, resulting in improved patient outcomes.In Germany, ICW has partnered with the insurer AOK to offer a telemonitoring program to CHFpatients living in the state of Saxony. Patients take their own blood pressure and weighthemselves regularly. The monitoring devices relay the measurements via blue tooth technologyto a centralized telemonitoring center where the data is trended and stored. Abnormal results aretreated as an emergency and patients are referred to their local hospital. Less serious changes indata are referred to the patient’s doctor for follow-up.Results• The Trans-European Network – Home-Care Management System (TEN-HMS) study hasdemonstrated that structured care of heart failure patients via telemonitoring leads toreduced mortality;• As with the TEN-HIMS study, AOK and Coventry patient participants are being measuredfor a reduction in hospitalizations and an improvement in the quality of life (using theMinnesota Heart Failure Questionnaire as the instrument);• It is anticipated that both Coventry and AOK will roll out similar programs to otherchronic disease patient populations.***Submitted by Anne Marie Heil, ICW, amheil@amheil.comMassachusetts eRx CollaborativeThe Massachusetts eRx Collaborative was established in October 2003 as an outgrowth of existinge-prescribing pilot programs at Blue Cross Blue Shield of Massachusetts and Tufts Health Plan,joined later by the Neighborhood Health Plan. Partnering with ZixCorp as the technologyprovider and later adding DrFirst, the Collaborative has sponsored the deployment of e-prescribing tools to thousands of healthcare providers, offering a turn-key approach toimplementing hardware, set-up, training and ongoing support at no cost to the prescribers.Through use of the e-prescribing tools, physicians are able to access patient-specific prescriptiondrug and medical histories, be alerted of drug-to-drug and drug-allergy interactions;electronically transmit prescriptions directly to a pharmacy, minimizing possible errors fromillegible handwriting; view formulary compliance information; and access drug reference guidesto review generic alternatives for brand-name prescriptions.In 2005, the Massachusetts eRx Forum was established by insurers, technology vendors,pharmacies and other organizations to raise awareness of e-prescribing and increase its adoptionstatewide. The Forum has partnered with the Massachusetts Medical Society to develop acontinuing medical education course called “Electronic Prescribing Education: How to ImproveMedication Safety and Reduce Drug Costs Through e-Prescribing,” in order to inform practicingphysicians of the value of health information technology.Results:• Nearly five million prescriptions transmitted electronically in 2007, and more than 13.5million since the Collaborative’s inception;• In 2007, approximately 104,000 electronic prescriptions were changed or cancelledbecause of drug-safety alerts to the physician;• In 2006, BCBSMA e-prescribers saved five percent on their drug costs compared toprescribers that did not use the technology. Of that savings, BCBSMA members saved

$800,000 in co-payments for their prescriptions resulting from improved formularycompliance and increased use of generic alternatives;• More than 81 percent of prescribers reported that they would recommend e-prescribingto a colleague, and 71 percent said the technology saves time as a result of its use.***Submitted by Adrienne Cyrulik, Program Manager, eHealth Innovation, Blue Cross Blue ShieldMassachusetts, Adrienne.Cyrulik@bcbsma.com & Geoff Bibby, Vice President, Corporate Marketing, ZixCorporation, GBibby@ZixCorp.comThe University of Texas M.D. Anderson Cancer CenterSince 1944, nearly 800,000 patients have turned to M. D. Anderson for cancer care in the form ofsurgery, chemotherapy, radiation therapy, immunotherapy or combinations of these and othertreatments. This multidisciplinary approach to treating cancer was pioneered at M. D. Anderson.Because they focus only on cancer, experts here are renowned for their ability to treat all types ofcancer, including rare or uncommon diseases.M.D. Anderson Cancer Center in Houston, Texas, recognized that the diagnostic process in mostareas of medicine is strongly influenced, and therefore can be transformed, by informationtechnology investments in two major areas: access to clinical data, particularly clinical laboratoryand pathology data, and access to radiological reports. In cancer medicine today, it is thecombination of pathology data and images that in most cases confirm the presence of cancer.Transforming access to these two fundamental sources of data leads to a fundamentaltransformation of the diagnostic process. However, clinical transformation does not end with thediagnosis; hospitals must also transform their communications process with patients and withreferring physicians and, finally, must transform how they document provided care.To accomplish these goals, M.D. Anderson took several steps.First, the health system developed SPiDR, a Shared Pathology Data Repository for clinicallaboratory and pathology data. The repository has transformed the delivery of patient care byproviding real-time pathology and laboratory information needed for clinical decision-makingand diagnosis.Second, M.D. Anderson created timely access to radiology reports. Previously, M.D. Andersonstruggled with timeliness of CT scans. Patients would often have their scan, but radiologists wouldnot have time to interpret the scan before the patient's next physician visit. An informationtechnology solution (in this case, a workflow engine) was developed that was updated every 10-17minutes throughout the day, with a re-prioritization process determined by the patient’sscheduled appointment and case priority.Third, M.D. Anderson began capturing the appropriate information so that a facility could bereimbursed for the care it provided. Physicians were given PDAs which serve as “point-of-service”dictation devices as well as a “point and click” documentation device to register the treatmentcode for the particular service provided. At the end of rounds, the data are uploaded to a fileserver for processing.Finally, the health system created the myMDAnderson website to improve communicationspatient-physician and physician-physician communication. Initially piloted in 2002,myMDAnderson is a secure, personalized web portal for registered patients and communityphysicians. Patients can complete pre-registration documents, view upcoming appointments andreview customized patient education materials. For physicians, the portal customizes patientreferral processes by care center and allows physicians to view their patients’ M. D. Andersonappointment schedules; access their patients’ clinical results and reports; send and receive secure

messages to and from M. D. Anderson practitioners; and easily maintain up-to-date physiciancontact information.Results:• SPiDR: M.D. Anderson has seen a total financial return of $1,386,300. Cost savingsmostly come from de-commissioning of legacy systems and nurses no longer having toretrieve history data. Non-financial returns include: a single repository makes all of thisdata much more accessible for both current decisions that clinicians need to make and forhistorical review that is so important to cancer research;• M.D. Anderson’s workflow-prioritization engine: after the development andimplementation of the workflow engine and linking it to patient appointment time andpriority, radiologists in the CT body area were achieving a rate of 95 percent of reportscompleted prior to a patient’s visit with their physician. The system eliminated more than100 calls per day with requests to “expedite” readings, which at an average of 5 minutesper call, corresponds to an increase in efficiency of over 630 hours annually. EstimatedInvestment Costs total $62,000 and estimated ROI After three years equals 215 percent;• MyMDAnderson: Estimated investment costs totaled $372,000 whereas estimatedannual returns have totaled $2,164,500. Sources of Financial Returns: 70 percent ofphysician referrals become registered patients, compared with 40 percent of those whoself-refer via the M. D. Anderson website. Online self-referred patients generate about$74,000 in revenue, and that on this revenue they target a margin of 5 percent, the netfinancial gain to the institution from 195 new patients would be $721,500. Sources ofNon-Financial Returns: Significantly increased ability of external physicians to referpatients to M. D. Anderson, and to follow their care while the patients are in M. D.Anderson’s care. Estimated ROI After 3 Years: 582%.***Submitted by Lynn H. Vogel, Ph.D., Vice President and CIO & John Mendelsohn, M.D., President, M.D.Anderson Cancer Center.Memorial HermannHealth Centers for SchoolsWith nearly $2.5 million in corporate, foundation and individual gifts, Memorial HermannHealthcare System partnered with three school districts in Houston, TX to create the MemorialHermann Health Centers for Schools, a group of five school-based clinics that operate Mondaythrough Friday, year-round and provide about 24,000 annual visits.Memorial Hermann operates the clinics and provides more than $700,000 in funding each year.Host schools are selected strategically so that students from other nearby schools can accessservices easily. More than three-quarters of students seen at the clinics have no health insuranceat all, while the remainder do not typically access care because of transportation issues or otherchallenges. The five school-based clinics serve as a medical home for uninsured children and as asecondary access point for those with insurance by offering primary care, mental healthcounseling, health education and mobile dental care.The program diligently collects outcomes data, which strengthens the program and sustainscommunity support. Conscious of making every dollar count, the program is willing to curtail orrestructure services that are not meeting objectives and add services that will be most beneficial.The annual performance evaluations of all Health Centers for Schools staff are at least in part tiedto strategic objectives.Results (2006-2007)• Student asthma exacerbations, ED visits and hospitalizations decreased by 67 percent;

• Cholesterol levels among students in the cholesterol management program declined by 73percent;• Students who received mental health counseling had improved grade point averages andself-reported well-being, along with fewer suspensions, detentions and days absent.*** Deborah Ganelin, Memorial Hermann, deborah.ganelin@memorialhermann.org.Mercy ClinicsReorganizing Care around the Wagner Chronic Care ModelMercy Clinics, Inc., in partnership with Mercy Medical Center in Des Moines, IA, providespatients and families convenient and effective treatment for sudden illness, minor injuries,disease prevention, diagnosis, treatment and education.Prior to 2008, Mercy Clinics faced a problem: their inconsistent healthcare delivery systems wereresulting in inconsistent patient care. They found that only 55 percent of patients were receivingevidence-based care in primary care settings; blood sugar was being controlled in only 37 percentof diabetic patients; and blood pressure was being controlled in only 35 percent of patients withhypertension.To combat these issues, Mercy created systems that supported proactive rather than reactivepatient care. Mercy took the following actions:• Implemented disease registries;• Partnered with insurers for pay-for-performance incentives to accelerate change;• Redesigned care around teams;• Hired and trained health coaches to support patients in self-management;• Restructured patient visits around pre-visit, encounter and post-visit segments;• Allowed for greater transparency of results whether good or bad.Results:• 97 percent of patients identified as needing care sought care when presented theopportunity;• Coumadin (Warfarin) patients at INR goal increased from 60 – 85 percent;• 65 percent of Diabetic patients had an HgA1c< 7.0, 70 percent had an LDL < 100, and 63percent had a BP < 140/80;• Office visit average cycle time reduced from 80 minutes to 45 minutes;• 1.6 FTE Health Coaches increased net revenues;• $866,500 was paid in incentive payments from insurers.***For further information, please contact Julie Sanderson-Austin, VP of Quality, American MedicalGroup Association, JSanderson-Austin@amga.org.MinuteClinicMinuteClinic is the pioneer and largest provider of retail-based healthcare in the United States.Thanks to their innovations and safeguards, MinuteClinic provides quick, convenient, top-qualityhealthcare seven days a week. Visits last about 15 minutes with no appointment necessary, andtreatments are affordable, ranging between $30 and $110, which are reimbursed by most healthplans.In November 2008, CVS Caremark announced the findings from a yearlong study on theinfluenza vaccine, suggesting that influenza vaccinations can help reduce the risk ofhospitalizations in patients with chronic conditions. The CVS Caremark study monitored the

impact of influenza vaccination on subsequent hospitalization rates for all participants. Resultsindicated that for chronic disease patients who received the influenza vaccine there was a 19percent reduction in hospitalization for all causes and a 24 percent reduction in flu andpneumonia-related hospitalizations.The study and analysis evaluated 19,908 participants enrolled in a comprehensive commonchronic disease management program. The subjects were selected from a continuously enrolledpopulation of all ages – all of whom were predetermined to have one of a number of chronicconditions including asthma, diabetes, coronary artery disease, heart failure or chronicobstructive pulmonary disease (COPD).But despite the benefits of flu vaccinations, a nationwide survey conducted by CVS in Septemberfound that only half of adults (50 percent) planned to get a flu shot in 2008. Among those who doregularly get a shot, 55 percent wait until a normally scheduled visit to their doctor or healthcareprovider. Those at highest risk for the flu include individuals with chronic diseases such asdiabetes, asthma and heart disease; women who are pregnant; healthcare workers and youngchildren, but those who wait too long, or choose not to get vaccinated at all risk time away fromwork, school and other activities. They also risk the possibility of hospitalization or an even moreserious outcome.In an effort to take a proactive pharmacy approach to help patients benefit from the positiveimpact of an annual influenza vaccination, CVS pharmacy and MinuteClinic announced inDecember 2008 that they had surpassed their goal of delivering one million flu vaccinationsduring the fall's flu shot season. The companies, both divisions of CVS Caremark Corp., launchedan integrated campaign on Oct. 1 which provided vaccinations to consumers at 7,500 scheduledflu shot clinic events in select CVS/pharmacy stores as well as flu shots on demand seven days aweek at more than 550 MinuteClinic healthcare centers located in 27 states. Flu shots atMinuteClinic are $30 and may be covered in whole or in part by insurance.Results• According to an article in the leading health policy journal Health Affairs, entitled "UseAnd Costs Of Care In Retail Clinics Versus Traditional Care Sites," after adjusting for thedifferences in chronic illness burden, total costs for an episode of care at MinuteClinicsare lower than at physicians' offices and urgent care centers (largely because of lowerE&M service costs);• Average pharmacy costs per episode are also slightly lower at MinuteClinics than at othersites of service. This might be attributable to lower prescribing rates, as observed byothers;• In 2008, MinuteClinic provided more than 1 million influenza vaccinations to consumersat 7,500 scheduled flu shot clinic events in select CVS/pharmacy stores as well as flushots on demand seven days a week at more than 550 MinuteClinic healthcare centerslocated in 27 states.***For further information, please visit cvscaremark.com or contact Christine Cramer, CVS Caremark,ckcramer@cvs.com.New York State Family Health PlansThe New York State Family Health Plus program is the result of consensus among New YorkState government leaders and key consumer and advocate groups, labor organizations andhealthcare providers. Under Governor Pataki’s leadership, the State legislature enacted thisprogram as part of the Healthcare Reform Act of 2000. Family Health Plus is a public healthinsurance program for adults between the ages of 19 and 64 who do not have health insurance -either on their own or through their employers but have income or resources too high to qualify

for Medicaid. The program provides comprehensive coverage, including prevention, primary care,hospitalization, prescriptions and other services.Program Details: Eligibility: single adults, couples without children, and parents with limited income whoare between the ages of 19 and 64 and residents of New York State and are United Statescitizens or fall under one of many immigration categories:o Adults who have health insurance – either on your own or through your employer, orare eligible for employer-sponsored health coverage through a federal, state, county,municipal or school district benefit plan - are not eligible to enrollo There are limits on the amount of assets or resources that adults can have and still beeligible to enroll in Family Health Plus.o Different family sizes are eligible at different levels of income and resources in 2006 Health insurance: provided through participating managed care plans Costs: no cost to apply for the program and no deductibles once you are enrolled;minimal co-payments for medical care/services Coverage: includes physician services, inpatient and outpatient hospital care;prescription drugs; smoking cessation products; lab tests and x-rays; vision, speech andhearing services; rehabilitative services; durable medical equipment; emergency roomand emergency ambulance services; behavioral health and chemical dependence services;diabetic supplies and equipment; hospice care; radiation therapy; chemotherapy andhemodialysis; and dental services Application Process: includes personal interview to complete an application, provideproof of certain information and help select a health plan. Enrollment facilitators areavailable to ease the enrollment process and answer questionsResults:• Within the first year of commencement, in 2002, enrollment in the Family Health Plusprogram increased from 6,691 in January to 27,272 in May;• By March 2006, enrollment totaled 528,414 consisting of 320,784 adults with childrenand 207,630 adults without children enrolled;• In 2002, Pataki increased funding for the program by $20 million to help 47 communitybasedorganization conduct outreach to increase enrollment in the program. The state isusing the model provided by the Child Health Plus program to increase enrollment. Aprevious state grant of $40 million to the Child Health Plus program allowed intensivecommunity outreach efforts and an extensive mass media campaign, which increasedenrollment from 90,000 in 1994 to more than 500,000 in 2002.***For further information, please visit, http://www.health.state.ny.us/nysdoh/fhplus/.North Fulton Family MedicineDr. James Morrow, vice president of the thirteen-physician North Fulton Family Medicinepractice outside of Atlanta, Georgia, credits their electronic health record with saving his group $1million in the first 18 months of operation—after accounting for the cost of implementation.The EHR has given North Fulton instant access to patient records; eliminated the need for staff tolocate, deliver and re-file paper records; saved time through notes that are created during thevisit, rather than afterward; allowed for significant reductions in paperwork; and eliminatedvirtually all transcription costs. The electronic health record also has freed up office spacepreviously used for chart storage and sharply decreased the amount of time staff spend onadministrative functions.Results

• North Fulton’s recouped transcription costs saved approximately $775,000 in the first 18months alone;• In the first year, they eliminated $9,337 per day and $253,978 per year in the areas ofchart pulls, new patient chart generation, missing chart searches, transcription, lab resulthandling, referral letters and medical chart supplies;• In total, the leadership of North Fulton concluded that the EHR saved their practice $33per patient visit;• North Fulton saved 44 staff hours per day of practice and 11,968 hours per year;• Although overall staff numbers have increased, there has been a proportionate reductionin non-clinical staff and an increase in revenue generating clinical providers.***Submitted by Dr. James Morrow, Vice President, North Fulton Family Medicine practice outsideAtlanta, GA, http://www.nffm.mdPC1PC1, promoted by Physicians Healthcare Solutions, Inc. in concert with Medical Justice, wasdeveloped to solve the twin problems of providing care for the uninsured in West Virginia andpreemptively managing non-complex chronic medical conditions. The targeted populationtraditionally receives care in the most expensive way possible—by going to the emergency room.It is estimated that nearly one-third of nonelderly U.S. adults without insurance have at least onechronic condition. This runs counter to the prevailing notion that most of the uninsured arehealthy without need for ongoing care. Uninsured patients with chronic conditions are morelikely than insured patients to use the ER and are less likely to have visited a health professionalin the past 12 months.No Standard Site forCare When SickUse EmergencyDepartment MostOftenNo Visit to HealthProfessional Past 12MonthsInsured Uninsured Insured Uninsured Insured UninsuredCardiovascular disease 3.5percent17.4percent3.1percent15.3percent3.0percent23.4percentHypertension 4.6percent21.9percent1.3percent6.5percent4.7percent19.7percentDiabetes 1.8percent9.3percent1.3percent3.7percent2.0percent11.6percentHypercholesterolemia 5.5 24.4 0.5 6.5 5.9 24.2percentAsthma / COPD 5.8percentpercent26.1percentpercent1.2percentpercent10.8percentpercent4.8percentFrom: A.P. Wilper, et al. National Study Chronic Disease Prevalence and Access to Care inUninsured US Adults. Ann. Intern. Med. 2008; 149: 170-176.percent19.2percentPC1 was developed by Dr. Vic Wood in 2003. Under the program, patients pay $85 per month,and families pay $125 per month in return for unlimited primary care visits, X-rays, a menu of labstudies and free generic medication. At launch, critics felt primary care doctors would beinundated with the sickest patients, rendering the model unprofitable. But PC1 has found that notto be the case.Results:• Patients do not abuse the system (the average patient is seen less than three times a year).The doctor is incentivized to manage the patient for optimal health and increased

frequency of unnecessary care is not rewarded. Patients and doctors incentives arealigned;• Patients with chronic conditions behave similar to those who have insurance (see chartabove). Virtually all PC1 patients with chronic conditions have a standard site for carewhen sick, do not use the ER most often for care and have seen a physician within thepast twelve months;• Anecdotally, patients are happy with care delivered and pre-emptive management of noncomplexconditions decreases ER visits and hospitalizations;• The program has low administrative costs as there are no “claims” to be filed;Physicians and physician practices did not lose money.***Submitted by Jeffrey Segal, M.D. Founder and CEO, Medical Justice Services, Inc.,jsegal@medicaljustice.com.Pfizer and Florida’s Agency for Health Care AdministrationFlorida: A Healthy StateFlorida: A Healthy State is a ground-breaking disease management public-private partnershipbetween the State of Florida’s Agency for Health Care Administration (AHCA) and Pfizer. Pfizerand Florida created a new health partnership with community hospitals, consumer advocacygroups, physicians and participants to provide new health benefits and improve the health of atleast 50,000 Medicaid beneficiaries. The goal of the program is to improve the health ofchronically ill Medicaid beneficiaries while reducing healthcare costs for the state as well s toprove that changes in health behavior lead to improvements in clinical measures—resulting inchanges in utilization and overall financial savings to the state.The program focuses on the health of patients suffering from diabetes, hypertension, asthma andheart failure. It uses hospital based care managers stationed at ten community hospitals acrossthe state (and one remote call center) to provide the information and support necessary to helpparticipants make informed healthcare decisions. The program educates patients so they canbetter understand and manage their own disease, follow their physician’s treatmentrecommendations and to stay healthier. Participants also have access to a 24/7 nurse hotline forafter-hours advice and support. Beneficiaries are encouraged to consistently seek care inphysicians’ offices rather than via costly visits to the emergency department or hospitalIn 2004, OPPAGA analyzed value added programs and subsequently the legislature concludedthat Florida should not continue to engage in value added contracts in lieu of supplementalrebates from pharmaceutical companies. Pfizer and AHCA have created a transition programtogether to ensure continuity of care for needy Floridians with chronic disease. Florida isplanning to roll out a Medicaid reform program in two years that employs many diseasemanagement strategies espoused by the Florida: A Healthy State program.Results (2003-2004):• The Healthy State program has distributed over 640,000 educational pieces and morethan 35,000 home-health devices to help patients self-monitor at home;• Better control of chronic conditions led to more efficient utilization of healthcareresources, such as ED and hospital admissions:o People with heart failure reduced their ED visits by 18 percent and their costlyhospitalizations by 22 percent;o Asthmatics reduced their ED visits by 12 percent and hospitalizations by 23percent;o Participants with high blood pressure reduced their ED visits by 11 percent andreduced hospitalizations by 31 percent;

o Overall, ED utilization was reduced by 12 percent and hospitalizations fell by 28percent• Clinical and behavioral metrics include:o Peak flow monitoring among the asthmatic population nearly doubled to 63percent at follow-up compared to only 32 percent at baseline;o Daily weight monitoring among heart failure participants increased to 46.2percent compared to only 12.7 percent at baseline;o Participants who monitored blood glucose at home grew from 87.8 percent to93.2 percent;o Diabetics with normal blood pressure increased by 26 percent from baseline tothe most recent follow-up. Improvement was seen as early as 6 months afterentering care management;o Only 50 percent of diabetics had an HbA1c value at baseline compared to 71percent at most recent follow-up;o Participants with diabetes, hypertension and/or heart failure (asthmatics werenot included), who knew their total cholesterol numbers, increased 42.6 percent(from 47 percent to 67 percent) at most recent follow-up. Participants whofollowed a special diet increased by 19 percent;o Medication compliance improved 21 percent;o Physical and mental health scores improved in all follow-up periods and alldisease states showed higher scores at most recent follow-up;o Participants who exercised increased by 7 percent at most recent follow-up.***Submitted by Larry Fields, Larry E. Fields, MD, MBA, FAHA, FACC, Senior Director, Strategic PolicyWorldwide Public Affairs & Policy, Pfizer Inc., Larry.Fields@pfizer.comPrimary Care Access Network (PCAN)In 1999, after Orange County Health Department closed Princeton Hospital, a facility that servedpatients from underserved areas, Orange County, Florida faced a major healthcare situation. Thearea was experiencing rapid growth, especially in tourism-related jobs, which pushed the numberof uninsured to 175,000. Other local hospitals experienced a surge in their emergencydepartments as people turned to their EDs for primary care.In response, the Primary Care Access Network (PCAN) was formed, a collaboration of communityorganizations, the county and three local hospitals—Health Central in Ocoee, Florida Hospital inWinter Park and Orlando Regional Healthcare in Orlando. PCAN’s reach is very broad as itsservices include inpatient care, outpatient care, including pediatrics, family planning, maternitycare, dental care, short-term recuperative care after hospitalization, behavioral care, and mentalhealthcounseling. Overall, PCAN has been show to be self-sustaining, with partners providing notonly in-kind services but financial support as well.Results• More than 50,000 uninsured patients have established contact with a primary caredoctor since April 2001;• The shift in care from the ED to primary care clinics decreased the cost of care from$3,000 to $1,000 per patient, according to the network.***For further information, please visit, http://www.pcanorangecounty.com/.PfizerAmigos en Salud (“Friends in Health”)

In the United States today, diabetes disproportionately affects the Hispanic population, thelargest minority and fastest-growing population group in the country. Prevalence rates are highestamong Hispanics whose income falls below the federal poverty level (17.2 percent) and those whoare obese (15.5 percent). The prevalence of diabetes is almost twice that of non-Hispanic whites ofsimilar age, and the number of Hispanics diagnosed with diabetes is projected to double between2002 and 2020.Amigos en Salud is a culturally relevant education program that improves the health ofunderserved Hispanics living with diabetes and depression. Using community health workers or“promotores,” the 10-week education program focuses on providing people with the tools theyneed to manage their disease in a way that complements their culture and lifestyle. Communityhealth workers who teach the course come from similar cultures and help participants overcomethe myths and misconceptions about diabetes and depression that may exist within the culture.Program objectives include:• Helping participants understand their condition.• Teaching better patient/physician communication skills.• Encouraging and sustaining behavior changes such as smoking cessation, exercise andhealthy diets.• Supporting development of self-management skills such as self-testing.Results:• Los Angeles, California, QueensCare Family Clinics Program:o Lower mean A1c with 64 percent achieving the goal of

In June, 2005, Pfizer Healthy Directions launched its employer-directed prevention and wellnessprogram which attempts to improve health outcomes, enhance productivity and lower healthcosts for its 41,000 U.S.-based colleagues and their families. Healthy Directions moves Pfizer andcolleagues away from a focus on the cost of healthcare, to a focus on the value of good health.Pfizer offers a diverse health benefit program with more than 70 percent of employees in fee-forserviceplans and the remaining 30 percent in national and local managed care plans. Pfizer alsooffers 100 percent drug coverage. Significant research was done internally and externally to betterunderstand Pfizer’s own employee health situation and to understand the gaps that HealthyDirections could best address for employees and their familiesHealthy Directions provides the tools, resources and support employees need to be theirhealthiest including: Healthy Directions Portal – an online total health resource that’s personalized tomeet unique health needs and concerns Health Questionnaire (HQ) – a health assessment tool that offers valuable insightinto overall health and possible risk factors Call Healthy Directions – a toll-free number that provides access to healthprofessionals around the clock, every day of the year Health Improvement and Management Programs – one-on-one health coachesand outreach counseling that colleagues may qualify for based on their health status Benefit Design – consistent with goals of the Healthy Directions program, such as 100percent coverage for all pharmaceutical drugs and preventative careResults:• At launch, over 13,000 Pfizer colleagues completed health screenings;• 84 percent of colleagues and 53 percent of dependents registered on the HealthyDirections portal;• 84 percent of colleagues and 52 percent of dependents completed the HealthQuestionnaire (HQ);• 25 percent of identified colleagues and 17 percent of identified dependents enrolled in aGordian risk management program;• 19 percent of identified colleagues and 17 percent of identified dependents enrolled in aMatria disease management program.***Submitted by Larry Fields, Larry E. Fields, MD, MBA, FAHA, FACC, Senior Director, Strategic PolicyWorldwide Public Affairs & Policy, Pfizer Inc., Larry.Fields@pfizer.comPiedmont HospitalPiedmont Hospital, a private, not-for-profit, 481-bed facility, located in Atlanta, GA, has a varietyof health information technologies, including an electronic medical record system, pharmacyrobotics, and computerized physician order entry (CPOE). The use of CPOE has brought aboutdramatic improvements in patient safety and the quality of care.To develop its CPOE system, Piedmont approached and engaged physicians early in theimplementation process. Involving physicians in all phases of the implementation process provedto be essential in achieving 100 percent adoption.Results• Since implementation, Piedmont has seen a 6 percent reduction in unadjusted mortalityover a three-year period.

• Piedmont has also reduced medication errors by nearly 90 percent, from 5.5 per 10,000doses dispensed to 0.9 per 10,000 doses dispensed.***Submitted by Connie F. Whittington, MSN, RN, ONC, VP Patient Care Services & CNO, PiedmontHospital, http://www.piedmonthospital.orgSiemensLifespanLifespan’s mission is to improve the health status of the community in Rhode Island andSoutheastern New England. Its information technology guiding principles recognize that astandard network-wide information platform is key to improved decision-making,communication, transferability of technology gains and patient safety by providing clinicians withthe information they need.When initially implementing its CPOE system, Lifespan utilized medical residents from BrownUniversity who had taken a special elective in informatics. They became a pool of "super users"who could support physicians at implementation. Physicians could order medication without anurse's help. Once doctors were online, Lifespan implemented an automated medicationadministration check process. After an order is placed electronically, the hospital pharmacyreleases the medication to a nurse through an automated fulfillment system. Nurses then cancheck barcoding systems to verify the medication against any patient and chart informationonline.Results• Adoption rate for online medication is consistently above 90 percent;• Time studies of closed-loop process showed a reduction in turnaround time from anaverage of 2 hours to an average of 11 minutes;• There was also a 55-60 percent reduction of in-bound calls made to the pharmacy toclarify orders.***For further information, please visit, www.usa.siemens.com/executivegateway.SiemensMeridian HealthMeridian Health of New Jersey, a nursing Magnet-designated health system, provides healthservices and programs through 70 locations throughout Monmouth and Ocean Counties,including four hospitals, 7,500 employees and more than 1,400 physicians.Meridian’s use of CPOE has helped physicians adhere to evidence-based treatment guidelines andreduced medication errors by alerting them to potential adverse events at the time an order isplaced. The health system has made significant strides by developing guidelines for acutemyocardial infarction into their CPOE. The system prompts physicians to administer aspirin andbeta-blockers at the time of admission to patients who present suspected AMI. Following thesuccess of AMI-interactive protocol, the hospital has added 17 additional interactive clinicaldecisionsupport protocols across 6 areas of care. Today there are more than 25.Results:

• Compliance rates increased by 10 percent within 2 months and have remained at 100percent compliance since its inception in 2005;• Meridian was awarded the John M. Eisenberg Award for patient safety and quality in2005 by the Joint Commission and the National Quality Forum in recognition for itswork.***For further information, please visit, www.usa.siemens.com/executivegateway.SimplyWellFounded by physicians at The Nebraska Medical Center, SimplyWell provides comprehensive,results-driven population health management services to improve health and lower healthcarecosts for employers. SimplyWell’s model empowers employees with the necessary tools to modifypersonal health risks, including an electronic personal health record to manage their health,access to lab data, tailored patient education, disease monitoring, a nurse call line, and an annualscreening.One of SimplyWell’s 175 employer clients is the Greater Omaha Packing Company, Inc. (GOP).GOP has annual sales of nearly $1 billion and is ranked 5th in beef processing nationally. GOP is90 percent non-English speaking with 53.3 percent of the population without a primaryphysician. Since implementing SimplyWell in 2001, GOP has experienced significantimprovement in employee engagement as well as measurable clinical improvement. The majority(89 percent) of their employees have elected to participate in SimplyWell, free of charge, inexchange for a comprehensive group medical insurance program including lower deductible andout-of pocket employee expenses with minimal employee contribution to their health planpremium costs.Results• Repeat participants from 2004 – 2008 experienced a 27 percent improvement in normalblood pressure readings; 16.7 percent fewer participants with elevated total cholesterol;13.2 percent fewer with elevated LDL levels and 41.3 percent fewer participants withelevated glucose levels.• From 2001-2008 this group has experienced an average healthcare cost increase of 2.4percent, far below the national average.• In the previous plan year, medical plan costs per employee were $4,259 compared to theindustry average of $8,607, resulting in approximately $3.4 million dollars in savingscompared to the competition.• As part of their future plans, GOP is opening an onsite clinic staffed with qualifiedmedical professionals to continue this successful program.*** Submitted by James Canedy, M.D., Medical Director for Executive Physicals, Nebraska Medical Centerand President of SimplyWell, LLC., JCanedy@nebraskamed.com.Somerset Medical CenterProject MillenniumSomerset Medical Center is a nationally accredited, 355-bed regional medical center that providesa variety of comprehensive emergency, medical, surgical and rehabilitative services to CentralNew Jersey residents. Over the last several years, health care professionals from more than 60hospitals throughout the country have visited Somerset Medical Center (SMC) to see the future.The intrigue focuses on SMC’s unique and innovative information technology system, a system

that gives physicians, nurses, pharmacists and other healthcare providers access to one ElectronicHealth Record (EHR) for each patient. Rather than having separate and distinct databases forvarious hospital departments, the system enables cross-functional communication thatstreamlines medication orders, reduces health care costs, enhances clinical decision-making andensures appropriate patient testing. It is the future of quality healthcare, available in just 2% ofcommunity hospitals across the country, and it is “live” in Somerset County.Somerset credits its successful EHR implementation to a two-phase process. Phase one was called“The Big Bang” because it was completed in less than one year. SMC replaced its core ancillaryclinical systems and added the EHR feature, converting a record 14 applications on the “go live”day. After automating its patient records, nursing departments, hospital lab reports, radiology,pharmacy and surgery, the hospital moved into phase two of its project: deploying an electronicmedication administration record and Computerized Physician Order Entry (CPOE) withadvanced point-of-care clinical decision support tools.Throughout its implementation process, Somerset created various committees essential to its ITtransformation. The committees engaged organizational management on information technologystrategies and kept IT momentum moving forward. In addition, Somerset did a needs-assessmentup front to determine the computer literacy of staff. They provided training for those who scoredpoorly on computer-related tests and on-the-spot training for per-diem staff and physicians whodid not receive enough training prior to going live.Holding the gains and keeping the technology current while deploying new functionality is alwaysa challenging balancing act. The Somerset team succeeded in both by establishing solid changemanagement processes and committees to drive implementation.Results• 100 percent of doctors utilize Somerset’s EHR system to treat patients;• 61 percent of inpatient medication orders are placed using a CPOE system;• On average, 11,000 drug-food/drug-allergy alerts are fired per month;• The average length of stay decreased to 0.33 days;• The inpatient pharmacy doses dispensed per patient per day decreased to 0.9(approximately 14,000 doses per year);• The number of inpatient X-Rays per patient day per day was reduced to 0.04(approximately 700 exams per year);• Reduced FTEs/adjusted occupied bed was 0.97;• Reduced nursing unit secretarial staff by 1.0 FTEs / unit (with two on days);• Reduced outpatient radiology pre-certification denials totaling a cost savings of$500,000;• Improved Press Ganey patient satisfaction raw score for registration and scheduling by2.0 points;• Reduced annual supply increase by 3 percent;• Information Services staff retention was greater than 92 percent, totaling 37 FTEs;• Excluding scheduled downtime, systems availability was greater than 99.9 percent.***Submitted by David P. Dyer, Vice President and CIO & Kenneth Bateman, Chief Executive Officer,Somerset Medical Center.Southeast Michigan e-Prescribing Initiative (SEMI)Launched in February 2005, The Southeast Michigan ePrescribing Initiative (SEMI) is one of thelargest, employer-driven ePrescribing initiatives to encourage the adoption and use of electronicprescribing and validate the impact of the technology on improving patient safety and reducingprescription drug costs. SEMI is a joint collaboration between General Motors, Ford MotorCompany, Chrysler LLC, the United Auto Workers (UAW), Blue Cross Blue Shield of Michigan,

Health Alliance Plan, Henry Ford Medical Group, Medco Health Solutions, Inc., CVS CaremarkCorporation, RxHub, LLC and SureScripts.DaimlerChrysler has also been working with Ford Motor Company and General Motors totransform health and healthcare through the use of best practices and health informationtechnology. Working together with Covisint, a division of Compuware, the three automakers haveengaged employers, hospital systems, physician groups and healthcare payer organizations to joinan eight-week pilot project that gathered input for a long-term healthcare IT solution insoutheastern Michigan. The goal was to increase patient safety by reducing medical errors andreducing healthcare costs. Electronic health record technology will also provide patients withgreater control of their information, empowering individuals as healthcare consumers. The threeautos are also working with the State of Michigan’s Health Information Network (MI HIN)Conduit to Care project to promote connecting healthcare communities across the State ofMichigan.Results• As of June 2006, more than 800 physicians had enrolled in the SEMI program;• In 2005, SEMI was awarded a grant by the Centers for Medicare and Medicaid Services tostudy the results of the initiative on seniors;• Henry Ford Health System and Health Alliance Plan were awarded the HealthInformation Technology Award by the Greater Detroit Area Health Council in partbecause of their success in enrolling over 60 physicians into the SEMI program;• In February, 2006, the Henry Ford physicians reached the milestone of 500,000prescriptions placed via e-prescribing;• E-prescribing messages alerted doctors to 6,500 potential allergic reactions and 50,000+prescriptions were changed or cancelled due to formulary alerts, which increased the useof generic drugs;• E-prescribing helped improve overall generic use rate by 7.3 percent, which is estimatedto save $3.1 million in pharmacy costs over a one-year period.***For further information, please visit www.daimlerchrysler.comState of VirginiaHealthy VirginiansAs many as 58 percent of all Virginians are overweight or obese, 23 percent do not exercise on aregular basis and 25 percent smoke or use other tobacco products. Obesity in Virginia hasjumped 10 percent in just the last decade, which is more than any other state in the nation. Inresponse, the Department of Health initiated multiple wellness programs at both the corporateand community levels, as well as for state employees. In 2004, Governor Warner launched astatewide initiative entitled Healthy Virginians.The program attempts to make state and local employees in Virginia the healthiest in the nationby changing individual behavior and integrating health into the work culture. The HealthVirginians program promotes healthy lifestyles in workplaces, schools and among families whoreceive healthcare through Medicaid. It includes confidential health assessments, on-line trackingof health routines (Virginia on the Move program) and informational tool kits for stateemployees. It also includes nutritional and physical activity scorecards and breakfast funding forschools.The state program CHAMPION (Commonwealth’s Healthy Approach and Mobilization Plan forInactivity, Obesity and Nutrition) has a main goal of obtaining clarity into the scope of the obesityproblem in Virginia. It assesses existing programs and intervention activities and availablecommunity resources pertaining to nutrition and physical activity; identifies issues in the

prevention, treatment, and control of obesity within the communities; composesrecommendations for state, community, and local nutrition and physical activity programs as wellas policies and legislative actions. Over 200 obesity related programs are registered withCHAMPION, which includes a searchable database at www.vahealth.org/wic/champion.htm. Theprogram publishes and disseminates a CHAMPION report to provide policy makers, coalitionsand interested organizations with insight into what participants across the Commonwealth arethinking and recommending.Other programs include, Step ‘n’ Up for a Healthier Virginia, a program for Department ofHealth employees to promote stair climbing as a means of increasing physical activity during theworkday, and Superfit!, a program targeted toward overweight children and children at risk forobesity, specifically in the Medicaid population.Results:• Step ‘n’ Up for a Healthier Virginia evaluation results show that employees increasedtheir stair usage and physical activity levels during and after work, logging nearly 568million steps on the Virginia on the Move website tracking tool (based on 20,000 stepcounters distributed);• Online health assessments have demonstrated improvements in terms of weight loss,blood pressure, BMI, activity levels and overall wellness;• Almost 2,000 individuals were identified as high risk for type 2 diabetes during the 2004diabetes education program;• From 2004-2005, 2,672 state employees shed more than 16,000 pounds, or 4.92 poundsper person, through the weight management program;• 26 percent of nearly 1,400 participants in the smoking cessation program remained freefrom tobacco after one year.***For further information, please visit, http://www.healthyvirginians.virginia.gov.St. Joseph's Hospital & Candler Health System (SJCHS)In 2006, the Institute of Medicine reported that among hospitalized patients at least 400,000preventable adverse drug events (ADEs) occur annually with costs of $3.5 billion, or $8,750 perpreventable ADE. Their recommended medication-error-prevention technologies includecomputerized prescriber order entry, bar-code medication administration and computerizedintravenous (IV) safety systems with dose-error-reduction software.St. Joseph's Hospital and Candler Hospital, the two main facilities of SJCHS and two of the oldestcontinuously operating hospitals in the United States, was the first U.S. hospital system to replaceits existing IV pumps for computerized "smart" PCA pumps. The decision to incur theincremental cost for changing technology resulted in financial benefits, improved safety,improved quality of care and increased nursing satisfaction.Electronic data recorded at the bedside as caregivers administered medications providedinformation from which actual cost avoidance could be more readily calculated and providedobjective evidence of the fiscal value of investments in innovative technologies. Financial analysison the incremental costs of IV safety systems can help to more accurately calculate anticipatedROI and better prioritize IV safety system implementation.Results• Over a five-year period, implementation of these “smart” systems reduced high-riskmedication errors and patient-controlled analgesia-related undesired outcomes, helpedavert at least 471 preventable ADEs;

• The implementation of a smart IV system reduced high-risk medication errors andprovided a five-year return on investment (ROI) of $1.87 million and an internal rate ofreturn (IRR) of 81 percent.***Submitted by Ray R. Maddox, PharmD, Director, Clinical Pharmacy, Research & Pulmonary MedicineSt. Joseph's/Candler Health System, Inc., MADDOXR@sjchs.org.TelaDocTelaDoc, a network of licensed, board certified primary care, emergency and internal medicinephysicians who provide cross coverage services on demand, is transforming healthcare deliverywith improved consumer access to quality medical care at significantly lower costs.TelaDoc physicians have access to a member’s electronic health record and can diagnose and treatminor non-emergency medical problems via the telephone—24 hours a day, 365 days a year.TelaDoc improves existing cross coverage by providing access to care for patients whose primarycare physician (PCP) is not immediately available. All TelaDoc physicians are carefullycredentialed and covered by medical malpractice insurance provided by the TelaDoc PA. TheTelaDoc service ensures patients that a physician will call for a consultation within three hours,and on average, patients are contacted by a physician in less than 30 minutes. TelaDoc does notreplace but complements the patient’s relationship with his or her PCP. TelaDoc resolves routinemedical issues at a fraction of the cost of a normal visit to the urgent care facility, emergencyroom or the doctor’s office, with a flat fee that is typically +/- $35.00 without any hiddenexpenses. All consults end with a recommendation to visit and share information with the PCP.TelaDoc’s increased access to care benefits:• Employees— who are not forced to leave work in order to see their physicians. Withtelehealth consultations they get timely treatment – resulting in reduced workforceabsenteeism, decreased probability of spreading infections to other employees, andimproved access for patients with pre-existing conditions who might forego receivingproper care for minor issues;• Rural residents— those living in remote rural areas can rely upon a physiciantelephone consult program to more rapidly deliver quality medical services at areasonable cost. This enhances patient safety, eliminating the drive time to the nearestphysician’s office;• Travelers – find these consumer-friendly services to be extremely convenient.Telephones are universally available at any time and from anywhere, allowing patients toaccess care at home, in a hotel, or in the office. People who forget to pack theirmedications can also take advantage of short-term prescription refills;• Culturally Appropriate Care – programs must make a multi-lingual helplineavailable 24 hours a day. This will help the most culturally isolated members of ourworkforce obtain timely care.Results• 97 percent of patients report that they are satisfied with the services.***Submitted by Fritz Johnson, Business Development, TelaDoc Medical Services, fjohnson@teladoc.comThe City of Oklahoma“This City Is Going on a Diet”

On January 1, 2007, prompted by his own personal struggle to lose weight, Oklahoma City MayorMick Cornett challenged the citizens of his city to lose one millions pounds. Cornett created thechallenge in an effort to combat obesity in Oklahoma City, which is among the top ten most obesecities in the United States and the 8 th fattest city in America, according to Men’s Fitness.Cornett decided to start his weight loss program at the beginning of the new year when manypeople attempt to lost weight and adopt healthier lifestyles. As a part of Cornett’s initiative,residents can sign on to the mayor’s interactive website, http://www.thiscityisgoingonadiet.com,to set their goals, calculate their body mass indexes, and track their weight loss. The site alsoserves as an accountability tool because it tracks everyone’s progress. Once participants log on,they can update their information and instantly know if they are doing better or worse.Additionally, Mick Cornett is attempting to change the culture of Oklahoma City in order to makediet and exercise more appealing. He is increasing the number of bike trails and sidewalks andbuilding new gymnasiums in all 47 of Oklahoma’s inner-city schools. Cornett is also working withlocal fast food chains to develop more health-conscious choices.No government money has gone into developing thiscityisgoingonadiet.com. It was entirelyfunded by contributors from the private sector and is a testament to the power that communityleaders can have to create a culture of health.Results (As of 1/13/09)• There are a total of 25,874 registered participants in the program.• Since December 31, 2007 participants have lost a total of 305,344 pounds, an average lossof 11.8 pounds per person.*** Submitted by David Holt, Chief of Staff, Mayor Mick Cornett’s Office, Oklahoma City, OK,david.holt@okc.govUCLA Cardiovascular Hospitalization AtherosclerosisManagement Program (CHAMP)In 1994, the UCLA Division of Cardiology initiated the Cardiovascular HospitalizationAtherosclerosis Management Program (CHAMP) as a way to promote the utilization of effectivecardiovascular protective therapies in the hospital setting and during follow-up care. The programtargets all inpatients with coronary artery disease (CAD) and attempts to reduce the risk ofconsequences of the disease by greater use of secondary prevention treatments.Under CHAMP, prior to discharge, hospital patients with CAD are initiated on cholesterollowering drugs or other cardiovascular protective medicines in conjunction with diet and exercisecounseling. The program utilizes not only medication therapies and cholesterol loweringmedications but also educational materials including guidelines, pocket cards and lecturessupporting awareness of the program. Following discharge, patient prescription therapies arereviewed at each outpatient visit. In addition, protocols require a fasting lipid panel in six weeksto assess the effectiveness of current therapy and to allow for dosing adjustments.CHAMP is managed by a collaboration of cardiologists, emergency medicine physicians,cardiothoracic surgeons, primary care physicians, nurses and pharmacists using treatmentguidelines. UCLA partnered with the American Heart Association and further enhanced theCHAMP model, under the program Get with the Guidelines. The program has expanded toinclude not just CAD but stroke and heart failure as three separate modules. Get with theGuidelines developed an internet-based data management system to be used with the CHAMPmodel called Outcomes Sciences. It allows hospitals to track a patient’s care during the course of

their hospital stay and make sure they are getting the interventions recommended by theguidelines. Currently over 1,000 U.S. hospitals are participating in Get with the Guidelines.Results• Death or recurrent MI was 6.4 percent in patients enrolled in CHAMP vs. 14.8 percent forpatients pre-CHAMP;• Statin treatment rate of 86 percent seen with CHAMP is two to three times higher thanthe national average. Two-year period studies show that in the pre- and Post-Champpatient groups:o Aspirin use at discharge improved from 68 percent to 92 percent (p < 0.1);o Beta blocker use improved from 12 percent to 62 percent (p < 0.1);o ACE inhibitor use increased from 6 percent to 58 percent (p < 0.1);o Statin use increased from 6 percent to 86 percent;o Increased use of treatment persisted during subsequent follow-up achieving anLDL cholesterol £ 100 mg/dl (6 percent vs. 58 percent, p < 0.1)***For further information, please visit, http://www.med.ucla.edu/champ/.Virtua HealthVirtua Health, a non-profit community hospital system of 950+ beds located in southern NewJersey, has successfully deployed a standard process improvement methodology that includes SixSigma, Design for Six Sigma and LEAN to enhance all aspects of the business and to improveclinical quality and safety processes that effect direct patient care.Utilizing internal Black Belts and Management Engineers working with cross-functionaldisciplinary teams, there have been over 100 projects. This approach of having a standardmethodology to improving overall patient care has included the following projects: CMS CoreMeasures (pneumonia, cardiac medication administration, SCIP, normothermia); patientnavigation; revenue cycle enhancement; charge capturing for surgical implants; and design offuture state processes for health information technologies and new facilities. Project closeimprovements are all statistically significant in improvement and sustained post project.Results• To date project activities have returned a hard dollar savings/new dollars to theorganization of $26M+.***Submitted by Arienne Elberfeld, Six Sigma Champion-Operations Improvement, Virtua Health,aelberfeld@virtua.org.Virginia Mason Medical CenterVirginia Mason Medical Center is an award-winning, private, not-for-profit organization offeringa network of primary and specialty care clinics throughout the Puget Sound region and a hospitalin Seattle, Washington. Six years ago, however, the health system was struggling. The 336-bedhospital faced a slew of problems, including quality concerns, a three percent defect rate, anincrease in cost of care, low morale among employees, an aging workforce and budget constraintsdue to inefficiency. Virginia Mason calculated that employees wasted 2.5 hours a day simplysearching for things in their hospital.By 2002, Virginia Mason’s board demanded a new strategic plan—a plan that was efficient,calculated, reliable and proven to generate results. For inspiration, they turned to one of the mostefficient corporations in the world: Toyota. With a new strategic plan in place, Virginia Masontook action. In 2002, the hospital sent several senior executives to Japan to work in and learn the

Toyota production method. By experiencing the Japanese management method first hand, theboard hoped that these leaders would apply their learned principles to the hospital setting. Nineleadership trips later as of June, 2008, Virginia Mason is indeed seeing real results.The Toyota management method is simple. The company is passionate about quality, safety, staffengagement and, most importantly, customer satisfaction. In addition, they have waged a “war onwaste,” which Virginia Mason now applies to its daily operations. Whereas Toyota avoids thewaste of overproduction, now Virginia Mason avoids the waste of unnecessary or repeated labtests. And whereas Toyota avoids the waste of motion, Virginia Mason now has a system in placeto decrease the waste of searching for patient charts.Virginia Mason has also adopted Toyota’s method of “stopping the line.” When any Toyotaemployee, whether an executive or a service line worker, sees a problem with a car on the line, heor she has complete autonomy to stop production. This method is both empowering and effectivein making each and every employee an integral member of a team. By implementing the stoppingthe line system at Virginia Mason, now every employee within the health system has the authorityto create a patient safety alert that shuts down the entire hospital.With a more efficient system in place, Virginia Mason has enhanced their health informationtechnology capabilities, making them one of the most integrated health systems in the country. Infact, since 2001, the health system has implemented clinical messaging, computerized physicianorder entry, ambulatory prescribing, surgery scheduling and much more.Virginia Mason has also teamed up with Starbucks, one of Washington’s largest employers, andtheir health plan provider, Aetna, to combat back pain, the number one healthcare expenditurefor the famous coffee company. Upon investigation, Virginia Mason found that 45 percent ofStarbucks employees received an unnecessary MRI after one week of back pain. To combat thisissue, Virginia Mason along with Starbucks and Aetna designed a model where patients receivesame day appointments with a physiatrist and physical therapist to assess the situation. Since thisprotocol has been in place, many MRIs have been deemed unnecessary, and MRI usage hasdecreased, which in turn is leading to better care at a lower cost.Results• By utilizing the Toyota LEAN method, Virginia Mason now uses only one-half of thehuman effort, space and equipment that they did in years past.• Since September of 2002, the health system has had over 900 patient safety alertsresulting in improved care and better outcomes.***Submitted by Gary S. Kaplan, M.D., Chairman & CEO Virginia Mason Medical Center,https://www.virginiamason.orgWakeMed Health & HospitalsENERGIZE!WakeMed Health & Hospitals in Raleigh, North Carolina, in concert with the YMCA of theTriangle and the Raleigh Parks and Recreation Department, with the financial support from theJohn Rex Endowment and the Duke Endowment, have created a program that dramaticallyimpacts children at risk for or already showing signs of type 2 diabetes. ENERGIZE! is a 12-weekintensive lifestyle education initiative that focuses on nutrition, physical fitness and behaviormodification.ENERGIZE! was inspired by the Diabetes Prevention Program, a major clinical trial thatdemonstrated that diet and exercise sharply reduce the chance that adults with impaired glucosetolerance will develop diabetes. Those types of lifestyle interventions have not been proven

effective in children, but in theory could, which WakeMed did when developing its kid and familyfriendlyprogram.Pediatricians refer children based on criteria developed by WakeMed, including a body massindex greater than 85 percent for the child’s age, a family history of diabetes and/or being ofAfrican-American or Latino ethnicity. WakeMed personnel then meet with the children and theirfamilies, conduct lab tests, explain the child’s risk factors and describe the program. Familiesenroll free-of-charge, but commit to three months of nutritional and health education and avariety of physical activities. ENERGIZE! expanded sessions now are held in at least eightlocations.Results• Of 500 children who have completed the program, 50 percent had a decreased body massindex after six months, and 50 percent of participants with fasting blood sugars higherthan 100 had reduced the figure to normal (below 100) within six months;• The state legislature appropriated $250,000 to expand a pilot to five other counties.***For further information, please visit, http://www.wakemed.org/body.cfm?id=609.WellPointTonikBeginning in 2005, WellPoint, the nation's largest health benefits company, launched Tonik, aninsurance offering targeting the young and uninsured, often referred to the ”young invincibles.”Tonik provides coverage to people between the age of 19 and early 30s who are unemployed orhave jobs without healthcare benefits. The program covers preventive care, emergency care ($100copay for ER visits), generic prescription coverage only ($10 co-pay), limited dental (preventive,diagnostic and minor restorative services) and vision coverage ($50 dollars of vision expenses forthe year). The program does not cover maternity nor branded drugs.Tonik currently offers three different products, based on price:Thrill Seeker(least expensive)Part Time Devil(moderate)Calculated RiskTaker (mostexpensive)Office Visits/Year 4 office visits per year 4 office visits per year Unlimited office visitsper yearCopay $20 copay $30 copay $40 copayDeductible $5,000 $3,000 $1,500Premium $64 per month $73 per month $80 per monthTonik offers all members Healthy Check screenings at various centers. Patients can get a basicscreening ($25), which includes routine blood tests and an individual health status report, or apremium screening ($75), which includes additional testing and a 300 page self care text book.Members also have access to HealthyExtensions, a service offering 10 percent to 50 percentdiscounts on independent vendor services such as laser vision correction, teeth whitening andweight loss programsResults:• As of 2005, 70 percent of people enrolled in Tonik were previously uninsured;• 60 percent of people who apply for Tonik are approved quickly over the internet and canprint out a member ID card;

• While the deductible is high for all plans, the monthly premium is relatively low allowingenrollees to have some form of basic insurance in case of an emergencies or catastrophicevents. It also offers basic preventive care and screenings at low cost.For further information, please visit, https://www.tonikhealth.com/.