Unearthing Cost Containment Opportunities in Surprising Places

  • February 14, 2017
  • 11:00 AM – 12:00 PM ET
  • Online

Effective solutions to improve the quality and efficiency of care for medically complex conditions require an understanding of how to overcome the shortcomings of our highly-fragmented healthcare system. Fragmentation of care often leads to misdiagnoses, medical errors and inappropriate high-cost interventions.

The statistics are startling:

  • 15% of all medical cases in developed countries are misdiagnosed1
  • 1/3 of all health care costs in the U.S. are wasted dollars, the bulk of which are tied to misdiagnosis2
  • 10% of all medical diagnoses in the U.S. are incorrect3, causing 10 % of all U.S. deaths4
  • Over 250,000 of all hospital deaths each year are due to medical errors5

Four years ago, a CareFirst BlueCross BlueShield (CarefFirst) launched a successful Patient Centered Medical Home (PCMH) program and their Total Cost of Care Improvement (TCCI) initiatives to provide physicians with tools to coordinate care for members with chronic conditions. To identify cases with highly complex and troubling diagnosis and conditions, the payer implemented a unique approach within their PCMH—targeted and rigorous expert physician reviews. This approach was developed collaboratively with a proven partner to minimize adverse consequences while improving care quality for their members.

Key learning objectives:

  • Discover how this collaboration supported the CareFirst’s Patient Centered Medical Home (PCMH) and their Total Care and Cost (TCCI) initiative
  • Understand the Data, Analytics and IT Platforms that provided key programmatic support leading to a solid ROI
  • Hear about the positive impact for members, providers and care managers
  • Learn why and how CareFirst plans to expand the program with Best Doctors in 2017

Who should attend:

  • CFO
  • CMO
  • VP, Clinical Care Mgmt/Patient Experience
  • Director, Clinical Operations
  • Care Coordinator/Case Manager
1. The American Journal of Medicine (2008) Vol 121 (5A), S2–S23
2. Diagnostic Errors: The Next Frontier for Patient Safety”.
3. Institute of Medicine of the National Academies, To Err is Human: Building a Safer Health System, Nov. 1999; http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/1999/To-Err-is Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf
4. L.L. Leape, Counting deaths due to medical errors, JAMA. 2002;288:2404-05
5. M. A. Makary and M. Daniels, Medical Error – the Third Leading Cause of Death in the US, May 2016; BMJ 2016;353:i2139. http://dx.doi.org/10.1136/bmj.i2139


jennifer-baldwinJennifer Baldwin, RN, MPA, Senior Vice President for Patient-Centered Medical Home, CareFirst
Jennifer joined CareFirst BlueCross BlueShield in 2012. Prior to her position at CareFirst, Ms. Baldwin held two positions at Kaiser Permanente; the first as the chief nurse executive, then, the area administrator for the District of Columbia and Suburban Maryland for Kaiser Permanente. Prior to her time at Kaiser, she held positions as the senior vice president for patient care and services and the chief nurse executive at Holy Cross Hospital, and she has held nursing, administrative, and policy positions at Inova Fairfax and Inova Fair Oaks Hospitals, Georgetown University Hospital, and the U.S. Department of Health and Human Services.

Ms. Baldwin holds a master’s degree in public administration from George Washington University and a bachelor of science in nursing from Villanova University.

lewis-levyLewis Levy, MD, FACP, Chief Medical Officer, Best Doctors
Lew provides medical leadership to the clinical operations team to deliver the highest quality clinical information on diagnosis and treatment to members and their treating physicians. He has over 25 years of clinical experience as an internist at Harvard Vanguard Medical Associates in Boston. Dr. Levy also has an extensive teaching career as a preceptor in the Internal Medicine Residency Program at Brigham and Women’s Hospital and is an instructor at Harvard Medical School. He continues to practice primary care internal medicine and has participated in pioneer ACO, HMO and FFS arrangements.

Dr. Levy earned his medical degree from the University of Rochester School of Medicine and Dentistry and completed his residency in Internal Medicine at the Graduate Hospital of the University of Pennsylvania.

peter-mcclennenPeter McClennen, Chief Executive Officer, Best Doctors (Moderator)
Peter brings more than 20 years of experience leading a wide range of health care IT service companies and health systems operations. Immediately prior to joining Best Doctors, he served as President of Population Health Management at Allscripts Health Solutions, building a new business unit focused on the transition to value-based care through patient engagement, systems interoperability and analytics. Previous to that, he led dbMotion Inc, a global medical informatics company, from its early days as a start-up with only one client, to an industry leader in the interoperability and Health Information Exchange (HIE) market space; dbMotion was subsequently acquired by Allscripts. Peter spent his early career in hospitals and medical imaging centers followed by roles at Fujifilm Medical Systems, GE Healthcare and AMICAS Inc. With a deep concentration in health care, he uniquely understands the complex environment and the critical intersection of quality service and efficient operations that lead to sustained success, both in the U.S. and in global markets.