An internal risk management program helped bond the staff and healthcare providers involved with CFS Health Group.
CFS executives saw to it that all parties involved in their plan-from enrollees to healthcare providers-were made aware of the effort to consolidate risk management with quality improvement.
"It's one thing to come up with programs, but you need to give people feedback," said Daniel Winn, M.D., CFS Health Group's medical director, who helped form the program in 1990.
CFS, a Baltimore-based administrative management subsidiary of Blue Cross and Blue Shield of Maryland, is the umbrella organization for four Maryland Blues HMO plans.
CFS doubled its risk management personnel in an effort to reach across all organizational lines.
The operating budget for its 1994 plan includes: $400,000 for 51/2 risk management/quality improvement employees; $200,000 for three credentialing employees; and $400,000 for six case management workers. The budget has grown 25% in the past three years to allow a $200,000 increase in the case management area.
"Most important is the need to develop partnerships with the providers of care: individual doctors, physician groups, hospitals, and even partnerships with plan members," Dr. Winn said.
"The combined efforts of risk management and quality improvement have developed processes in problem-solving and monitoring that not only have had an impact on cost but also have improved the quality of patient care," said David Wolf, CFS Health Group's president.
Through the internal risk program, medical malpractice insurance has been reissued without an increase since 1991, executives said.
Last year alone, CFS executives said there was a savings of more than $200,000 on malpractice insurance because the liability carrier didn't increase what CFS would have normally paid if the company hadn't developed its risk management program. CFS paid $72,000 on its medical liability insurance to a carrier that's pleased with the company's risk management activities. Other insurers would have charged $275,000, CFS executives said.
"We've been able to avoid litigation so well that our (malpractice) insurance hasn't been raised," said Joy McCorkle, CFS' risk management and quality improvement manager.
Added Dr. Winn, "Communication is vital in accomplishing any corrective action plans. I have instituted ongoing meetings with major external clients and physicians to discuss issues identified and plan needs."
Communication also involves patients. Through what is called "advance directives usage," the health plan encourages open communication between providers and patients and their families. "This could save the plan a lot of money and resources for high-tech services," which could be unnecessary, Dr. Winn said.
CFS also has made inroads through wellness and educational classes. For example, a smoking cessation program incorporated behavior modification with nicotine patch use.