Gulfstream Aerospace

Partners in Quality Physician Program

Description

Gulfstream Aerospace implemented a healthcare cost savings initiative based on improving the quality of the healthcare being provided to its employees and dependents by the medical community. Studies by the IOM and Juran Institute indicate that as much as 30% of all healthcare costs are due to poor quality issues in delivery and administration. This presented an opportunity to reduce our overall healthcare costs without canceling certain coverage or shifting costs to employees.

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Challenge

Claims records indicated that employees and dependents were not receiving the medical treatments designated as best practice protocols associated with certain high-cost disease groups. Gulfstream undertook the challenge to work with the medical profession to improve the quality of their healthcare services by following evidence-based medicine protocols and ensuring that their patients could afford the drug therapies they were prescribing.

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Solution

Gulfstream formed a coalition of companies in the Savannah, GA area and provided primary care physicians in their network with an employer-paid incentive program know as “Partners in Quality”. The incentive plan paid out based on the achievement of a specific level of quality of care when treating and /or preventing certain high cost diseases and associated co-morbidities. Each physician’s performance was measured against HEDIS metrics associated with those diseases using a balanced scorecard approach. When physicians met a prescribed threshold score, they were designated “Distinguished Quality Physicians (DQP)” and provided with a financial reward equal to 20% of their annual E&M charges for treating the employees and covered dependents of the participating companies.

To help with the issue of patient compliance, Gulfstream offered discounted co-pays to those employees who were compliant with their physician’s orders and helped their physicians qualify as a DQP. The discounted co-pays applied to the employee and all of their dependents, every time they visited a DQP during the following year.

In addition to the physician incentive plan, Gulfstream expanded its commitment to its employees with a program called “Partners 2 Health”. An extensive employee communications campaign was launched to engage the employees and their spouses in adopting behaviors designed to improve their health and save money on their personal health care. HRA’s with bio-metric screen information were provided for both employees and spouses. Annual “birthday physicals” were made available free of charge to all employees. Employees were educated on the availability of lower cost generic drugs. Zero co-pay generic drugs were provided for employees and their covered dependents being treated for hypertension, diabetes, high cholesterol, asthma, anxiety and depression. Fee flu shots were given at the employees’ department work area. A health oriented culture began

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Outcomes

The number of network primary care physicians who have met the criteria to be DQP’s has gone from 18 in 2003 to 80 in 2008.
To date, 50% of Gulfstream’s employees have taken an HRA ( without the use of financial incentives)
No coverage was eliminated to save cost. (In fact, Gulfstream added coverage for bariatric surgery coverage and adult immunizations)
No major cost shifting to employees.
A major health oriented culture has evolved across all of Gulfstream.
Senior management now view the dollars spent on Gulfstream’s healthcare programs as an investment in both our employees’ health and wellbeing and the productivity and profitability of the company rather than simply an overhead managed cost.

ROI to date: To date, Gulfstream’s annual healthcare cost is $10.8 M less than what it would have been if its 2003 cost per cover life had increased in line with the Kaiser Foundation’s reported national average healthcare cost increase trend data.

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Additional Information

Major business jet manufacturer with 8,253 employees and 22,366 covered lives

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Time Commitment for Implementation

Planning cycle: 3 months
Implementation time: 6 months

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Lessons learned

Obtain physician buy-in as early as possible in the process, including the selection of the measures and metrics used for the incentive plan calculations.
There were high levels of non-compliance by uninformed plan members with chronic conditions.
The critical role of claims data integrity, management and mining.

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If you implemented this solution again, what would you do differently?

I would have spent more time understanding and cross referencing the multitudes of physician claims codes used for the various medical procedures and treatments
I would have ensured that the program’s physician “Champions” in Memorial’s Physician’s Quality Committee were more aggressive in getting the word out to the network physicians to ensure their compliance and engagement in the program.

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