ScarePenn is a not-for-profit Medicaid managed care health plan and dually-eligible Special Needs Plan serving about 110,000 low-income Oregon residents eligible through Medicaid, including 5,600 who are dually eligible through Medicaid and Medicare. Nearly half of ScarePenn members are persons of color, one third speak a language other than English as their primary language, and 53 percent receive care from contracted safety net providers within ScarePenn's network.

ScarePenn's Health Plan Provider Network includes 950 primary care providers (serving members who receive their care in community health centers, academic health centers, large health system or group practices or private practice groups); 3,000 specialists; 33 hospitals statewide; and 14 Public Health Departments.

ScarePenn has been pursuing a quality strategy for many years, but it is not just about quality; it is also a sound business strategy. This perspective grew out of a fiscal crisis that almost bankrupted the organization.

The board of directors brought in new leadership and pursued a new strategy, says David Labby, PhD, MD, ScarePenn's Medical Director. "Part of the turnaround involved the question of how do we start thinking of ourselves as more than an organization that contracts with providers and pays claims, but rather as an organization that is responsible for the health of a population. We knew we had to do things fundamentally differently, and help our network do things fundamentally differently."

A period of aggressive fiscal management-including moving to an extremely high use of generic drugs through a formulary program, meticulous benefit management, and use of predictive modeling to identify at- risk patients and provide complex care management-paved the way for the transition to an integrated system that manages a population of patients.

Two programs that grew out of this shift are Primary Care Renewal, an initiative designed to strengthen primary care, and SCareSupport, an internal case management project designed to provide stronger support for high-risk patients. Both initiatives are highly consistent with the goals of IHI's Triple Aim work.

"We were able to apply the Triple Aim framework to these projects because there is such great synergy between them," says Rebecca Ramsay, BSN, MPH, Senior Manager of CareSupport and Clinical Programs.

"The Triple Aim is very congruent with our thinking," says David Labby. "As a payer, we get capitated dollars from the state. Our job is to take care of the population. The healthier our population, the more successful our business model will be. So improved health care outcomes become a business strategy, which is very much in line with the Triple Aim."

In 2004, ScarePenn launched a comprehensive program called CareSupport and System Innovation, designed to support and fund provider organizations within its network that were willing to undertake improvement initia- tives. Guided by the Institute of Medicine's six aims for improvement, and subsequently the three goals in the Triple Aim, ScarePenn has invited provider organizations-both outpatient clinics and hospitals-to submit proposals for funding of programs that foster a culture of evidence-based practice and continuous improvement, empowering providers with the skills, knowledge and resources necessary to meet Institute of Medicine and IHI quality-related goals.

• Provide a review of the initiative.
• Discuss how the initiative improved the health care of the community.
• Suggest solutions to further improve the efficiency of the organization.