Presentation is loading. Please wait.

Presentation is loading. Please wait.

Why Not the Best? Towards A High Performance Health System Cathy Schoen Senior Vice President, The Commonwealth Fund Alaska Health Summit December 6, 2006.

Similar presentations


Presentation on theme: "Why Not the Best? Towards A High Performance Health System Cathy Schoen Senior Vice President, The Commonwealth Fund Alaska Health Summit December 6, 2006."— Presentation transcript:

1 Why Not the Best? Towards A High Performance Health System Cathy Schoen Senior Vice President, The Commonwealth Fund Alaska Health Summit December 6, 2006

2 2 Presentation Overview High Performance Health System –The Commonwealth Fund Commission on a High Performance Health System –What Constitutes A High Performance System? Where Are We Now? Performance and Achievable Benchmarks Levers for Change to Improve Performance: States in Action Moving Forward THE COMMONWEALTH FUND

3 3 The Commonwealth Fund Commission on a High Performance Health System Objective: Move the U.S. toward a higher-performing health care system that achieves better access, improved quality, and greater efficiency, with particular focus on the most vulnerable due to income, gaps in insurance coverage, race/ethnicity, health, or age Commission Members, including James J. Mongan, MD, Chairman; Alan Weil, JD; and others

4 4 Key Dimensions of a High Performance Health System EFFICIENT CARE HIGH QUALITY CARE EQUITY ACCESS and Affordability LONG, HEALTHY, AND PRODUCTIVE LIVES SYSTEM INNOVATION AND IMPROVEMENT THE COMMONWEALTH FUND

5 5 Achieving a High Performance Health System Requires: Committing to a clear, coherent strategy and establishing a process to implement and refine that strategy Enabling universal participation Delivering care through models that emphasize coordination and integration Implementing payment systems that support and encourage high quality, efficient, and accessible care Developing information systems and establishing/tracking metrics for health outcomes, quality, access, and efficiency THE COMMONWEALTH FUND

6 6 National and State Performance: Where We Are Now and Achievable Benchmarks THE COMMONWEALTH FUND

7 7 Scorecard on U.S. Health System National scorecard including spanning core domains of performance –Benchmarks based on achieved performance. Top states, regions, providers or countries –Overall score of 66 reflects pervasive shortfalls The U.S. falls far short on each of the core goals for health system performance –Wide gaps and variation within U.S. The consequence is needlessly lost lives, wasted health care expenditures, and lower economic productivity Given that the U.S. spends more than any other country, we should expect to lead on access, quality and efficiency –High value: benchmarks provide targets for improvement With cost and coverage moving in the wrong direction, action to achieve better performance is of great urgency THE COMMONWEALTH FUND

8 8 Mortality Amenable to Health Care Deaths per 100,000 population* Percentiles International variation, 1998 State variation, 2002 * Countries’ age-standardized death rates, ages 0–74; includes ischemic heart disease. See Technical Appendix for list of conditions considered amenable to health care in the analysis. Data: International estimates—World Health Organization, WHO mortality database (Nolte and McKee 2003); State estimates—K. Hempstead, Rutgers University using Nolte and McKee methodology. Mortality from causes considered amenable to health care is deaths before age 75 that are potentially preventable with timely and appropriate medical care Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 LONG, HEALTHY & PRODUCTIVE LIVES 8

9 9 Infant Mortality Rate, 2002 * Data: International estimates—OECD Health Data 2005; State estimates—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2005a). Infant deaths per 1,000 live births Percentiles International variationState variation LONG, HEALTHY & PRODUCTIVE LIVES Source: Commonwealth Fund National Scorecard on U.S. Health System Performance,

10 10 States Vary In Quality of Care – Medicare Indicators Alaska Ranks in Third Quartile on Provision of Appropriate Care First Third Fourth Source: S.F. Jencks, E.D. Huff, and T. Cuerdon, “Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998–1999 to 2000–2001,” Journal of the American Medical Association 289, no. 3 (Jan. 15, 2003): 305–312. Second Quartile Rank Note: State ranking based on 22 Medicare performance measures. 2000–2001 THE COMMONWEALTH FUND

11 11 Receipt of Recommended Screening and Preventive Care for Adults, by Family Income and Insurance Status, 2002 Percent of adults (ages 18+ yrs) who received all recommended screening and preventive care within a specific time frame given their age and sex* *Recommended care includes: blood pressure, cholesterol, Pap, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot. Data: Columbia University analysis of 2002 Medical Expenditure Panel Survey SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: RIGHT CARE

12 12 Preventive Care Visits for Children, 2003 Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource Center for Child and Adolescent Health database at Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: THE RIGHT CARE 12 Percent of children (ages <18) received BOTH a medical and dental preventive care visit in past year

13 13 Immunizations for Young Children, 2003 * Recommended vaccines include: 4 doses of diphtheria-tetanus-pertussis (DTP), 3+ doses of polio, 1+ dose of measles-mumps-rubella, 3+doses of Haemophilus influenzae type B, and 3+ doses of hepatitis B vaccine. PI = Pacific Islander; AI/AN = American Indian or Alaskan Native. Data: National Immunization Survey (AHRQ 2005a, 2005b). Percent of children (ages 19–35 months) who received all recommended doses of five key vaccines* Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: THE RIGHT CARE 13

14 14 Heart Failure Patients Given Written Instructions or Educational Materials When Discharged, by Hospitals and States, 2004 Percent of heart failure patients discharged home with written instructions or educational material* * Discharge instructions must address all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen. Data: National and hospital estimates—A. Jha and A. Epstein, Harvard University analysis of data from Hospital Quality Alliance national reporting system; State estimates—Retrieved from Hospital Compare database at HospitalsStates Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: COORDINATED CARE 14

15 15 * Child had 1+ preventive visit in past year; access to specialty care; personal doctor/nurse who usually/always spent enough time and communicated clearly, provided telephone advice or urgent care and followed up after the child’s specialty care visits. Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource Center for Child and Adolescent Health database at Children with a Medical Home, 2003 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: COORDINATED CARE Percent of children who have a personal doctor or nurse and receive care that is accessible, comprehensive, culturally sensitive, and coordinated* 15

16 16 Nursing Homes: Hospital Admission and Readmission Rates Among Nursing Home Residents, per State, 2000 Percent Hospitalization ratesRe-hospitalization rate (within 3 months of nursing home admission) Data: V. Mor, Brown University analysis of Medicare enrollment data and Part A claims data for all Medicare beneficiaries who entered a nursing home and had a Minimum Data Set assessment during Percent Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: COORDINATED CARE 16

17 17 Hospital-Standardized Mortality Ratios, 2000–2002 Ratio of actual to expected deaths in each decile (x 100) Decile of hospitals ranked by actual to expected deaths ratios See Technical Appendix for methodology. Data: B. Jarman analysis of Medicare discharges from 2000 to 2002 for conditions leading to 80 percent of all hospital deaths. Standardized ratios compare actual to expected deaths, risk-adjusted for patient mix and community factors. Medicare national average for 2000 = 100 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: SAFE CARE 17

18 18 High-risk residents Pressure Sores Among High-Risk and Short-Stay Residents in Nursing Facilities Percent of nursing home residents with pressure sores AI/AN = American Indian or Alaskan Native. Data: Nursing Home Minimum Data Set (AHRQ 2005a, 2005b). Short-stay residents High-risk residents Short-stay residents White13%21% Black1726 Hispanic1525 Asian1222 AI/AN1723 State distribution, 2004By race/ethnicity, 2003 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: SAFE CARE 18

19 19 Percent of Uninsured Adults Ages 18–64 is Increasing Alaska’s Rate Average 22 to 23% Data: Two-year averages 1999–2000 and 2004–2005 from the Census Bureau’s March 2000, 2001 and 2005, 2006 Current Population Surveys. Estimates by the Employee Benefit Research Institute. WA OR ID MT ND WY NV CA UT AZNM KS NE MN MO WI TX IA IL IN AR LA AL SC TN NC KY FL VA OH MI WV PA NY AK MD ME VT NH MA RI CT DE DC HI CO GAMS OK NJ SD WA OR ID MT ND WY NV CA UT AZNM KS NE MN MO WI TX IA IL IN AR LA AL SC TN NC KY FL VA OH MI WV PA NY AK ME DE DC HI CO GAMS OK NJ SD 19%–22.9% Less than 14% 14%–18.9% 23% or more 1999– –2005 MA RI CT VT NH MD NH Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 ACCESS: UNIVERSAL PARTICIPATION 19

20 20 States Average Employer Health Insurance Premiums, Employee-only Annual Source: AHRQ, 2004 MEPS-IC; Retrieved from MEPS State-level Insurance Component Summary Tables at Dollars THE COMMONWEALTH FUND

21 21 International Comparison of Spending on Health, 1980–2004 Data: OECD Health Data 2005 and Average spending on health per capita ($US PPP) Total expenditures on health as percent of GDP Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 EFFICIENCY 21

22 22 Ambulatory Care Sensitive (Potentially Preventable) Hospital Admissions for Select Conditions, 2002 Adjusted rate per 100,000 population * Combines four diabetes admission measures: uncontrolled, short-term complications, long-term complications, and lower extremity amputations. Data: National estimates—Healthcare Cost and Utilization Project, Nationwide Inpatient Sample; State estimates—State Inpatient Databases; not all states participate in HCUP (AHRQ 2005a). * Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 EFFICIENCY 22

23 23 Medicare Hospital 30-Day Readmission Rates and Associated Costs, by Hospital Referral Regions, 2003 Rate of hospital readmission within 30 daysReadmission reimbursement as percent of total reimbursement for all admissions Quartile of regions ranked by readmission rates Data: G. Anderson and R. Herbert, Johns Hopkins University analysis of 2003 Medicare Standard Analytical Files (SAF) 5% Inpatient Data. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 EFFICIENCY Percentiles 23

24 24 Quality and Costs of Care for Medicare Patients Hospitalized for Heart Attacks, Colon Cancer and Hip Fracture, by Hospital Referral Regions, Median Relative Resource Use = $25,995 * Indexed to risk-adjusted 1 year survival rate (median = 0.70). ** Risk-adjusted spending on hospital and physician services using standardized national prices. Data: E. Fisher and D. Staiger, Dartmouth College analysis of data from a 20% national sample of Medicare beneficiaries. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 EFFICIENCY 24

25 25 Percent of National Health Expenditures Spent on Insurance Administration/Overhead, 2003 *Includes claims administration, underwriting, marketing, profits and other administrative costs. Data: OECD Health Data 2005 SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 Net costs of health administration and health insurance as percent of national health expenditures a a 2002 b 1999 b c 2001 c * EFFICIENCY

26 26 Physicians’ Use of Electronic Medical Records, U.S. Compared to Other Countries, 2000/2001 Percent of physicians *2000 Data: 2001 European Union EuroBarometer and 2000 Commonwealth Fund I Survey of Physicians (Harris Interactive 2002) SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 EFFICIENCY

27 27 Receipt of All Three Recommended Services for Diabetics, 2002 Percent of diabetics (ages 18+) who received HbA1c test, retinal exam, and foot exam in past year * Insurance for people ages 18–64. ** Urban refers to metropolitan area >1 million inhabitants; Rural refers to noncore area <10,000 inhabitants. Data: 2002 Medical Expenditure Panel Survey (AHRQ 2005a). * ** Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 EQUITY: THE RIGHT CARE 27

28 28 Keys to Transforming the U.S. Health Care System 1.Guarantee affordable health insurance coverage 2.Implement major quality and safety improvements 3.Develop more organized delivery systems that emphasize patient-centered primary and preventive care 4.Increase transparency and reporting on quality and costs 5.Expand the use of interoperable information technology 6.Reward performance for quality and efficiency 7.Encourage public-private collaboration to simplify and achieve more effective change THE COMMONWEALTH FUND

29 29 1. Guarantee Affordable Health Insurance Coverage THE COMMONWEALTH FUND Guarantee Affordable Health Insurance Coverage

30 30 Massachusetts Health Plan MassHealth expansion for children up to 300% FPL; adults up to 100% poverty Individual mandate, with affordability provision; subsidies between 100% and 300% of poverty Employer mandatory offer, employee mandatory take-up Employer assessment ($295 if employer doesn’t provide health insurance) Connector to organize affordable insurance offerings through a group pool Source: John Holahan, “The Basics of Massachusetts Health Reform,” Presentation to United Hospital Fund, April THE COMMONWEALTH FUND

31 31 Maine’s Dirigo Health: Knitting Together Public, Private and Employer Insurance New insurance product; sliding scale deductibles and premiums below 300% poverty Employers pay fee covering 60% of worker premium Began Jan 2005; Enrollment 14,700 as of 4/30/06 Combined with expanded public * After discount and employer payment (for illustrative purposes only). Annual expenditures on deductible and premium $550 $0 $1,100 $1,638 $2,188 $2,738 THE COMMONWEALTH FUND

32 32 Vermont Health Care Affordability Act Enacted May 2006 Coverage expansion –Catamount Health Plans Targets those w/o access to work-based coverage Premium subsidies based on sliding scale up to 300% FPL Comprehensive benefit package including primary, chronic, acute care & other services No patient cost-sharing for preventive or chronic care Builds upon Wagner’s Chronic Care Model Financing –Employer assessment –Increase in tobacco taxes –Federal matching funds from Medicaid waiver Quality improvement initiatives –Public-private collaboration –Collection of health care data from all payers Rules to publicly report price & quality information THE COMMONWEALTH FUND

33 33 Illinois All-Kids Effective July 1, 2006 Available to any child uninsured for 6 months or more Cost to family determined on a sliding scale Linked to other public programs - FamilyCare & KidCare Federal and state funds –Children <200% of FPL covered by federal funds –Children 200%+ of FPL funded by state savings from Medicaid Primary Care Case Management Program All-Kids Training Tour –Public outreach program to highlight new and expanded healthcare programs THE COMMONWEALTH FUND

34 34 New Jersey Raises Age of Dependent Status for Health Insurance As of 5/2006, NJ requires all state insurers to raise dependent age limit to 30 –Highest age limit in country –Covers uninsured, unmarried adults with no dependents who are NJ residents or FT students –Premium capped at 102% of amount paid for dependent’s coverage prior to aging out 200,000 young adults expected to receive coverage Source: S.R. Collins, C. Schoen, J.L. Kriss, M.M. Doty, B. Mahato, “Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help,” Commonwealth Fund issue brief, May (Analysis of the March 2001–2005 Current Population Surveys) Millions uninsured, adults ages 19–29 THE COMMONWEALTH FUND

35 35 Implement Major Quality and Safety Improvements 2. Implement Major Quality and Safety Improvements 1. Guarantee Affordable Health Insurance Coverage THE COMMONWEALTH FUND

36 36 Rhode Island: Five-Point Strategy 1.Creating affordable plans for small businesses & individuals 2.Increasing wellness programs 3.Investing in health care technology 4.Developing centers of excellence 5.Leveraging the state’s purchasing power RI Quality Institute –Non-profit coalition -- hospitals, providers, insurers, consumers, business, academia & government –Partnered with “SureScripts” to implement state-wide electronic connectivity between all retail pharmacies and prescribers in the state Health Information Exchange Initiative –Statewide public/private effort –AHRQ contract 5 yr/ $5M –Connecting information from physicians, hospitals, labs, imaging & other community providers THE COMMONWEALTH FUND

37 37 Work Towards Coordinated and Patient- Centered Delivery of Care With A Focus on Primary Care 3. Emphasize Patient- Centered Primary, and Preventive Care 1. Guarantee Affordable Health Insurance Coverage 2. Implement Major Quality and Safety Improvements THE COMMONWEALTH FUND

38 38 Importance of Primary Care US has fewer primary care physicians per capita, no designated medical home, higher out-of-pocket costs, better financial rewards for specialty care Better access to primary care lowers total cost, improves outcomes –Starfield et al, Milbank Quarterly 2005 –Fisher analysis of Medicare expenditures and patient outcomes New primary care payment models need to be tested Health plans should exempt preventive and primary care from deductibles, and Encourage enrollees to designate medical home THE COMMONWEALTH FUND

39 39 Utah’s Primary Care Network Section 1115 Medicaid Waiver Targets uninsured adults (19–54) with family income less than 150% FPL Provides primary care and preventive care services –Physician office visits –Immunizations –Emergency care –Lab, X-ray, medical equipment & supplies –Basic dental care –Hearing & vision screening –Prescription drugs Hospitals provide $10 million in charity care for PCN participants THE COMMONWEALTH FUND

40 40 Helping Patients Become Informed and Active Partners in Their Care - Online surveys of patient experiences with feedback to community groups and physicianswww.howsyourhealth.org Primary Care Development Corporation New York – advanced access collaborative Shared decision-making Resident-centered care in nursing homes Family-centered care in Healthy Steps & ABCD THE COMMONWEALTH FUND

41 41 Center for Shared Decision-Making Dartmouth-Hitchcock Medical Center Provides tools to help patients understand trade-offs of medical vs. surgical treatment given their preferences Assist with health care decisions (e.g., videotapes, booklets, websites) Provides follow-up counseling with skilled staff Results in lower rates of invasive procedures, such as low-back surgery Kate Clay, BA, MSN, Program Director THE COMMONWEALTH FUND

42 42 Patient-Centered Hospital Care: Staff Managed Pain, Responded When Needed Help, and Explained Medicines, by Hospitals, 2005 Percent of patients reporting “always” * Patient’s pain was well controlled and hospital staff did everything to help with pain. ** Patient got help as soon as wanted after patient pressed call button and in getting to the bathroom/using bedpan. *** Hospital staff told patient what medicine was for and described possible side effects in a way that patient could understand. Data: CAHPS Hospital Survey results for 254 hospitals submitting data in National CAHPS Benchmarking Database. *** *** Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 QUALITY: PATIENT-CENTERED, TIMELY CARE 42

43 43 Transitional Care Reduces Rehospitalization for Heart Failure Patients Percentage of patients who were rehospitalized or died Number of hospital readmissions Average cost of care Source: Medical records and patient interviews (N=239) (Naylor et al. 2004), S. Leatherman and D. McCarthy, Quality of Health Care for Medicare Beneficiaries: A Chartbook, 2005, The Commonwealth Fund. Usual care groupIntervention group Resource use among congestive heart failure patients ages 65+ treated at six Philadelphia hospitals during 1997–2001 who were randomly assigned to receive a three-month transitional care intervention or usual care

44 44 Increase Transparency and Reporting on Quality and Costs 4. Increase Transparency and Reporting on Quality and Costs 3. Emphasize Primary, Preventive, and Patient-Centered Care 2. Implement Major Quality and Safety Improvements 1. Guarantee Affordable Health Insurance Coverage

45 45 Wisconsin Wisconsin Collaborative for Healthcare Quality –Voluntary consortium formed in physician groups, hospitals, health plans, employers & labor –Develops & publicly reports comparative performance information on physician practices, hospitals & health plans –Includes measures assessing ambulatory care, IT capacity, patient satisfaction & access Wisconsin Health Information Organization –Coalition formed in 2005 to create a centralized health data repository based on voluntary sharing of private health insurance claims, including pharmacy & laboratory data –Wisconsin Dept of Health & Family Services and Dept of Employee Trust Funds will add data on costs of publicly paid health care through Medicaid THE COMMONWEALTH FUND

46 46 Expand the Use of Interoperable Information Technology 5. Expand the Use of Interoperable Information Technology 4. Increase Transparency and Reporting on Quality and Costs 3. Emphasize Primary, Preventive, and Patient-Centered Care 2. Implement Major Quality and Safety Improvements 1. Guarantee Affordable Health Insurance Coverage

47 47 Primary Care Doctors Use of Electronic Patient Medical Records, 2006 Percent Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians THE COMMONWEALTH FUND

48 48 Value of Electronic Medical Records and Information Systems Reduce duplicate tests Reduce hospital admissions with information accessible to ER Improve patient care Decision support for physicians and patients Facilitate “referrals”, secure transfer of responsibility Reduce medical errors Better management of chronic conditions and care coordination –Registries –Performance information –Reminder and alerts –Facilitated by interoperability Saves physician and staff time on paperwork; redirects to patients THE COMMONWEALTH FUND

49 49 Information Exchange: States In Action Rhode Island Quality Institute Information Exchange –Provide access to patient data (as permitted) to all providers initially through secure web-based portal – future integration into EHRs –Create the ability to aggregate and utilize data for public health purposes (e.g., population-based analysis, biosurveillance) MidSouth e-health Alliance: Memphis, TN –State-wide data exchange with initial focus on EDs Utah Health Information Network –Secure exchange of health care data using standardized transactions through a single portal New York State Health Information Technology (HIT) initiative –Under the Health Care Efficiency and Affordability Law for New Yorkers, $52.9 million awarded to 26 regional health networks to expand technology in NY health care system and support clinical data exchange; Commonwealth Fund-supported evaluation underway Source: Evolution of State Health Information Exchange, AHRQ, Publication No , January THE COMMONWEALTH FUND

50 50 Reward Performance for Quality and Efficiency 6. Reward Performance for Quality and Efficiency 4. Increase Transparency and Reporting on Quality and Costs 3. Emphasize Primary, Preventive, and Patient-Centered Care 2. Implement Major Quality and Safety Improvements 1. Guarantee Affordable Health Insurance Coverage 5. Expand the Use of Interoperable Information Technology

51 51 Building Quality Into RIte Care Higher Quality and Improved Cost Trends Quality targets and $ incentives Improved access, medical home –One third reduction in hospital and ER –Tripled primary care doctors –Doubled clinic visits Significant improvements in prenatal care, birth spacing, lead paint, infant mortality, preventive care Source: Silow-Carroll, Building Quality into RIte Care, Commonwealth Fund, Tricia Leddy, Outcome Update, Presentation at Princeton Conference, May 20, Cumulative Health Insurance Cost Trend Comparison RI Commercial Trend RIte Care Trend Percent THE COMMONWEALTH FUND

52 52 New York State Medicaid Pay-for-Performance 1997 — NYS began transition to mandatory statewide Medicaid managed care. Currently > 2.5 million enrollees (including Family Health Plus) 2002 — NYS DOH incorporated quality incentive into computation of Medicaid managed care capitation rates –Incentive tied to performance on 10 quality of care measures and 5 consumer satisfaction measures –Initial incentive up to an additional 1% of monthly premium; as of April 2005, maximum incentive increased to 3% 2005 — incentive payments totaled $40 million Commonwealth Fund supporting Dr. Robert Berenson (Urban Institute) to evaluate impact of quality incentive program — qualitative analysis (interviews/site visits of participating plans) and quantitative analysis of measures THE COMMONWEALTH FUND

53 53 Medicare Physician Group Practice Demonstration The Everett Clinic (WA) Deaconess Billings Clinic Park Nicollet Health Services (MN) Marshfield Clinic (WI) St. John’s Health System (MO) Source: “Medicare Physician Group Practice Demonstration,” January 31, 2005.www.cms.gov Univ. of Michigan Faculty Group Practice Geisinger Health System (PA) Forsyth Medical (NC) Middlesex Health (CN) Dartmouth-Hitchcock Clinic 10 physician group practices 3-year project, began April 2005 Bonus pool based on savings relative to local area Practices expected to save 2%, keep up to 80% of additional savings Actual bonuses depend on savings and quality targets THE COMMONWEALTH FUND

54 54 Medicare Premier Hospital Demonstration: Higher Quality Hospitals Have Fewer Readmissions Readmission Rates by Pneumonia Quality Ranking (Percent) © 2005 Premier, Inc. Source: Stephanie Alexander, “CMS/Premier Hospital Quality Incentive Demonstration Project:1st Year Results,” Presentation at IOM P4P Subcommittee Meeting, November 30, 2005 THE COMMONWEALTH FUND

55 55 California Integrated HealthCare Association Pay for Performance Initiative Clinical50%40%50% Patient Experience40% 30% IT Investment10%20% Patient Experience domain: Communication with doctor Overall ratings of care Care coordination Specialty care Timely access to care Source: Tom Williams, “California Pay for Performance (P4P): A Case Study.” THE COMMONWEALTH FUND

56 56 Encourage Public-Private Collaboration to Achieve Simplification, More Effective Change 7. Encourage Public-Private Collaboration 4. Increase Transparency and Reporting on Quality and Costs 3. Emphasize Primary, Preventive, and Patient-Centered Care 2. Implement Major Quality and Safety Improvements 1. Guarantee Affordable Health Insurance Coverage 6. Reward Performance for Quality and Efficiency 5. Expand the Use of Interoperable Information Technology

57 57 Minnesota Smart-Buy Alliance Initiated in 2004 – alliance between state, private businesses, and labor groups Purchase health insurance for 70% of state residents ~3.5 million people Pool purchasing power to drive value in health care delivery system Set uniform performance standards, cost/quality reporting requirements & technology demands Four key strategies: 1. Reward or require “best in class” certification 2. Adopt and utilize uniform measures of quality and results 3. Empower consumers with easy access to information 4. Require use of information technology THE COMMONWEALTH FUND

58 58 Washington State Puget Sound Health Alliance Founded in 2004 as independent non-profit organization Five-county partnership among employers, physicians, hospitals, consumers, health plans and others Multi-prong approach to improving care and “systemness” –Developing evidence-based guidelines for physicians, hospitals and other health care professionals –Designing tools for consumers and patients to support decision making & self management of chronic conditions –Producing regional reports on quality, cost & value to be made publicly available by end of 2006 –Promoting data sharing across health plans & providers with the goal of a shared data repository –Building regional infrastructure to support and sustain QI, including workforce development & training THE COMMONWEALTH FUND

59 59 West Virginia Small Business Plan Leveraging Purchasing Power Enacted March 2004 Partnership between WV Public Employees Insurance Agency (PEIA) & private market insurers Small business insurers pay providers at same rates negotiated by PEIA THE COMMONWEALTH FUND

60 60 Several States Looking to More Comprehensive Health Reform Statewide Maine, Maine, Vermont, Rhode Island have quality initiatives built into coverage expansions Maine –Created Maine Quality Forum to advocate for high quality health care and help each Maine citizen make informed health care choices. Massachusetts –Cost and Quality Council formed Vermont –Quality improvement initiatives Public-private collaboration Collection of health care data from all payers Provides rules to publicly report price & quality information THE COMMONWEALTH FUND

61 61 Moving Forward THE COMMONWEALTH FUND

62 62 National Legislative Proposals to Facilitate State Health Insurance Innovations Baldwin-Price: Health Partnership through Creative Federalism –State proposals for coverage, quality and efficiency and information technology. Statewide or multi-state –Commission to review Voinovich-Bingaman: Health Partnership Act –State grants for innovation, priority to coverage and access –Commission to establish performance measures and goals and review proposals Multiple proposals to expand federal match for coverage to higher poverty levels and adults THE COMMONWEALTH FUND

63 63 What States Can Do Promote a High Performance Health System: Strategies to Expand Coverage Develop blueprints toward more universal coverage Expand public programs and “connect” with private Provide financial assistance for affordability – premium assistance; “buy-in” provisions Assure benefit designs that cover primary, preventive and essential care Pool risk and purchasing power, partnerships with employers Pool purchasing power Efficient insurance arrangements Develop reinsurance programs to make coverage more affordable, pool risk and stabilize group rates Mandate that employers offer and/or individuals purchase coverage THE COMMONWEALTH FUND

64 64 What States Can Do to Promote a High Performance Health System: Strategies to Improve Quality and Efficiency Promote Evidence-based medicine Effective chronic care management Transitional care post-hospital discharge Encourage data transparency and performance reporting Promote/practice value-based purchasing Promote the use of health information technology Encourage selection of medical home and improved access to primary care and preventive services Simplify and streamline public program eligibility and re- determination; Insurance Promote wellness and healthy living THE COMMONWEALTH FUND

65 65 Laboratories for Change Continue to Lead the Way to Achieving a High Performance Health System! THE COMMONWEALTH FUND

66 66 Selected Commonwealth Fund Publications The Commonwealth Fund Commission on a High Performance Health System, Framework for a High Performance Health System for the United States, The Commonwealth Fund, August 2006 The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, The Commonwealth Fund, September 2006 C. Schoen and S.K.H. How, National Scorecard on U.S. Health System Performance: Complete Chartpack and Chartpack Technical Appendix, The Commonwealth Fund, September S. Silow-Carroll and F. Pervez, States in Action: A Quarterly Look at Innovations in Health Policy, The Commonwealth Fund, Summer 2006, Vol. 5. Forthcoming: State Scorecard on Health System Performance All publications are available at THE COMMONWEALTH FUND

67 67 Acknowledgements Stephen C. Schoenbaum Executive Vice President and Executive Director, Commission of a High Performance Health System Karen Davis President Ilana Weinbaum Program Associate Sabrina How Research Associate Alyssa Holmgren Research Associate THE COMMONWEALTH FUND Anne Gauthier Senior Policy Director, Commission of a High Performance Health System


Download ppt "Why Not the Best? Towards A High Performance Health System Cathy Schoen Senior Vice President, The Commonwealth Fund Alaska Health Summit December 6, 2006."

Similar presentations


Ads by Google