Value Driven Health Care, an Opportunity for Change Presented by, Jeff Flick CMS Regional Administrator, Region IX January 22 th, 2007

The Healthcare Challenge What do we know today? We spend more per capita on healthcare than any other country in the world We spend more per capita on healthcare than any other country in the world In spite of those expenditures, quality is often inferior to other nations In spite of those expenditures, quality is often inferior to other nations Often doesn’t meet expected evidence-based guidelines Often doesn’t meet expected evidence-based guidelines There are significant variations in quality and costs across the nation There are significant variations in quality and costs across the nation

Public Perceptions * Percent who say they are dissatisfied with the quality of health care in this country… Has the quality of health care in this country… Gotten worse Gotten better Stayed about the same Don’t Know Source: Kaiser Family Foundation / Agency for Healthcare Research and Quality / Harvard School of Public Health National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7 – September 5, 2005). * Gallup Poll conducted September 11-13, 2000 with 1,008 U.S. adults.

Dartmouth Atlas of Healthcare A Variation Problem

President Bush Signs Executive Order on Value-Driven Health Care August 22, 2006

Four Cornerstones of Value-Driven Health Care Quality Standards: Systems need to be designed to collect quality-of-care information, and help define what constitutes quality care. Quality Standards: Systems need to be designed to collect quality-of-care information, and help define what constitutes quality care. Price Standards: Agreement is needed on how to aggregate claims information so “episode of care” costs for specific doctors and hospitals can be measured and compared. Price Standards: Agreement is needed on how to aggregate claims information so “episode of care” costs for specific doctors and hospitals can be measured and compared.

Four Cornerstones of Value-Driven Health Care Interoperable Health System: Standards must be set so different health systems can quickly and securely communicate and exchange data. Interoperable Health System: Standards must be set so different health systems can quickly and securely communicate and exchange data. Properly Placed Incentives: All parties – providers, patients, insurance plans, and payers - must be subject to contractual arrangements that reward both those who offer and those who purchase high- quality, competitively – price heath care. Properly Placed Incentives: All parties – providers, patients, insurance plans, and payers - must be subject to contractual arrangements that reward both those who offer and those who purchase high- quality, competitively – price heath care.

6 AQA Pilot Sites Massachusetts Health Quality Partners California Cooperative Healthcare Reporting Initiative Phoenix Regional Healthcare Value Measurement Initiative Indiana Health Information Exchange Wisconsin Collaborative for Healthcare Quality Minnesota Community Measurement

Stay Informed Through Region IX Stakeholder Call Every 3 rd Thursday of the Month, 2-3pm PST Every 3 rd Thursday of the Month, 2-3pm PST Next call March 15th, 2007 Next call March 15th, 2007 Toll Free: Toll Free: Pass Code: Stakeholder Call Leader: Jeff Flick Register for “ CMS Region IX Stakeholder ” ListServ for notification and details about calls through: Register for “ CMS Region IX Stakeholder ” ListServ for notification and details about calls through:

Thank You! Jeff Flick, Regional Administrator