Regulation of the Internet: The How’s and Why’s of Telecommunications Reform
Money in the Bank: The Why’s & How’s of Investing in Chronic Care
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Transcript of Money in the Bank: The Why’s & How’s of Investing in Chronic Care
Presentation to:National Academy for State Health Policy
Money in the Bank: The Why’s &
How’s of Investing in Chronic Care
Donna MarshallExecutive Director
Colorado Business Group on HealthOctober 15, 2007
Colorado Business Group on Health
The BEST Trust Public Employees’ Retirement Association
City of Boulder (P. E.R.A.)
City of Colorado Springs State of Colorado
Colorado College Sun Microsystems
Colorado Springs Utilities TIAA-CREF
Colorado Springs SD #11 University of Colorado
Denver Newspaper Agency Woodward Governor El Paso County
Intel
Poudre School District
303-922-0939
www.coloradoHEALTHonline.org
200 S. Sheridan Blvd. #105Denver, CO 80226-8010
Colorado Business Group on Health
We welcome these Associations:
Rocky Mountain HealthCare Coalition
Colorado Association of School Executives
Colorado Education Association
The Colorado Business Group on Health
Member organization Established in 1996 Mission
To be a catalyst in promoting cost-effective delivery of quality health care to the benefit of our members and the community
One of over 70 coalitions in the U.S.; a proud member of the National Business Coalition on Health
WHY a Purchaser Coalition?
Inability of any one purchaser to move the market
Inability of any one health plan to move the market
Importance of creating and supporting common sets of requirements and expectations
Create a presence in the marketplace
Elements of Gridlock in the System
• Purchasers — Not Buying Right
• Plans — Not Letting Provider Value Show Through to
Consumers
• Providers — Not Seeing Business Case for
Reengineering; or Transparency of Cost & Quality
• Consumers/Patients — Not Yet Into Value Purchasing
• Consultants/Brokers — Do They Drive Market-wide
Improvement?
Why should purchasers drive quality?
• Purchasers — Not Buying Right
The Why’s the Wise Should:
• Cost of chronic care: medical services for chronic
care conditions are estimated to drive 80% of
spending
• The Rand Study illustrates The “Quality Chasm” and
the opportunity cost to purchasers/ patients
What does the Expert Say?
“In theory there is no difference
between theory and practice.
In practice there is.”
--Yogi Berra
Half Rate Care
The Quality of Health Care Delivered to Adults in the United States
McGlynn E. A., Asch S. M., Adams J., Keesey J., Hicks J., DeCristofaro A., Kerr E. A. New England Journal of Medicine 2003; 348:2635-2645, Jun 26, 2003.
“Our results indicate, on average, Americans receive about half of recommended medical care processes. …the gap between what we know what works and what is actually done is substantial enough to warrant attention.”
pp 2643-2644
Do We Get the Care We Need?
RAND STUDY Results, NEJM, 2003
Condition # of Indicators
% of Recommended
Care
Prenatal Care 39 73.00%
Coronary Artery Disease 37 68.00%
Depression 14 57.70%
Asthma 25 53.50%
Hyperlipidemia 7 48.60%
Diabetes 13 45.40%
NCQA Quality Dividend Calculator
Employers reduce costs with better quality health plansUsing diabetes as an example:
A financial services company with 7,000 employees avoids roughly 780 more days of sick leave:
– when enrolled in NCQA-accredited health plans than when enrolled in a non-accredited plan
avoids paying out about: – $155,000 in sick wages– $120,000 in temporary replacement worker costs
experiences related benefits such as: – lower direct medical expenses – higher employee morale
Visit www.ncqa.org for more information
Physicians Attaining Recognition Show Improvement
Physicians Achieving Diabetes Physician Recognition Show Substantial Improvement In Key Clinical Measures
% of adult patients with
60
17
37
50
25
21
58
37
10
67
46
8
78
36
63
85
45
74
0 20 40 60 80 100
Monitoring for Nephropathy
Lipid Control (<100 mg dl)
Lipid Control (<130 mg dl)
BP < 140/90 mm Hg
Good HbA1c Control (<7.0%)
Poor HbA1c Control* (>9.5%)
200320001997
Diabetes Physician Recognition Program, average performance of applicants, 1997-2003 data.* Lower is better for this measure.
Can We Relate Improvement to Savings?
“For every 1% reduction in blood glucose levels (HbA1c blood tests), the risk of developing eye, kidney/ESRD and nerve disease is reduced by 40 percent.
Improved control of cholesterol can reduce cardiovascular complications 20 to 50 percent.
Every 10 millimeters of mercury reduction in systolic blood pressure in diabetics results in a 12 percent reduction in diabetic complications.”
Source: The State of Health Care Quality, Industry Trends and Analysis, 2006. National Committee for Quality Assurance.
Do purchasers have tools?
What can be done: Management,
metrics and transparency
– ◙ How can purchasers move the
market?
What is Bridges to Excellence (BTE)?
Non-profit organization dedicated to improving health care quality through physician measurement, reporting, incentives, and education
Mission: – encourage providers to deliver optimal care
Focus:– Diabetes care, cardiac care, information technology– A national program, built on national performance
standards– Recognition of physicians conducted by the National
Committee for Quality Assurance– Program costs paid by participating employers
Concept behind Bridges to Excellence
Employers are interested in achieving cost savings for patients seeing high-performing physicians
Willingness to share portion of projected cost savings per patient to physicians as reward for health care excellence
Rewards to top physicians act as incentives for other physicians to change their practice patterns and improve performance
Physicians receive rewards, employers realize cost savings, and consumers’ health is improved
Colorado’s Bridges to Excellence Program
CBGH is one of four coalitions to receive technical assistance to implement this program
We have commitment from eight employers in the Colorado Springs, 50k lives
We have a commitment from one physician’s group and the endorsement of the local medical society to participate in the program.
Five health plans have joined: Anthem, CIGNA, Great West, United and Rocky Mountain Health Plans
Colorado’s Bridges to Excellence Program
The program began January 1, 2006
More program details can be found on the web at the Bridges to Excellence website.
Physicians attain the Diabetes Recognition status by submitting a sample of their patient data to NCQA and reaching goals for screening frequency and patient management.
We have moved the marketplace, with just a modest program.
We will expand the program to add more employers, more geographic areas and add the cardiovascular program to the diabetes recognition program.
Number of Diabetes Recognized Physicians in Colorado has been enhanced
Date
2003 to June 2006
July toDecember
2006
ByMarch2007
By June 30,
2007
By Sept 30,
2007
ByDecember
2007*
Other Colorado Locations 4 10 10 22 50 35*
Colorado Springs # 0 0 6 7 13 25*
Total #(cumulative) 4 10 16 29 63 60*
Total eligible physicians in the Colorado Springs Area is approximately 300* = estimate made in January 2007
Purchaser Role: Influencing Gridlock
• Purchasers — Not Buying Right: Value Based
Purchasing
• Plans — Not Letting Provider Value Show Through to
Consumers: Standard Reporting, Standard Metrics
• Providers — Not Seeing Business Case for
Reengineering: Leapfrog, Health Matters, BTE
• Consumers/Patients — Not Yet Into Value
Purchasing: Give them real data
Purchaser Role: “Value Based Purchasing”
Buy on quality and cost…not just cost.
Identify quality providers using national data sources that are valid and reliable
Let’s standardize performance measures and buy more health, not more healthcare
Use incentives to change the landscape, to encourage accountability and health information technology
Educate and inform patients and employees using Health Matters and other resources
The Institute of Medicine
The Committee’s Conclusion
“The American health care delivery
system is in need of fundamental
change. The current care systems
cannot do the job. Trying harder
will not work. Changing systems
of care will. “
How can we work together? Use a
coalition to drive projects, market
expectations and to reduce costs.