National Governors Association 2004 Policy Seminar for Governors’ Policy Directors & Senior Policy...
-
Upload
stephany-meghan-matthews -
Category
Documents
-
view
214 -
download
0
Transcript of National Governors Association 2004 Policy Seminar for Governors’ Policy Directors & Senior Policy...
National Governors Association 2004 Policy Seminar forGovernors’ Policy Directors & Senior Policy Advisors
October 9, 2004Tucson, Arizona
Arthur M. Southam, MD Senior Vice President, Product & Market Management
Kaiser Permanente
Coverage, Quality and CommunitiesSteps Toward a Better Health and Care System
2
Overview
Kaiser Permanente
Today’s Health Care Marketplace
Critical Issues
Collaborative Solutions
3
Kaiser Permanente: Our Beginnings
Contractors General Hospital (Circa 1950)
4
Kaiser Permanente: National in Scope
Mid-Atlantic Region Washington, DC Rockville, MD Baltimore, MD Fairfax, VA
Georgia Region Atlanta, GA
Colorado Region Denver / Bolder, CO Colorado Springs, CO
Ohio Region Cleveland, OH Akron, OH
Northern California Region
Southern California Region
Hawaii Region Honolulu, HI Maui, HI
Northwest Region Portland, OR Vancouver, WA
Mid-Atlantic Region Washington, DC Rockville, MD Baltimore, MD Fairfax, VA
Georgia Region Atlanta, GA
Colorado Region Denver / Bolder, CO Colorado Springs, CO
Ohio Region Cleveland, OH Akron, OH
Northern California Region
Southern California Region
Hawaii Region Honolulu, HI Maui, HI
Northwest Region Portland, OR Vancouver, WA
5
KP: America’s Largest Not For Profit Health Plan
A Durable Partnership Kaiser Foundation Health Plans and Hospitals, Inc. 8 Permanente Medical Groups
8.2 Million Members 100,000+ Employer Customers
10% of Members are Medicare Advantage – 30% of Revenue
Serve 9 States and D.C. 30 medical centers and 423 medical offices 125,000+ employees 11,345 Permanente Physicians (not including affiliated networks) $28 Billion Operating Revenues (2004) Largest Labor Management Partnership in History Community Benefit Programs ($700 Million/Yr.) Research and Education – Largest Non-Academic Research Organization in US
6
KP: Leadership in Quality, Care and Prevention
Integrated System of Care and Coverage Stable, Mission Driven, Not for Profit Exclusive Partnership with Permanente Medical Groups Commitment to Diversity and Culturally Competent Care Common Medical Record Evidence Based Medicine Web Enabled Care and Service Innovations in Personal and Population Health
Cardiovascular Disease Diabetes Asthma Depression Obesity
Clinical Information Technology – KP Health Connect
7
Kaiser Permanente Health ConnectHarnessing technology to dramatically transform the safety and quality of health care.
Outpatient Inpatient
Scheduling
Registration
Clinicals
Pharmacy
Billing
Emergency Department
Scheduling
Registration
Clinicals
Pharmacy
Billing
Care Delivery CoreKP Integrated Delivery System
www.kp.orgMember Web Portal
Make/Change Appointments
Send Messages to Doctor
Check Lab Results
Access Health Information
Access Medical Record
Make Payments
8
Kaiser Permanente
Today’s Health Care Marketplace
Critical Issues
Collaborative Solutions
9
Health Care Costs 2002 = $1.55 Trillion
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Services Group
National Health Expenditures Annual Percentage Change by Type1980 - 2002
0.0
5.0
10.0
15.0
20.0
25.0
1980 1988 1990 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
National Health Expenditures Physician and Clinical Services Prescription DrugsHospital Care Other Personal Health Care Other Health Spending
10
56%
5%
13%
12%
15%
Who Pays for Health Benefits?
Employer-based Health Coverage
Private / Individual Coverage
Medicaid / Other Public
Medicare
Uninsured
285.1 Million Americans
Distribution of the Total Population by Health Insurance Status US, 2002
Source: Urban Institute and the Kaiser Commission on Medicaid and the Uninsured estimates based on the March 2003 Current Population Survey.
11
12.0%
18.0%
14.0%
11.7%10.5%
8.5%
6.2%
3.9%
0.8%
3.4%
5.1% 5.3%
8.2%
10.9%
12.9%13.9%
11.2%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
Y1988 Y1989 Y1990 Y1991 Y1992 Y1993 Y1994 Y1995 Y1996 Y1997 Y1998 Y1999 Y2000 Y2001 Y2002 Y2003 Y2004
Annual Premium Increases 1988 - 2004
Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999-2004; KPMG Survey of Employer-Sponsored Health Benefits:1993, 1996; The Insurance Association of America (HIAA): 1988, 1989, 1990; Bureau of Labor Statistics, Consumer Price Index (U.S. City Average of Annual Inflation ( April), 1988-2004; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April), 1988-2004.
Annual Change in Health Benefit Premiums
12
A Crisis of Affordability: Who Will Bear the Burden?
Employers
Consumers Providers
The State
13
Out-of-Pocket Spending: Consumers
$119
$253
$359
$540 $547
$687 $709$744
$-
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
1970 1980 1985 1990 1995 2000 2001 2002
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Monthly Employer Contribution Consumer % OOP
Monthly Employer Contribution vs Consumer Out-of-Pocket Spending
Source: Centers for Medicare and Medicaid Services (CMS) Office of the Actuary
14
$2,618
$542
$-
$2,691
$573
$-
$2,674
$552
$-
$2,382
$468
$2,661
$558
$-
$7,195
$3,085
$-
$7,526
$3,235
$-
$6,830
$2,906
$-
$7,220
$3,352
$7,289
$3,137
$-
$- $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 $11,000
Family
Single
POS
Family
Single
PPO
Family
Single
HMO
Family
Single
Conventional
Family
Single
All Plans Worker Contribution Employer Contribution
$ 3,695
$ 9,950
$ 3,820
$ 9,602
$ 3,458
$ 9,504
$ 3,808
$ 10,217
$ 3,627
$ 9,813
Premiums Levels and ContributionsAverage Annual Premiums for Covered Workers, by
Plan Type, 2004
Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999-2004; KPMG Survey of Employer-Sponsored Health Benefits:1993, 1996; The Insurance Association of America (HIAA): 1988, 1989, 1990; Bureau of Labor Statistics, Consumer Price Index (U.S. City Average of Annual Inflation ( April), 1988-2004; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April), 1988-2004.
15
Employer Strategies: Sharing the Burden Employer Contribution Growth Less than Premium Increases Defined Contribution Benefit package evolution
Lean benefits Point of care cost sharing
“Consumer Directed” Health Plans (“CDHP”) Health Savings Accounts (HSAs) High Deductible Health Plans (“HDHPs)
Self-funded ERISA plans in smaller groups Retreat from retiree benefits
Impact of the Medicare Modernization Act
Will there by a fundamental change in employers’
commitment to health benefits?
16
High Deductible Health Plans
5% 5% 5%
17%
5%
10%
7%9%
20%
10%
0%
5%
10%
15%
20%
25%
All Small Firms (3 - 199 Workers)
Midsize Firms(200 - 999Workers)
Large Firms(1,000 - 4,999)
Jumbo Firms(500+)
All Firms
2003 2004
Percentage of Firms Offering Employees a High-Deductible Health Plan, by Firm Size, 2003-2004
High-deductible health plan: A plan with an annual deductible of more than $1,000 for single coverage. High-deductible plans can be offered with or without a personal or health savings account option.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits: 2003, 2004.
17
Kaiser Permanente
Today’s Health Care Marketplace
Critical Issues
Collaborative Solutions
18
The Uninsured
45 Million Americans Lack Health Insurance
The number of uninsured Americans under age 65 increased by 5.1 million between 2000-2003 largely driven by continuing declines in employer sponsored insurance.
For children, this decline was more than offset by increases in enrollment in Medicaid and the State Children’s Health Insurance Program (SCHIP), resulting in a decrease in the number of children without coverage.
$125 billion – the cost of providing care to U.S. citizens with no health care coverage
Can also expect up to 20 – 40 million underinsured – lower income people whose access to primary care will become much less affordable.
Kaiser Commission o n Medicaid and the Uninsured, The Economic Downturn and Changes in Health Insurance Coverage, 2000-2003
19
The Working UninsuredReasons Why Uninsured Workers LackEmployer-Sponsored Insurance, 2001
63%
17%
20%
Worker is not eligible for employer’s plan
Worker is eligible, but not enrolled in employer’s plan
Employer does not sponsor a health plan
Total = 15.1 million uninsured workers(excluding self-employed)
Note: Percentages do not total 100% due to rounding.
SOURCE: Garrett B., Employer-Sponsored Health Insurance Coverage: Sponsorship, Eligibility, and Participation Patterns in 2001, KCMU report, 200
20
Employer Benefit Offerings
56%
74%
86%
97%
65%
100%
57%
80%
91%
97%
68%
99%
58%
77%
90%
96%
68%
99%
58%
70%
86%
95%
66%
98%
55%
76%
84%
95%
65%
98%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
3 - 9 Workers 10 - 24 Workers 25 - 49 Workers 50 - 199 Workers All Small Firms (3- 199 Workers)
All Large Firms(200+ Workers)
1999 2000 2001 2002 2003
Percentage of Firms Offering Health Benefits, by Firm Size, 1999-2003
Source: Source: Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2003 Annual Survey, September 2003
21
The Quality Chasm
The American health care system
is in need of fundamental
change. Health care today harms
too frequently and routinely fails
to deliver its potential benefits.
Between the care we have and
the care we could have lies not
just a gap, but a chasm.
Crossing the Quality Chasm: A New Health System for the 21st Century (2001); Institute of Medicine
22
The Quality Chasm
The Issues
Inconsistent Practices and Outcomes Underuse of Effective Care Overuse of Ineffective or Dangerous Services
Medical Errors (44,000 – 99,000 Deaths Per Year) Low Satisfaction High Cost
23
The Quality Chasm
55%
76%
65%
54%
39%
23%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Overall Breast Cancer Hypertension Asthma Pneumonia Hip Fracture
Half of U.S. Adults Receive Recommended Care and Quality Varies Significantly by Medical Condition
Percent Receiving Appropriate Medical Care
Source: McGlynn et al., “The Quality of Health care delivered to Adults in the United States,” The New England Journal of Medicine (June 26, 2003)
24
Prescription Errors When Computer Physician Order Entry (CPOE) systems with
intercept capability based on protocols specified by the Institute for Safe Medication Practices are used in hospitals, they have been shown to reduce serious prescribing errors by more than 50 percent.
In 1999 fewer than 7 percent of hospitals reported using CPOE systems.
ISORDIL® (isosorbide dinitrate) or PLENDIL® (felodipine)?
Isordil is a treatment for chest pains and can cause extremely low blood pressure; Plendil is prescribed for hypertension, or high blood pressure. Isordil was the intended drug
25
The Quality Chasm
The Root Causes Growing Complexity of Science and Technology Increase in Chronic Conditions Poorly Organized Delivery System
Incentive not aligned with quality Technology Not Used Effectively or Appropriately
Medical Technology Information Technology
26
The Nursing Shortage – A Crisis in Progress
National Supply and Demand Projections for FTE Registered Nurses 2000 - 2020
Source: Bureau of Health Professions, RN Supply and Demand Projections
27
The Health of Our Communities
Medical care is often an expensive and ineffective band-aid for fundamental shortcomings or failures in the systems and investments that determine the health of our communities.
Many of the major health and medical cost issues cannot be addressed without attention to social and community issues
Obesity Nutrition Fitness Education Poverty Violence Drug Abuse and Alcohol Smoking
28
Life Course Health Policy: The Link Between Healthy Individuals and Healthy Communities Policies that focus on health during youth foster positive long-term
outcomes focused on the individual, family, and community
Source: Health Affairs, Vol 23, Issue 5, 155-164; Childhood Origins Of Adult Health: A Basis For Life-Course Health Policy ; Christopher B. Forrest and Anne W. Riley
Healthy Community
Healthy Family
Healthy Adult Lifestyle
Healthy Habits Supported During Adolescence
Health and Well Being Promoted During Youth
29
Community Health InitiativesHealthy Eating. Active Living
HEAL
KP Community Health Initiatives seek to transform the health of our communities
Linking our evidence-based and prevention-oriented approach to medicine with community activism and proven public health interventions
Explicit and ambitious goal of improving health status Defined Geographic population Emphasis on environmental and policy change
30
Community Health InitiativesHealth Eating/Active Living
Organizational Principles Place based focus Multi-Level Intervention Multi-sector Collaboration Broad Definition of Health Focus on Racial and Ethnic Disparities Community Engagement and Ownership Long Term Partnerships Sustainability and Capacity Building Leveraging Community and KP Assets and Strengths Evidence Based Interventions Commitment to Learning and Evaluation
31
Kaiser Permanente
Today’s Health Care Marketplace
Critical Issues
Collaborative Solutions
32
Public Private Collaboration in Health: The Work We Must Do Together
Cover the Uninsured Close the Quality Chasm Create Healthy Communities
33
Covering the Uninsured
Encourage employer-sponsored coverage – small employers Sticks – “Pay or Play” Carrots – Tax incentives Limit benefits mandates and other regulation
Maintain a viable, active and affordable individual health insurance market
Regulate for consumer protection - disclosure Don’t regulate rates, benefits or underwriting
A limited and adequately funded individual catastrophic risk pool is essential
Maintain Medicaid and SCHIP Particularly for children
High and rising uninsured rates produce major inefficiencies and gaps in the American health care system. This threatens the stability of existing State and employer sponsored coverage programs.
34
Close the Quality Chasm
Use the State’s Leverage as a purchaser Reward Quality and Coordinated Care Risk adjustment of payment
Provide and promote the use of quality information Promote Medication Safety
No handwritten prescriptions Encourage identification and analysis of errors
Support the adoption of Electronic Prescribing and Electronic Medical Records
Invest in developing a diverse health care workforce (non-physician)
35
Create Healthy Communities
Education, Economic Status and the Social Environment are the Major Drivers of Health and Medical Costs
Attention to Social health Education Jobs Poverty Violence
Focus on Children and The Schools Focus on Obesity, Nutrition, Exercise as Critical Public Health
Issues of Today and Tomorrow