1 minnesota’s efforts to enhance the quality of health care david k. haugen director, center for...
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Minnesota’s Efforts to Enhance the Quality of Health Care
David K. HaugenDirector,
Center for Health Care Purchasing Improvement, MN Dept. of Employee Relations
5:00 – 6:30 p.m.August 22, 2006
“Minnesota Model”
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Overview
Problem StrategiesExamplesThe Future?
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Problem
The Health Care System is Broken It is dangerous and far less effective than it
could be Problems of both quality and cost
A system problem -- will take a system solution
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Health care purchasing challenges in the 21st century
HugeHuge variation in costs and quality Where you go, who you see, how you use
health care makes a big difference Needed:
Information, incentives to select and use health care wisely
Appropriate recognition and rewards to deliver high quality, efficient health care
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Strategies
Work in synchLead by example
Help drive the marketBuild on solid foundation
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Joining forces, working in synch Governor’s Health Cabinet
State now purchases for over 780,000 people at over $4 billion per year
Develop common demands, develop common rewards for the market
Smart Buy Alliance Partner with the private sector to also implement
common, reinforcing purchasing strategies Coalition of coalitions representing nearly 3/5 of
Minnesotans Not a government takeover
Government working more in synch Government working more in synch with the private
sector
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State Employee Group Insurance Program (SEGIP)
Scope and sizeCovers all three branches of state governmentApproximately 115,000 covered livesCosts: now $450 million per year
Examples in practice:Transparency of costs and qualityAligned incentives and accountabilityInformation and assistance
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SEGIP Examples
Tiered health benefits design (Advantage)
Rewarding higher quality careHealth improvement programs and incentives
Expanding choices, options, information, assistance
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Tiered Program -- Advantage Tiered health benefits plan for state
employees1. Clinic systems placed into 1 of 4 cost levels
Based on risk adjusted costs and collective bargaining
Risk adjustment -- apples to apples comparisons
2. If a higher cost level provider is selected, the user pays more at the point of service Higher copays, deductible, coinsurance
3. Quality information provided via links to MN Community Measurement website
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Advantage’s key features
Information and incentives to:• Employees and families to choose
high quality, high value providers• Providers to deliver greater value, or
lose market share• Use health care wisely and
protect/improve health
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Quality information for Advantage MN Community Measurement
Providers, Health Plans, Employers Website comparing how MN clinics
perform in providing tests and basic treatments for common medical conditions
Asthma, diabetes, children’s health, high blood pressure, women’s health, depression
www.mnhealthcare.org
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Example of MN Community Measurement
Diabetes
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Advantage -- Rewarding higher quality care
First public sector group in national Bridges to Excellence programParticipating with other major employers
2006 – Paid top 9 clinic groups in optimal diabetes care extra $100 per diabetic patient
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Health improvement programs and incentives
Costs are driven by key chronic conditions Chronic conditions increase with ageAve. state employee age (47) continues to
increase Approximately 20% of the SEGIP population
account for 80% of total costs Focused efforts in education and care
management can lead to improved member health and cost reductions
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Advantage Impacts Greater transparency of costs and
quality Cost savings – 0% increase for 2006 Council of State Governments
Innovation Award Reference to Advantage in MedPac
report to Medicare
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MN’s increasing transparency and value-based purchasing
Quality measurement and public reporting “triple play” Health Plans – “eValue8” Clinic groups – “MN Community Measurement” Hospitals – “Adverse events” reporting
Nursing home report card Information Clearinghouse
www.Minnesotahealthinfo.org
“Best in class” and value-based purchasing Tiered arrangements (e.g., Minnesota Advantage) + quality
measures “Bridges to Excellence” program and other initiatives
Dept of Human Services (Medicaid) also planning to join
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Most recently: Q-CareQuality Care and Rewarding ExcellenceAnnounced July 31, 2006
What is measured can be managed. What is paid for is done.
Help cross the “quality chasm”Minnesota uniquely prepared
ICSI, MN Community Measurement, Adverse Events reporting, www.minnesotahealthinfo.org
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Q-Care Rapid Transformation Agree on best care Set stretch goals Align measurement, reporting, rewards and
incentives Significantly improve in key areas
Preventive careDiabetesCardiovascularHospital-based care
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QCare Executive Order
…The Commissioner[s] of Human Services and …Employee Relations are directed to adopt and apply the QCare standards and align payments and incentives for all state purchased health care
…All future state contracts with health plans and health care providers must include new incentives and requirements for greater reporting of costs and quality of care delivered based on the QCare standard
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Rapid, broad, consistent use across purchasers State government
Health Cabinet, Center for Health Care Purchasing Improvement, Interagency agreements
Will include local units of government Private sector
Smart Buy Alliance Consumers
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Problem Solved?
Future of health care in Minnesota