community dialogue: health care waste, overuse and high cost november 29, 2012
TRANSCRIPT
Community Dialogue:Health Care Waste, Overuse and
High Cost
November 29, 2012
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State Employee Group Insurance Program (SEGIP)
50,000 Employees1120,000 lives covering Judicial, Executive & Legislative Branches
$1.5 billion biennial budget
Largest employer group in the state
1,200 clinics
55 care systems
90% Union
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What is Health Care Waste to an Employer?
Anything that doesn’t result in a more productive employee!
Why does an Employer offer Benefits?
• To recruit and retain employees
• To maintain a healthy and productive workforce
60% of MN citizens receive health care through an employer
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Where Does Waste Occur?
As a purchaser waste occurs in 3 areas:
1.The care and management of a chronic condition
2.The care and management of acute care
3.The achievement of either by an employee
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*The Triple Aim: Care, Health, And Cost. Berwick DM, Nolan TW and Whittington J., Health Affairs, May 2008, Vol. 27, No. 3, 759-769.
• Never Events and Hospital-Acquired Conditions (e.g. falls, medication errors, infections)
• Other Potentially Preventable Events (Admits, ED visits)
• Increase best practices (ICSI Guidelines, LBP, elective inductions, C-sxns)
• Never Events and Hospital-Acquired Conditions (e.g. falls, medication errors, infections)
• Other Potentially Preventable Events (Admits, ED visits)
• Increase best practices (ICSI Guidelines, LBP, elective inductions, C-sxns)
• Care coordination, care management• HealthCare Homes• RARE• “SuperUtilizers”• Palliative Care, LiLLIE• Shared Decision Making• Primary-Specialty Care Communication &
Coordination
• Care coordination, care management• HealthCare Homes• RARE• “SuperUtilizers”• Palliative Care, LiLLIE• Shared Decision Making• Primary-Specialty Care Communication &
Coordination
• End of Life Care• Decision support for HTDI• “Choosing Wisely”• Reduce redundant tests & procedures• Address supply-driven behaviors
• End of Life Care• Decision support for HTDI• “Choosing Wisely”• Reduce redundant tests & procedures• Address supply-driven behaviors
• Support MN’s AUC work• Redundancy in care
coordination/management among providers and health plans
• Promote HIT
• Support MN’s AUC work• Redundancy in care
coordination/management among providers and health plans
• Promote HIT
Wedge Model for US Health Care With Theoretical Spending Reduction Targets for 6 Categories of Waste
Graph Source: Eliminating Waste in US Health Care, Berwick, D., Hackbarth, A. JAMA. 2012;307(14):1513-1516
Potential Waste Reduction Efforts
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The MN Advantage Plan?
Health Plan Intervention (Health Plan Focus)
Provider Efficiency (Member Focused)
Care Coordination (Provider Focus)
Transparency/Pay for Performance
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Health Plan Intervention
Disease/Case Management
Step Therapies
Telephonic/Pharmacy based MTM
Health Assessments/Wellness
Original “waste management” strategies by employers
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Provider Efficiency
Provider Group
PMPM Cost
Provider Group
PMPM Cost
Provider Group
PMPM Cost
Provider Group
PMPM Cost
A $332.27 N $377.92 BB $417.18 OO $456.87B $346.70 O $386.02 CC $418.23 PP $457.16C $347.74 P $386.23 DD $428.78 QQ $462.86D $349.75 Q $386.66 EE $429.48 RR $472.02E $350.07 R $389.44 FF $432.37 SS $481.37F $358.75 S $393.03 GG $438.77 TT $482.52G $360.19 T $393.81 HH $440.27 UU $483.27H $361.70 U $394.77 II $443.05 VV $513.06I $362.85 V $396.22 JJ $443.29 WW $516.58J $368.40 X $402.05 KK $443.74 XX $530.94K $371.09 Y $403.15 LL $446.47 YY $552.48L $372.33 Z $405.66 MM $447.26 ZZ $562.98M $374.33 AA $410.97 NN $449.16 AAA $575.40
Level 2Level 4
Level 3
Level 1
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Provider Efficiency
Tiered Networks – rewards providers who demonstrate value
Center of Excellence – reward systems who out perform on certain conditions
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Care Coordination
Primary Care Based Tiered Networks – Every member selects a PC facility
Provide Specific Health Care Home payment for those that qualify
DIAMOND participant
ACO Contracting – care coordination part of ACO value
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Transparency/Pay for Performance
BTE/QIPS – Champions of Change
MNCM quality reporting integration
Consumer Reports
ICSI – Affordability Advisor
MDH – PPG Advisor
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Where do we go from here?
Continue to measure and reward provider performance
Expand BTE/QIPS
Publish PPG
Meaningful ACO discussions
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Where do we go from here?
Start to measure and reward health plan performance
Pay for completion, engagement and outcomes of health services
Measure impact on health of members
Health Task Force recommendation to only contract with result oriented health plans
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Where do we go from here?
If costs are not contained and health not improved employers will have no choice but to select narrow networks of providers and question the value of health plans in the supply chain management of health care delivery.
or stop offering employer benefits altogether
