Value Driven Health Care, Value Driven Health Care, an Opportunity for Changean Opportunity for Change

Presented by, Jeff FlickPresented by, Jeff Flick

CMS Regional Administrator, Region IXCMS Regional Administrator, Region IX

January 22January 22thth, 2007, 2007

The Healthcare ChallengeThe Healthcare Challenge

What do we know today?What do we know today?

We spend more per capita on healthcare than any We spend more per capita on healthcare than any other country in the worldother country in the world

In spite of those expenditures, quality is often In spite of those expenditures, quality is often inferior to other nations inferior to other nations Often doesn’t meet expected evidence-based guidelinesOften doesn’t meet expected evidence-based guidelines

There are significant variations in quality and There are significant variations in quality and costs across the nationcosts across the nation

55%

44%

Public Perceptions

2004 2000*

Percent who say they are dissatisfied with the quality of health care in this country…

4%

40%

38%

17%

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 ProblemA Variation Problem

President Bush Signs President Bush Signs Executive Order on Executive Order on

Value-Driven Health Care Value-Driven Health Care August 22, 2006August 22, 2006

Four Cornerstones of Value-Four Cornerstones of Value-Driven Health CareDriven Health Care

Quality Standards:Quality Standards: Systems need to be Systems need to be designed to collect quality-of-care designed to collect quality-of-care information, and help define what information, and help define what constitutes quality care. constitutes quality care.

Price Standards:Price Standards: Agreement is needed Agreement is needed on how to aggregate claims information on how to aggregate claims information so “episode of care” costs for specific so “episode of care” costs for specific doctors and hospitals can be measured doctors and hospitals can be measured and compared. and compared.

Four Cornerstones of Value-Four Cornerstones of Value-Driven Health CareDriven Health Care

Interoperable Health System:Interoperable Health System: Standards must be set so different health Standards must be set so different health systems can quickly and securely systems can quickly and securely communicate and exchange data.communicate and exchange data.

Properly Placed Incentives:Properly Placed Incentives: All parties All parties – providers, patients, insurance plans, and – providers, patients, insurance plans, and payers - must be subject to contractual payers - must be subject to contractual arrangements that reward both those who arrangements that reward both those who offer and those who purchase high-offer and those who purchase high-quality, competitively – price heath care.quality, competitively – price heath care.

6 AQA Pilot Sites6 AQA Pilot Sites

Massachusetts Massachusetts Health Quality Health Quality PartnersPartners

California California CooperativeCooperativeHealthcare Healthcare ReportingReportingInitiativeInitiative Phoenix Regional Phoenix Regional

Healthcare Value Healthcare Value Measurement InitiativeMeasurement Initiative

Indiana Health Indiana Health Information ExchangeInformation Exchange

Wisconsin Wisconsin Collaborative Collaborative for Healthcare for Healthcare QualityQuality

Minnesota Community Minnesota Community MeasurementMeasurement

Stay Informed ThroughStay Informed ThroughRegion IX Stakeholder CallRegion IX Stakeholder Call

Every 3Every 3rdrd Thursday of the Month, 2-3pm Thursday of the Month, 2-3pm PSTPST

Next call March 15th, 2007Next call March 15th, 2007 Toll Free: 888-452-0273Toll Free: 888-452-0273

Pass Code: Stakeholder CallPass Code: Stakeholder CallLeader: Jeff FlickLeader: Jeff Flick

Register for “CMS Region IX Stakeholder” Register for “CMS Region IX Stakeholder” ListServ for notification and details about ListServ for notification and details about calls through:calls through:

http://www.cms.hhs.gov/apps/mailinglists/http://www.cms.hhs.gov/apps/mailinglists/

Thank You!Thank You!

Jeff Flick, Regional Administrator Jeff Flick, Regional Administrator

415-744-3501415-744-3501

Jeff.flick@cms.hhs.govJeff.flick@cms.hhs.gov