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

CBGHealth@aol.com

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.