Upload
jgw
View
7
Download
0
Embed Size (px)
DESCRIPTION
Healthcare Cost Reduction Strategies
Citation preview
Dr. Peter Lazes, Director, Healthcare Transformation Project
Cornell University
Rutgers University 7th Annual Labor-Management Conference December 9, 2011
Important strategies for improving the health of members and reducing costs Innovative processes of Benefit and Taft-Hartley Funds 32BJ Health Fund
1199 NW, UFCW local 21, OPEIU Locals 8 & 23,
Painters District Council 5 (Seattle, WA.)
UNITE-HERE Locals 54, 165 & 226 (Atlantic City and Las Vegas)
1199SEIU
Im astounded by people who want to know the universe, when its hard enough to find your way around Chinatown
Woody Allen
AUSTRALIA CANADA GERMANY NEW
ZEALAND
UNITED
KINGDOM
UNITED
STATES
OVERALL RANKING
(2007) 3.5 5 2 3.5 1 6
Quality Care 4 6 2.5 2.5 1 5
Right Care 5 6 3 4 2 1
Safe Care 4 5 1 3 2 6
Coordinated Care 3 6 4 2 1 5
Patient-Centered
Care 3 6 2 1 4 5
Access 3 5 1 2 4 6
Efficiency 4 5 3 2 1 6
Equity 2 5 4 3 1 6
Long, Healthy, and
Productive Lives 1 3 2 4.5 4.5 6
Health Expenditures per
Capita, 2004 $2,876* $3,165 $3,005* $2,083 $2,546 $6,102
Country Rankings
1-2.66
2.67-
4.33
4.33-
6.0
Source: K. Davis, C. Schoen,
S. C. Schoenbaum, M. M.
Doty, A. L. Holmgren, J. L.
Kriss, and K. K. Shea, Mirror, Mirror on the Wall: An
International Update on the
Comparative Performance of
American Health Care, The Commonwealth Fund, May
2007
* 2003 data
Access to care for 33 million newly insured Americans and servicing still the uninsured
America spends twice as much on healthcare per capita than any other nation
75% of all health dollars are spent on chronic conditions, many of which are preventable
America ranks 37 out of 191 countries in
quality
Where are we going?
Integrated Care
Coordinated Care:
Patient centered care involving collaboration
among primary care physician, nurses, patient,
family and community
Information Technology:
Electronic Medical Records/History, E-Prescriptions,
Interactive Patient Web Portal
Health Coach, Nurse Navigator:
Staff use of electronic portals and tracking tools to monitor progress of patients, especially those
with chronic conditions
Reimbursement Reform:
Restructuring of the current system used to compensate physicians based on fee for service to one that is
bundled/pre-paid, and quality outcome linked
Tracking Outcome Tools:
Use data to identify issues of critical care
Feedback to Physicians and Healthcare Team
Measure clinical or service performance by
physician/practice
Fragmented Care Integrated Care
No care coordination among physician, staff, family and community
System reacts to needs
Fee for service reimbursement
Limited tools/processes for preventive care or patient progress
Patient centered coordinated care involving all parties in patients healthcare
Needs are anticipated Electronic/staff tools to
track patient progress and monitor chronic conditions
Bundled payments supports a system approach
Importance of improving
transitions in care, doctor to
doctor, and post-hospital
Follow-up care following
hospital discharge could
reduce re-hospitalization
High cost care management
could reduce errors and
lower costs
Will require restructuring
Medicare benefits and
incentives
Dollars
$9,618
$6,152
Source: M.D. Naylor, Making the Bridge from Hospital to Home, The Commonwealth Fund, Fall 2003.
Effect of Advanced Practice Nurse Care on Congestive Heart Failure Patients Average
Per Capita Expenditures
Labor unions and their employer partners jointly govern approximately 3,000 plans covering the lives of roughly 23 million American workers, dependents, and retirees.
Many of the Taft-Hartley Fund dont manage the care of patients nor reward members for healthy behavior.
Program Savings
Patient Centered Medical Homes $1,089 per enrollee (currently) Total of $1.7 million in 2012 (projected) Total of $4.4 million in 2015 (projected)
Cigna Chronic Care Management $1,6 million in 2012 $6.7 million in 2015
Case Management for High-cost Members $1.2 million annually
Centers for Excellence $9 million annually
Increase in ER Co-pay $2.5 million
Prescription Benefits Management $5.9 million in 2011 (currently) $7.7 million in 2012 (projected)
Reduced fraud, abuse, and claims processing errors
$11 million saved to date (currently) $2 million annually (projected)
Re-enrollment and Eligibility Confirmation $ 4.1 million in 2011 (currently) $ 4.9 million in 2012 (projected)
Integrated Benefits Administration System $ 1.3 million (starting in 2013)
New Office $ 12 million per year (starting in 2012)
Kaiser Health Plan Enrollees in D.C. Area
$ 1.6 million in 2012 (projected)
The fund Provides comprehensive benefits to 169,000 people.
In 2005 the fund cut costs by $88 million and maintained quality.
The funds most comprehensive family benefit plan currently costs employers $12,871.
The national average is $15,073 for comparable plans.
The fund is projected to save $80.3 million in 2012 and $120.5 million by 2015.
In 2009 a group of unions and Group Health developed an innovative health plan for the unionized employees at Group Health.
Created capitated payments to Group Health.
Initiated several wellness programs.
Group Health is an innovative cooperative which serves as an insurance company and provider.
It provides integrated care for members and intensive chronic care management of the chronically ill.
It utilizes advanced health information technology.
Lifestyle Activities Health Care Activities Targeted Activities
Exercise Health advising Receiving health coaching
Healthier eating Having a personal physician
Tobacco-cessation efforts
Wellness challenges Having all preventative care tests and exams up-to-date
Weight management
Community physical activity events
Annual dentist visits Living Well with Chronic Conditions Workshops
Engaging with wellness champions
Consulting the Group Health nurse service
Chronic illness planned care visits
Facility-specific wellness champion events
Using the employee assistance program (EAP)
Shared decision-making
Group Health walking meetings
A flu shot every fall
The stay-tobacco-free initiative
Union members enjoy the same benefits as regular Group Health patients.
A labor-management agreement created an
innovative point-based incentive system that allows members to pay lower premiums for engaging in healthy behavior.
Members earn points by registering on the
MyGroupHealth web portal, completing an online health profile each year, and by completing activities within three main categories: 1) lifestyle activities; 2) health care activities; and 3) targeted activities.
.
Program Associated Savings
Hospitalists and case management for hospitalized members.
The average cost of a hospital stay has dropped from $14,800 to $13,200.
Dr. Tomorrow program. A $1 million reduction in ER visit expenses.
Reducing the doctors on their panels focusing on quality care of care, costs, and unnecessary care and/or hospitalizations.
Spending on professional care has dropped from $91 million to $90 million.
Free pharmacy. Drug costs have increased but overall costs for the fund have decreased---Adherence 75% to 95%.
The Fund provides extremely effective chronic care management through its Special Care Center (SCC).
The SCC is what is known as an Ambulatory Intensive Caring Unit provides intensive and pro-active managed care for the most unhealthy and chronically ill members of a group.
The cost of patient care for the group using the SCC was rising at 25% per year prior to enrollment in the SCC is currently 4%.
The group saw a decrease of over 20% in emergency room visits
and hospitalizations.
When members were hospitalized, their length of stay was 8% shorter.
The average cost per stay was 15% less in comparison to a group
of non-enrollees.
SCC patients have shown improvements in cholesterol, blood glucose levels, and blood pressure.
Nearly half the smokers in the SCC quit smoking.
Initiative Components
Aggressive cost management and creative benefit design. -One network -Renegotiated fee schedules for preferred lab and radiology providers. -Durable medical equipment purchased through a preferred network. -Low administrative costs. -Continually update prescription programs and preferred drug lists. -Reduce unnecessary care. -A mail-order prescription program. -Medicare HMO for retirees. -Preferred lab and provider networks.
Health Coach Program -Assists current and potential diabetics, people with or at risk for heart disease, overweight members, and smokers.
Weight Loss - Members receive coaching, access to a registered dietitian, and other benefits.
Tobacco Cessation -Participants can access a health coach, support staff, print material, and product discount.
Wellness Programs -24/7 Nurse Helpline. -Walking groups and weight loss competitions. -Monetary incentive program created by labor-management wellness committee.
The Health Fund manages approximately $1 billion and provides care for 500,000 people.
It has seen a net average cost increase of 4.5 percent over the past three years.
The national trend has increased by over 7 percent per year.
It costs $13,628 to cover a family of four in the fund. On average it cost $21,477 to cover a family of four
in New York City in 2010. The fund is currently projected to have annualized
savings of $46 million by 2015. The fund is achieving annual savings of over $200
million per year when one accounts for all efficiency initiatives in recent years.
Chronic care management and high flyers
Prescription drug programs
Integrated care
Wellness and member self-management
Trustees to get smart about best practices for improving the health of their members
Join a comprehensive plan that is already integrated
Develop various programs from prescription drug
to chronic management
Create or affiliate with Special Care Centers or Patient-Centered Medical Homes
Leverage your fund to incentivize providers to invest in creating an integrated delivery system