Your SlideShare is downloading. ×
0
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Marc Berg: Contracting value: shifting paradigms
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Marc Berg: Contracting value: shifting paradigms

805

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
805
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Contracting Value:ShiftingParadigmsNuffield Trust European Health Summit24 January 2012Marc Berg
  • 2. Challenges health care policy makers: same the world over Ageing demographics Healthcare cost inflation The economic downturn How do we achieve betterTechnology outcomes and control the Health advances cost curve? inequalities Rising patient Unhealthy expectations lifestyles Rising chronic diseasesThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 1subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 3. Major opportunity: bending cost curve through better outcomesThe safety, patient centeredness and effectiveness our health care systems deliver ishighly variable:• Care is too often too little, too much or sometimes just wrong• From the perspective of the patient, our care systems are highly fragmented and poorly coordinated Cost In a fascinating reversal of common sense economics, improving health care quality more often than not makes the delivery of health care less rather than more expensive. QualityThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 2subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 4. Example: Acute Stroke CareSaving more lives saves significant money as well...Total cost of care (all health care costs, incl. home care, long term care, excl. informal care) Percentage of patients living at home 365 days after strokeThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 3subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 5. Why do healthcare systems not deliver high value care efficiently? Because we pay providers to do so... We get exactly the results we ask for (Paul Batalden)Producing high quality health care efficiently is not rewarded by higherrevenues for providers. There are often substantial perverse incentives:• We pay for individual activities, or for the existence of a building or an organization...• We pay whether things go right or wrong; we often actually pay extra when things go wrong...We do not pay for the integration of all these individual activities, nor do we payfor the results that all this work delivers We pay for disjointed and non-coordinated inputs, not for integrated outcomesThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 4subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 6. The Quest for the Holy Payment Grail: a Payment System that ProducesHigh Value ↓ Price of care delivered (per unit) ↑ Quality Right Volume outcomes of care of care delivered delivered = ↑ ValueThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 5subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 7. Payment systems: the early classics we can live without… Payment system Desirable Perverse Macro effect incentive incentive Fee for Service Productivity Overproduction, lack Escalating costs, of integration fragmentation care delivery Block grant Cost control Reduced innovation, Waiting lists budgets reduced productivity Creeping costs escalation due to lack of disruptive innovation and creative destruction FFS block grantThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 6subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 8. Payment systems.. next steps Payment system Desirable Perverse Macro effect incentive incentive Fee for Service Productivity Overproduction, lack Escalating costs, of integration fragmentation Block grant Cost control Reduced innovation, Waiting lists & budgets reduced productivity Creeping costs escalation DRG – like Stimulate innovation, Volume incentive Possible volume systems productivity and explosion efficiency along the Negative quality patiënt’s path within creep through cost- Possible cost shifting the hospital cutting within DRG Capitated payment Population- and Underuse Cost shifting for general prevention-oriented (referring difficultThe first rudimentary step to redesign payment systems towards delivering ‘value’ but practitioners focus Negative quality patients)still ultimately input based creep Stimulus for efficiency FFS Cap. GP block grant DRGThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 7subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 9. Payment systems: P4P• Explicitly link the quality of care delivered to the payment of the provider.• Payment is no longer solely tied to ‘input’, and undoing the negative effects of fragmentation can actually be rewarded. Composite Quality Score (CQS) increase Hip and knee replacement Pneumonia CMS: Premier Hospital Quality Heart failure Incentive Demonstration project Coronary artery bypass graft Chronic Care Management Quality 5 AMI (heart attack) Optimal quality  4 0% 10% 20% 30% 40% 50% 3 2007 2 2008 2009 Blue Cross Blue Shield 1 Massachusetts (BCBSM) Alternative 1.1 2.0 3.2 2.0 2.2 2.2 0 Quality Contract (AQC) ACQ Non-ACQ FFS Cap. GP P4P block grant DRGThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 8subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 10. Payment systems: P4PIs often merely a sweet topping on a sour base...• P4P initiatives run into severe limitations, because the underlying payment structures remain unchanged• The institutional boundaries that all too often hamper overall quality rather than strengthen it remain untouched• Mostly based on process and structure measures – working to rule often does not improve outcome yet improves income... FFS Cap. GP P4P block grant DRGThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 9subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 11. Payment systems: Contracting Value What would contracting value look like? What should be done differently? FFS Cap. GP Contracting P4P block grant DRG ValueThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 10subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 12. Contracting Value: the building blocks that make it workThree principles that are much more within our reach than we tend to think: 1. Define integrated care ‘services’ or ‘products’ 2. Define meaningful and measurable outcomes for these services 3. Contract these outcomes with provider or prime contractorThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 11subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 13. 1. Define integrated care ‘services’ or ‘products’No longer see the historically grown institutions as the default…:these boundaries only sometimes coincide with entities of care relevant to the patient Primary care Specialty care Pharmaceutical care Nursing home care Physiotherapy Disabled care Hospital care Revalidation Dietary care Dental care Home care GPsThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 12subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 14. 1. Define integrated care ‘services’ or ‘products’The unit of care to be contracted should be an integrated care product or service Acute trauma care Acute cardiovascular care Maternity care (pregnancy & delivery) Continuous: focus on integrated, pro-active care; on Dental care secondary prevention; the focus on lifestyle, and so forth Mental health care Chronic care Basic medical Oncological care care & gatekeeper Multimorbidity / frail elderly care Non-continuous: focus on function patient-centered, rapid care Care for people with a handicap delivery, active patient decision Elective care making ‘Primary care’ ‘Secondary care’ ‘Tertiary care’This document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 13subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 15. 2. Define meaningful and measurable outcomes for these servicesMeasuring quality is seen as an almost unsolvable problem…… yet the complexity of the problem evaporates largely when we look athealth care through the lens of these servicesThe question is: What matters most to the patient?‘Value’ is produced when these goals are met – and this will vary perdomain of careThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 14subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 16. 2. Define meaningful and measurable outcomes for these servicesThe unit of care to be contracted should be an integrated care product or service • Healthy mother, healthy baby • High rescue rates Acute trauma care • High patient satisfaction • Low 3 months mortality • Low 3 months morbidity Acute cardiovascular care Maternity care (pregnancy & delivery) • Many high-quality life years• Quality of Life Dental care • No exacerbations, no complications• Low (re-)admissions rate • High patient satisfaction• Patient empowerment, self management Mental health care • Patient-empowerment, self management Chronic care Basic medical Oncological care care & gatekeeper Multimorbidity / frail elderly care function Care for people with a handicap Elective care ‘Primary care’ ‘Secondary care’ ‘Tertiary care’• High patient satisfaction• High quality referrals•This document is CONFIDENTIAL androle firm of the KPMGRESTRICTED. © 2011 KPMG LLP, a UK limited with KPMG International Optimal coordination its circulation and use are network of independent member firms affiliated liability partnership, is a subsidiary of KPMG Europe LLP and a member 15Cooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 17. 2. Define meaningful and measurable outcomes for these servicesData at our hands Clinical Billing data registries Patient Provider Questionnaires QuestionnairesThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 16subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 18. 2. E.g. acute cardiovascular care: Stroke – 1 yr outcomeThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 17subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 19. 2. E.g. acute cardiovascular care: Stroke – value of care Total cost of care (all health care costs, incl. home care, long term care, excl. informal care) Percentage of patients living at home 365 days after strokeThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 18subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 20. 2. E.g.: elective care - total hip replacement % significant improvement PROMs effect score Provider delivering higher value Provider delivering lower value Practice variation scoreThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 19subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 21. 3. Contracting these outcomes - there is not one answer Per case Per year of Per year of care care (population- based)This document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 20subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.
  • 22. 3. Contract outcomes in the right way The potential reductions in cost are enormous: - avoiding non-value added care (‘waste’) - increased efficiency in the delivery of value-added careThis document is CONFIDENTIAL and its circulation and use are RESTRICTED. © 2011 KPMG LLP, a UK limited liability partnership, is a 21subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG InternationalCooperative, a Swiss entity. All rights reserved. Printed in the United Kingdom.

×