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Research-Driven Solutions for Innovative State Policy

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Dr. Joe Thompson, Surgeon General of Arkansas, used this presentation at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and …

Dr. Joe Thompson, Surgeon General of Arkansas, used this presentation at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality."

Published in: Health & Medicine

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  • 1. Health Services Research: Helps Us Get Our Money’s Worth What works? For whom? Under what circumstances? At what cost?
  • 2. Research-Driven Solutions for Innovative State PolicyJoseph W. Thompson, MD, MPHSurgeon General, State of Arkansas September 27, 2012
  • 3. Health Care’s Iron Triangle Quality Cost Access
  • 4. Arkansas Health System ImprovementAgency Organizational Structure GovernorState Leadership Mike BeebeState Leadership Governor’s Policy StaffImplementation & Dr. Joe Thompson& Coordination ACHI Workforce Insurance Chancellor Payment & Quality Health Information ExchangeImplementation Dan Rahn Improvement Technology Commissioner & Dr. Paul Mr. John Selig Mr. Ray Scott Jay Bradford Halverson UAMS Steering Group: AFMC AID (Exchange)Workgroup ADH & ACHI DHS, ADH, BCBS, UAMS DHS (McdParticipation Higher Ed QualChoice, DIS eligibility & (2- & 4 yr) United, ACHI Medicaid expansion) EBD 4
  • 5. National and Arkansas Childhood Obesity Trends 23 Arkansas Assessments Percent Obese 22 25 Grades 8 & 10 Grades K, 2, 4, 6 21 AR grades 8 & 10 AR grades K, 2, 4, 6 20 20 2004 2005 2006 2007 2008 2009 2010Percent Obese 15 10 US 12–19 yr US 6–11 yr 5 0 1963-65 1971-74 1988-94 01-02 05-06 1966-70 1976-80 99-00 03-04 07-08 NHANES data sources: Ogden et al. Prevalence of Obesity Among Children and Adolescents: United States, Trends 19631965 Through 20072008. NCHS Health E-Stat, June 2010. Available at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Accessed 04/18/11. Arkansas data source: Arkansas Center for Health Improvement, Little Rock, AR, September 2010.
  • 6. Preliminary working draft; subject to changeOur vision to improve care for Arkansas is a comprehensive, patient-centered delivery system… For ▪ Improve the health of the population patients ▪ Enhance the patient experience of care Objectives ▪ Enable patients to take an active role in their care For ▪ Reward providers for high quality, efficient care providers ▪ Reduce or control the cost of care Population-based care Episode-based care How care is delivered ▪ Medical homes ▪ Acute, procedures or ▪ Health homes defined conditions ▪ Results-based payment and reporting Four aspects ▪ Health care workforce development of broader program ▪ Health information technology (HIT) adoption ▪ Expanded access for health care services 6
  • 7. Preliminary working draft; subject to changePayers recognize the value of working together to improve our system, withclose involvement from other stakeholders… Coordinated multi-payer leadership… ▪ Creates consistent incentives and standardized reporting rules and tools ▪ Enables change in practice patterns as program applies to many patients ▪ Generates enough scale to justify investments in new infrastructure and operational models ▪ Helps motivate patients to play a larger role in their health and health care1 Center for Medicare and Medicaid Services 7
  • 8. Spending Breakdown for CHF 30-day Episodes with and without a ReadmissionN=4,992 CHF $10,569episodes Avg Total Episode Cost = $23,511 $6,305 $3,975 24% $1,453 $832 $379 Index Readmits PAC OPD Physician Other % Total 27% 45% 17% 2% 6% 4% Costs 76% $5,936 Avg Total Episode Cost = $9,440 $2,510 Number of $0 $288 $337 $368 Episodes Index Readmits PAC OPD Physician Other % Total 63% 0% 27% 3% 4% 4% Costs 8 Source: Medicare FFS claims data, 2010
  • 9. Preliminary working draft; subject to changeCase for change: variation in costs by episode are substantial even afteradjusting for risk Total average cost per episode post-risk adjustment by Principal Accountable Provider, 2008-2010 Simple upper respiratory infection1 Pregnancy2 $120 Total episodes ~30,000 Total episodes ~80,000 $5,000 Median cost $3,608 100 Median cost $57 10% percentile $3,208 10% percentile $44 90% percentile $4,071 80 90% percentile $76 4,000 60 3,000 40 2,500 20 500 0 0 ADHD3 Total hip replacement$12,000 $20,000 Total episodes 140 10,000 Median cost $7,953 Total episodes ~20,000 10% percentile $5,867 8,000 Median cost $1,641 15,000 90% percentile $12,814 10% percentile $1,073 6,000 90% percentile $7,046 10,000 4,000 5,000 2,000 0 01 Episode costs for children less than 10 risk-adjusted by a historically-derived multiplier.2 Individual episode costs risk-adjusted for clinical drivers of severity based upon historically-derived multipliers.3 Eligible defined as ADHD without comorbidities between ages 6 and 17.SOURCE: Arkansas Medicaid claims data; Team analysis 9 9
  • 10. Preliminary working draft; subject to change Wave 1 episodes Principle Accountable ProviderTotal Hip/ Knee ▪ Surgical procedure plus allreplacement related claims from 30 days  Orthopedic surgeon prior to procedure to 90 days after ▪ Pregnancy-related claims forPerinatal mother from 40 weeks before(non-NICU1) to 60 days after delivery  Delivering provider ▪ Excludes neonatal care ▪ 21-day window beginning withAmbulatory URI initial consultation  First provider to diagnose ▪ Excludes inpatient costs and patient in-person surgical proceduresAcute/post- ▪ Hospital admission  Admitting hospitalacute heartfailure ▪ Care within 30 days of discharge  Depends care pathway ▪ 12-month episode • PhysicianADHD ▪ Includes all ADHD services + • Licensed clinical pharmacy costs (with exception of psychologist, and/or initial assessment) • RSPMI provider 10.5
  • 11. Preliminary working draft; subject to changeWhat’s next Examples Hip/ knee • Stents replacements • Pacemakers Perinatal • Include NICU • Urinary tract infections Ambulatory URI • Ear infections Acute / post-acute • Pneumonia CHF • Myocardial infarction ADHD • Depression Developmental • Long-term care disabilities • Severe and persistent mental illness