Open classroom health policy - session 10.16 - iselin and young

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  • 1. 1 The Myra Kraft Open Classroom Series Fall 2013: Policy for a Healthy America Every Wednesday, 6pm – 8pm September 4, 2013 through December 4, 2013 West Village F, Room 20 Northeastern University School of Public Policy and Urban Affairs
  • 2. This Week (October 16, 2013) “Why Paying Physicians and Hospitals for their Performance Scares Everyone” Sarah Iselin, MS Gary Young, JD, PhD Senior Vice President of Strategy, Policy and Community Partnerships and Chief Strategy Officer, Blue Cross Blue Shield of Massachusetts Director of The Center for Health Policy and Healthcare Research and Professor of Strategic Management and Healthcare Systems, Northeastern University School of Public Policy & Urban Affairs | Northeastern University
  • 3. School of Public Policy & Urban Affairs | Northeastern University
  • 4. 4 US Health Care Reform: Paying for Value Not Volume Gary Young, J.D., Ph.D. Center for Health Policy and Healthcare Research, School of Business and College of Health Sciences, Northeastern University Health Policy Open Classroom October 16, 2013
  • 5. 5 Paying for Health Care Services in the US • Fee-for-Service • Diagnostic Related Groups • Capitation • Pay-for-Performance (P4P) • Value-based purchasing through global payment
  • 6. 6 Why P4P in Health Care?  Quality problems  Escalating quality 6 costs – business case for
  • 7. 7
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  • 10. 10 What is P4P?  Financial incentive performance targets – (quality, efficiency)  Assigned – e.g., annual blood sugar test for patients with diabetes recipient/Unit of accountability – individuals, teams, organizations  Target
  • 11. 11 P4P: Centerpiece of US Health Policy  Over 200 P4P programs in private sector  Over half of state Medicaid programs have adopted P4P  ACA – Medicare value-based purchasing – Provider-specific P4P programs – Accountable care organization (ACO) shared savings program
  • 12. 12 ACA – Provider-Specific Programs • Law requires implementation of VBP: -- for most hospitals in 2012, -- physicians in 2015, and -- the planning of P4P for nursing homes, home health agencies, and other types of organizations
  • 13. 13 ACA – Outline of Medicare P4P for Hospitals • Funding: Budget neutral as funded from reduction in DRG payments -- initially 1% reduction in DRG payments transitioning to a 2% reduction in 2017. • Performance measures: clinical process measures; patient experience, patient outcome measures (2014); efficiency (2014). • Performance standards for both achievement and improvement. • Incentive payments: A hospital’s performance score determines the percentage of the DRG payments it earns as an incentive payment.
  • 14. 14 Medicare Hospital P4P: Examples of Measures  Clinical process – Prophylactic antibiotics for surgical patients within one hour of surgery – Discharge instructions for patients w/ heart failure  Clinical outcome – Mortality for heart attack, heart failure  Patient experience – Pain management – Communication about medicines
  • 15. 15 ACA -- ACO Shared Savings  ACO bears financial risk for spending in excess of a budget.  ACO gains for reducing spending below budget.  ACO receives bonuses for meeting designated performance targets on quality measures including measures to promote population health (e.g., influenza immunization, colorectal cancer screening.
  • 16. Global Payment/ACO Private-Sector Initiatives  Blue Cross Blue Shield of Massachusetts Alternative Quality Contract 16
  • 17. 17 17
  • 18. 18 Are Providers Scared?
  • 19. General Attitudes Toward VBP Physicians should be rewarded financially when they provide higher quality care. Strongly Disagree Disagree Neutral Agree Strongly Agree 2.2% California 5.7% 6.7% 43.3% 42.1% 5.3% Mass 5.1% 13.5% 40.5% 35.6% 4.5% Rochester 4.9% 0% 10.4% 10% 54.2% 20% 30% 40% 50% 26.0% 60% Percent of Respondents 70% 80% 90% 100% 19
  • 20. General Attitudes Toward VBP Financial incentives are an effective way to improve the quality of health care. Strongly Disagree California 4.8% Mass Rochester 8.8% 16.7% 7.0% 10% Neutral 18.8% Agree 23.0% 21.2% 39.8% 19.5% 20% Strongly Agree 44.6% 17.1% 8.4% 0% Disagree 30% 13.6% 45.6% 40% 50% 60% Percent of Respondents 70% 11.2% 80% 90% 100% 20
  • 21. 21 Should You be Scared?  P4P may not work  Unintended consequences – Patient selection – Teach to the test
  • 22. 22 Limited Evidence that P4P Works Selected Findings: – Rosenthal et al. (2006) Relative increase of 3.6 percentage points for cervical cancer screening. – Young et al. (2007) Absolute increase of 7 percentage points for diabetes measure (e.g., eye exam). _ Lindenauer et al. (2007) Relative increase of 2.6 percentage points for AMI measures; 3.4 points for pneumonia measures; 4.1 points for heart failure measures. -- Petersen et al. (2013) Relative increase of 8.3 percentage points. --Jha et al. (2012) No improvement in hospital mortality rates for cardiac care or pneumonia.
  • 23. 23 Pre-Post Study of Diabetes Quality Indicators Diabetes Measures (Annual) n = 334 1999 2004 Change in % Points HbA1c measurement – 2 tests annually 56% 63% +7% Microalbumin or urinalysis 61% 70% +9% LDL cholesterol level 58% 79% +21% Retinal exam – 1 test annually 40% 54% +14%
  • 24. 24 Overview: Six-Year Trends in RIPA Diabetes Care (n=334) HbA1c Check Urinalysis LDL Check Retinal Exam 0.9 Mean Adherence Rate (patients per physician) 0.8 0.7 0.6 0.5 0.4 0.3 0.2 Pre-Incentive Post-Incentive 2001 2002 0.1 0 1999 2000 2003 2004
  • 25. 25 What are the Barriers ? Money may not be an effective motivator in the long run. -- Some providers may perceive significant tradeoffs  between money and autonomy. -- Monetizing quality may not be sustainable and even counter productive.  Infrastructure and training may be inadequate.  Our knowledge for designing programs may be insufficient. – Who should be incentivized and by how much? – How should we structure incentives and performance measures?
  • 26. 26 Overview: Six-Year Trends in RIPA Diabetes Care (n=334) HbA1c Check Urinalysis LDL Check Retinal Exam 0.9 Mean Adherence Rate (patients per physician) 0.8 0.7 0.6 0.5 0.4 0.3 0.2 Pre-Incentive Post-Incentive 2001 2002 0.1 0 1999 2000 2003 2004
  • 27. 27
  • 28. 28
  • 29. 29 Are Any Improvements Sustainable in the Long Run? Table 2. Overall change in performance measures from initial to final measurement among VA facilities. Adoption of Performance-based Removal of Performance-based Incentives Incentives First Last Absolute First Last Absolute P Quarter Quarter Difference P Value Quarter Quarter Difference Value Cardiology Involvement 74 94 20 <.001 90 91 1 0.93 Troponin Returned 74 96 22 <.001 94 92 -2 0.35 84 95 11 <.001 ACEI or ARB 89 92 3 0.26 90 89 -1 0.50 Weight Monitoring 80 92 12 <.001 91 93 -2 0.11 Timely Antibiotic 53 82 29 <.001 81 84 3 0.06 Measure Diagnostic Catheterization Pneumococcal Immunization 85 92 7 <.001 94 89 93 92 -1 3 0.26 0.05
  • 30. 30 Figure 1A. Acute Coronary Syndrome Performance (%) 1 0.9 0.8 Diagnostic Catheterization Troponin Returned Cardiology Involvement 0.7 0.6 0.5 0.4 2004 2005 2006 2007 Fiscal Year (Oct-Sep) 2008 2009 2010 2011 Figure 1B. Heart Failure 1 Performance (%) 0.95 0.9 0.85 0.8 Weight Monitoring ACEI or ARB 0.75 0.7 0.65 0.6 2004 2005 2007 2008 Fiscal Year (Oct-Sept) 2009 2010 2011 Figure 1C. Pneumonia 1 Performance (%) 2006 0.9 0.8 Pneumococcal Immunization Timely Antibiotic 0.7 0.6 0.5 0.4 2004 2005 2006 2007 Fiscal Year (Oct-Sep) 2008 2009 2010
  • 31. What About Unintended Consequences?  Unintended Consequences --Patient selection --Teaching to the test 31
  • 32. 32 What Does the Future Hold?  No turning back (why be scared of stepping into the dark when you are already wearing a blindfold)  More experimentation -- payment incentives to keep people healthy!  Strong cooperation needed between purchasers and providers
  • 33. School of Public Policy & Urban Affairs | Northeastern University
  • 34. HEALTH REFORM IN MASSACHUSETTS: THE ROAD TO PAYMENT REFORM Sarah Iselin October 16, 2013 Northeastern University Open Classroom Series
  • 35. Massachusetts Now Has the Lowest Rate of Uninsurance in the Country PERCENT UNINSURED, ALL AGES 13.1% 13.9% U.S. AVERAGE 5.9% 6.7% 14.3% 7.4% 15.2% 6.4% 14.7% 14.9% 16.1% 16.3% 15.7% 5.7% 2.6% 2.7% 2008 2009 2.0% 3.1% MASS. 2000 2002 2004 2006 2007 2010 2011 NOTE: The Massachusetts specific results are from a state-funded survey — the Massachusetts Health Insurance Survey (MHIS). Using a different methodology, researchers at the Urban Institute estimated that 507,000 Massachusetts residents were uninsured in 2005, or approximately 8.1 percent of the total population. Starting in 2008, the MHIS sampling methodology and survey questionnaire were enhanced. These changes may affect comparability of the 2008 and later results to prior years. The national comparison presented here utilizes a different survey methodology, the Current Population Survey, which is known to undercount Medicaid enrollment in some states. SOURCES: Urban Institute, Health Insurance Coverage and the Uninsured in Massachusetts: An Update Based on 2005 Current Population Survey Data In Massachusetts, 2007; Massachusetts Center for Health Information and Analysis (formerly the Division of Health Care Finance and Policy), Massachusetts Health Insurance Survey 2000, 2002, 2004, 2006, 2007, 2008, 2009, 2010, 2011; U.S. Census Bureau, Current Population Survey, Health Insurance Historical Tables (HIB Series). Blue Cross Blue Shield of Massachusetts 35
  • 36. But the Highest Per Person Health Care Spending… PER CAPITA PERSONAL HEALTH CARE EXPENDITURES, 2009 $10,000 $9,000 $8,000 $7,000 NATIONAL AVERAGE $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 UT AZ GA ID NV TX CO AR CA AL VA SC TN NC OK MS OR KY MI MT NM IN IL KS WA LA HI IA MO WY NE SD OH FL WI MN MD NJ VT WV PA ND NH RI NY DE ME CT AK MA State NOTE: District of Columbia is not included. Medicaid Services, Health Expenditures by State of Residence, CMS, 2011. SOURCE: Centers for Medicare & Blue Cross Blue Shield of Massachusetts 36
  • 37. …In the World $10,000 Massachusetts $9,000 United States $8,000 Germany $7,000 Canada France $6,000 Australia $5,000 United Kingdom $4,000 $3,000 $2,000 $1,000 $0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 NOTE: U.S. dollars are current-year values. Other currencies are converted based on purchasing power parity. National Health Expenditures by State of Residence, CMS Office of the Actuary, 2011. SOURCE: OECD Health Data; Blue Cross Blue Shield of Massachusetts 37
  • 38. Though Health Reform Helped, Costs Are Still a Problem for Many Massachusetts Residents 2006 2010 20% 19% 19% 18% 10% 6% Had Out-of-Pocket Spending at or Above 10% Family IncomeHad Problems Paying Medical Bills Had Medical Debt SOURCES: Massachusetts Health Reform Survey, 2010 Blue Cross Blue Shield of Massachusetts 38
  • 39. With Wages Stagnant, Increasing Health Care Costs Consume a Greater Portion of Household Budgets MASSACHUSETTS PER CAPITA PERSONAL HEALTH EXPENDITURES AND MEDIAN INCOME, 1999-2009 MA PER CAPITA PERSONAL HEALTH CARE EXPENDITURES MA MEDIAN HOUSEHOLD INCOME $10,000 $8,568 $9,000 $7,000 $6,094 $6,000 $4,865 $5,000 $5,149 $6,988 $80,000 $7,436 $70,000 $5,590 $52,253 $44,005 $6,556 $46,753 $100,000 $90,000 $8,002 $8,000 $4,000 $8,926 $9,277 $60,000 $49,855 $50,955 $52,019 $56,017 $55,330 $58,463 $60,320 $59,375 $50,000 $40,000 $3,000 $30,000 $2,000 $20,000 $1,000 $10,000 $0 $0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year NOTE: Health care expenditures and household income reported in SOURCES: Data for current year (unadjusted) dollars. health care expenditures from CMS, Health Expenditures by State of Residence, 1991-2009. Data for median income from U.S. Census Bureau, State Median Income. Blue Cross Blue Shield of Massachusetts 39
  • 40. The Increasing Costs of Health Care Squeeze Out Other Public Spending Priorities, Too STATE BUDGET, FY2001 VS. FY2011 (BILLIONS OF DOLLARS) FY2001 FY2011 $16 $14 $12 +$5.1 B (+59%) -$4.0 B (-20%) $10 -15% $8 $6 -13% $4 -11% -23% -38% $2 Public Health Mental Health -50% -33% $0 Health Coverage (State Employees/GIC; Medicaid/Health Reform) NOTE: Dollar figures are inflation Education Infrastructure/ Housing Human Services Local Aid Public Safety adjusted using a measure specific to government spending as developed by the U.S. Bureau of Labor and Statistics. SOURCE: Massachusetts Budget and Policy Center Budget Browser. Blue Cross Blue Shield of Massachusetts 40
  • 41. Costs Are the Most Important Health Care Issue for Massachusetts Residents Q A PLEASE TELL ME IF YOU CONSIDER IT TO BE A CRISIS, A MAJOR PROBLEM, A MINOR PROBLEM, OR NOT A PROBLEM IN THE STATE OF MASSACHUSETTS. Crisis High cost of health care 25% 53% Major problem 78% Limited ability to get needed health care 14% 32% 46% Low quality of health care services 11% 22% 33% Long wait time for medical appointments 5% SOURCE: Blendon, R.J 26% 31% et al., ―Public Perceptions of Health Care Costs in Massachusetts,‖ October 2011 Blue Cross Blue Shield of Massachusetts 41
  • 42. Key Affordability/Cost-Related Developments in Massachusetts 2006  Health reform passes (Ch. 58) 2007  Much of Chapter 58 enacted, e.g.: – Begins path to near universal coverage Blue Cross Blue Shield of Massachusetts – MassHealth expansion – Commonwealth Care – Consumer affordability schedule – New health plan options for young adults – Employer Fair Share 2008  Cost Containment Part 1 (Ch. 305) passes – Increased transparency about cost drivers – Reports on health insurer and hospital ―reserves‖ 2009  Special Commission on Payment Reform – Recommends move to global payment 2010 2011  Government reports and hearings on cost drivers  Governor rejects small group premiums  Cost Containment Part 2 (Ch. 288) passes  Governor Patrick files payment reform legislation  Special Commission on Provider Price Reform 2012  Cost Containment Part 3 (Ch. 224) passes – Statewide cost growth targets and payment reforms – Continued focus on data transparency – Aims to control premiums for small businesses, individuals 42
  • 43. ―How Effective Do You Think Each of the Following Policy Strategies Would Be In Improving U.S. Health System Performance (Improving Quality and/or Reducing Costs)?‖ VERY EFFECTIVE Fundamental provider payment reform with broader incentives to provide high-quality and efficient care over time Bonus payments for high-quality providers and/or efficient providers 45% Increased competition among health care providers Increased government regulation of providers 40% 14% Public reporting of information on provider quality and efficiency Incentives for patients to choose high-quality, efficient providers EFFECTIVE 41% 18% 27% 10% 9% More consumer cost-sharing 5% 55% 35% 15% 18% 16% 14% 85% 53% 42% 28% 25% 19% SOURCE: Commonwealth Fund Health Care Opinion Leaders Survey, September/October 2008. Blue Cross Blue Shield of Massachusetts 43
  • 44. Special Commission on the Health Care Payment System‘s Recommendation CURRENT FEE-FOR-SERVICE PAYMENT SYSTEM PATIENT-CENTERED GLOBAL PAYMENT SYSTEM THE PROBLEM THE SOLUTION Care is fragmented instead of coordinated. Each provider is paid for doing work in isolation, and no one is responsible for coordinating care. Quality can suffer, costs rise and there is little accountability for either. Global payments made to a group of providers for all care. Providers are not rewarded for delivering more care, but for delivering the right care to meet patient‘s needs. $ $ $ $ $ $ PRIMARY CARE HOSPITAL SPECIALIST HOSPITAL SPECIALIST PRIMARY CARE HOME HEALTH HOME HEALTH GOVERNMENT, PAYERS AND PROVIDERS WILL SHARE RESPONSIBILITY FOR PROVIDING INFRASTRUCTURE, LEGAL AND TECHNICAL SUPPORT TO PROVIDERS IN MAKING THIS TRANSITION. Blue Cross Blue Shield of Massachusetts 44
  • 45. Ahead of the Curve – The Alternative Quality Contract  Jan 2009 First full contracts begin  Model developed  Sept 2011 Year 1 results published  July 2012 Year 2 results published  ~85% of network physicians participating in AQC AQC TIMELINE 2006 2007 2008 2009 2010 2011 2012 2013 LEGISLATIVE/GOV’T TIMELINE  Health reform passes (Ch. 58) – Begins path to near universal coverage Blue Cross Blue Shield of Massachusetts  Cost Containment Part 1 (Ch. 305) passes – Increased transparency about cost drivers  Special Commission on Payment Reform – Recommends move to global payment  Government  Governor Patrick  Payment Reform reports and files payment (Ch. 224) passes hearings on cost reform – Sets health drivers legislation care cost growth target  Governor rejects at state GDP small group premiums  Cost Containment Part 2 (Ch. 288) passes – Aims to control premiums for small business, individuals 45
  • 46. The AQC Model 1. Global Budget • Based on historical total medical expenses • Annual inflation for each year of the five-year contract period is defined up front and designed to continually moderate spending growth 2. Efficiency Opportunity • Budget constraint creates incentive to carefully steward resource use • Provider organizations share in budget savings and share risk for budget deficits Provider Organization's Total Spending Quality Performance Incentive (Illustrative) Efficiency Opportunity (Illustrative) Initial Global Budget Level 3. Quality Performance Incentive • Based on a broad set of nationally accepted, validated measures of ambulatory and hospital care • Range of performance targets on each measure reward ―good to great‖ performance Blue Cross Blue Shield of Massachusetts Year 1 Year 2 Year 3 Year 4 Year 5 46
  • 47. AQC Measure Set for Performance Incentives The 60+ measures include: Ambulatory Process Outcome • Preventive screenings • Acute care management • Chronic care management – Depression – Diabetes – Cardiovascular disease • Control of chronic conditions – Diabetes – Cardiovascular disease – Hypertension Hospital Evidence-based care elements for: • Heart attack (AMI) • Heart failure (CHF) • Pneumonia • Surgical infection prevention • Post-operative complications • Hospital-acquired infections • Obstetrical injury • Mortality (condition –specific) ***Triple weighted*** Patient Experience Emerging Blue Cross Blue Shield of Massachusetts • Access, Integration • Communication, Whole-person care • Discharge quality, Staff responsiveness • Communication (MDs, RNs) Up to 3 measures on priority topics for which measures are lacking 47
  • 48. Insurance Risk Versus Incentive Risk Insurance Risk • Variation in costs and outcomes due to factors beyond providers‘ control • Example: Flu pandemic Incentive Risk • Variation in costs and outcomes due to factors within providers‘ control— care processes, unnecessary utilization, etc. • Examples: HbA1c control among diabetics, ED use for ambulatory-care sensitive visits Blue Cross Blue Shield of Massachusetts • AQC aims to hold providers responsible for incentive risk— but not insurance risk • BCBSMA employs several strategies to insulate providers from insurance risk in the AQC: – Health status adjustment – Use of network-wide trend as benchmark for budget-setting – Prescription drug benefit adjustment – Reinsurance requirements/ contract terms – Caps on provider liability for budget deficits – Upside risk-only in payment for quality performance 48
  • 49. AQC Physician Participation Primary Care Physicians Specialty Care Physicians 86% 82% 5,136 11,731 12,986 4,592 2,303 1,373 2009 5,065 1,420 2010 Blue Cross Blue Shield of Massachusetts 2,577 2011 2012 2013 2,618 2009 2010 2011 2012 2013 49
  • 50. AQC Groups Blue Cross Blue Shield of Massachusetts 50
  • 51. AQC Results: Lower Costs and Higher Quality •AQC groups showed dramatic increases in quality, especially around measures of preventive care and chronic care management •Evaluations by researchers at Harvard Medical School found that spending in AQC groups was 1.9% lower in year one and 3.3% lower in year two when compared to non-AQC providers •There is evidence that these benefits largely extend to all practice members cared for by AQC physicians, regardless of whether they are BCBSMA members Blue Cross Blue Shield of Massachusetts 51
  • 52. The AQC is Driving Changes in How Care is Delivered There are four domains in which we see AQC Groups innovating to improve quality and outcomes while reducing overall spending Staffing Models Data Systems Blue Cross Blue Shield of Massachusetts Approaches to Patient Engagement Referral Relationships & Integration Across Settings 52
  • 53. Select AQC Group Improvement Initiatives AQC Provider Innovations Reducing ED Use • Staff on call for members at home hospital‘s ED: MD/NP responds to ED and manages patient‘s care (most appropriate setting) • Case managers making outreach calls to members who‘ve had an ED visit • Creating ED registry to notify PCP daily of patients using the ED providing opportunity to educate patient about proper use of ED and available alternatives • Opening an urgent care center near hospital to reduce ED visits • Creating physician ED profiles, focusing on improving same-day appointment access • Practices increasingly offering w/e and evening hours. Blue Cross Blue Shield of Massachusetts Reducing Readmissions • Enhanced care transitions program ensuring f/u visit w/i 14 days for members with chronic conditions. Embedding case managers in practices. • Formal multifaceted aftercare program implemented; includes case manager outreach calls. Reduced readmit rate from 11.2% to 9.6% (2010 to 2011). 53
  • 54. Provider Experience ―This has allowed me to be a better doctor. And it's better for my patients." Damian Folch, MD Primary Care Physician Lowell General PHO ―The contract is a way to support us as a physician group to help provide better care for our patients and care at a lower medical expense.‖ Richard Lopez, MD Chief Medical Officer, Atrius Health Hear for yourself! Go to www.bluecrossma.com, select Visitor, and then click on: About Us>Making Quality Health Care Affordable. Blue Cross Blue Shield of Massachusetts 54
  • 55. Member Experience ―The majority of the Blue Cross members know that something‘s a little different, a little better – more of a personal touch. A few members with chronic diseases seem to be the most appreciative. They notice the extra time that the physician spends with them, and the extra phone calls, and they see the biggest difference in their health care experience.‖ -Philip Gaziano, M.D., Accountable Care Associates “We‘re doing a lot of outreach to our members about the things they need to do for preventative care. We‘re developing a rapport with these patients and they seem to like receiving that sort of ‗concierge service‘ where they are actually the focus of the conversation when you call.‖ -Stacey Neudeck, Lowell General Hospital Blue Cross Blue Shield of Massachusetts 55
  • 56. Success Through Support: Components of the AQC support model Our four-pronged support model is designed to help provider groups succeed in the AQC. Data and Actionable Reports Best Practice Sharing/ Collaboration Opportunities Blue Cross Blue Shield of Massachusetts Consultative Support Communication & Training 56
  • 57. How Much We Pay – Prices – Is Just as Important as the Way We Pay for Care COST DRIVERS 2004-2008 FOR BCBSMA PERCENT INCREASE IN SPENDING DUE TO CHANGES IN UTILIZATION, PROVIDER/SERVICE MIX, AND PRICE 100% UTILIZATION (number of visits) 90% 80% PROVIDER MIX AND SERVICE MIX 70% 60% 50% 58.0% 53.3% 54.8% 53.8% 40% PRICE (amount providers get paid) 30% 33.1% 20% 10% 0% NOTES: 2004 2005 2006 2007 2008 1) Reflects fully-insured commercial trend. 2) ―Utilization‖ reflects the number of services provided. ―Provider Mix and Service Mix‖ reflect changes in providers and location of care (shift to more or less expensive providers) and the intensity of services provided. ―Price‖ reflects increases in provider rates. SOURCE: Office of Attorney General Martha Coakley, March 2010, ―Investigation of Health Care Cost Trends and Drivers.‖ Blue Cross Blue Shield of Massachusetts 57
  • 58. Current Wave of Hospital Mergers and Consolidation May Increase Prices More Mass Health Watchdog Says Partners Merger Raises Red Flags May 22, 2013 | 3:41 PM | By Carey Goldberg Lahey, Northeast Health finalize merger Boston Business Journal Date: Monday, May 7, 2012, 6:51am EDT Partners Looks to add hospitals in Medford, Melrose BY ROBERT WEISMAN OCTOBER 9, 2013 Blue Cross Blue Shield of Massachusetts Cooley Dickinson Trustees Choose Massachusetts General Hospital 02/28/2012 10:07 AM Beth Israel Deaconess acquires Jordan BY TARYN LUNA AUGUST 01, 2013 Steward Continues Buying Spree; Globe Reports Deal for Lowell Hospital April 4, 2011 | 12:37 PM | By Carey Goldberg 58
  • 59. Striking the Right Balance? Blue Cross Blue Shield of Massachusetts 59
  • 60. The Myra Kraft Open Classroom Series, Fall 2013: Policy for a Healthy America October 16 – “Why Paying Physicians and Hospitals for their Performance Scares Everyone” Any Questions? Sarah Iselin, MS Gary Young, JD, PhD Senior Vice President of Strategy, Policy and Community Partnerships and Chief Strategy Officer, Blue Cross Blue Shield of Massachusetts Director of The Center for Health Policy and Healthcare Research and Professor of Strategic Management and Healthcare Systems, Northeastern University School of Public Policy & Urban Affairs | Northeastern University
  • 61. Next Week (October 23, 2013) A Single Payer System: Closer Than You Think? Jim Hester, PhD Harry Chen, MD Director of Health Care Reform Commission, Vermont State Legislature; former Director of Population Health Models Group, Centers for Medicare and Medicaid Services Commissioner, Vermont State Department of Health; former practicing emergency physician and Medical Director, Rutland Regional Medical Center (Rutland, VT) School of Public Policy & Urban Affairs | Northeastern University
  • 62. 62 The Myra Kraft Open Classroom Series Fall 2013: Policy for a Healthy America Every Wednesday, 6pm – 8pm September 4, 2013 through December 4, 2013 West Village F, Room 20 Northeastern University School of Public Policy and Urban Affairs