NNEACC                        REDUCING COSTS        COLLABORATIVENORTHERN NEW ENGLAND     ACCOUNTABLE CARE                ...
PREVIOUSLY PUBLISHED STUDY                                                                    NNEACCLargest study of popul...
STUDY DESIGN                                                            NNEACC  Random assignment by predicted costs usin...
ENHANCED SUPPORT VERSUSUSUAL SUPPORT                                                                                      ...
PREFERENCE SENSITIVE FOCUS                                                                                                ...
OUTREACH ACTIVITY                                                                                                     NNEA...
COST AND UTILIZATION                                                                                                      ...
Achieving Patient Engagement through       Shared Decision Making        March 15, 2012
High Value Healthcare Collaborative – 20 Members                                                   9
Goals of the CMMI Innovation Grant• Enhance value by engaging patients to improve  care experience, outcomes and costs:  –...
Cost = cost per episode x # of episodesVariation in cost per episode:                                                     ...
Timing of shared decision making (SDM)                                  Referral for servicePrimary care MD               ...
SUMMING IT UP                                                                                NNEACC  Growing evidence tha...
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Reducing Costs Using Shared Decision Making

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David Wennberg, MD, MPH, describes a recent randomized trial he was involved with that studied the potential of shared decision making to reduce costs among preference-sensitive conditions. David also explains the vision of the 20-member High Value Healthcare Collaborative.

This presentation was part of the Shared Decision Making Month webinar "Turning Shared Decision Making Policy into a Reality."

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Reducing Costs Using Shared Decision Making

  1. 1. NNEACC REDUCING COSTS COLLABORATIVENORTHERN NEW ENGLAND ACCOUNTABLE CARE USING SHARED DECISION MAKING FIMDM March 19, 2013 David Wennberg, MD, MPH Chief Executive Of ficer NNEACC
  2. 2. PREVIOUSLY PUBLISHED STUDY NNEACCLargest study of population care management to date  Collaboration between Health Dialog and two clients  Randomized study of 174,120 individuals  Compared medical costs and utilization of two different care support strategies Overall results:  Total costs reduced by over 3.6%  Total population admissions reduced by 10.1%
  3. 3. STUDY DESIGN NNEACC  Random assignment by predicted costs using an ‘every other individual’ method.  Predictive models and real time data were used to assess the likelihood of using or needing health care services  Rank-order lists of individuals likely to have support needs were used to generate  Outbound mail  Interactive voice response calls  Calls by health coaches
  4. 4. ENHANCED SUPPORT VERSUSUSUAL SUPPORT NNEACC  Difference driven by WHO was targeted for engagement Health Continuum Preference Sensitive Other Chronic Care High Risk Healthy High Risk Usual Support Enhanced Support Enhanced Support Focus on Preference Sensitive Conditions N = 60,185 Low Risk
  5. 5. PREFERENCE SENSITIVE FOCUS NNEACC  Based on original randomize trial  60,185 identified as potential candidates for Shared Decision Making Usual Support Enhanced SupportNumber 30,240 29,945Costs Total medical costs (PMPM) $371.92 $371.73 Inpatient costs (per 1,000/yr) $106.77 $106.05Resource Use Inpatient admissions (per 1,000/yr) 131 129 Emergency department (per 1,000/yr) 377 379 Surgeries for PSC (per 1,000/yr) 32 30 Advanced imaging studies (per 1,000/yr) 372 382 Standard imaging studies (per 1,000/yr) 1,396 1,394 Northern New England Accountable Care Collaborative 5
  6. 6. OUTREACH ACTIVITY NNEACC 1000 Coach Contacts Usual 800 Enhanced 600 400 200 0 Any PSC Heart Condition Benign Uterine Cond Prostatic Cond Hip Pain Benign Knee Pain Back Pain 70 Videos Sent Usual 60 Enhanced 50 40 30 20 10 0 Any PSC Heart Condition Benign Uterine Cond Prostatic Cond Hip Pain Benign Knee Pain Back Pain Northern New England Accountable Care Collaborative 6
  7. 7. COST AND UTILIZATION NNEACC Usual Enhanced Relative Absolute Support Support diff (%) diffNumber 30,240 29,945Costs Total medical costs (PMPM) $436.05 $412.78 (5.3%) ($23.27) Total Medical Costs were $23.27 Inpatient costs (per 1,000/yr) $132.73 $116.20 (12.5%) ($16.53) per member per$96.91 lower month $92.49 (4.6%) ($4.42)Resource Use (per 1,000/yr) in Enhanced Support Group Inpatient admissions (per 1,000/yr) 155 135 (12.5%) (20) • Reduced inpatient costs - $16.53 PMPM Emergency department (per 1,000/yr) outpatient 409 - $4.42 PMPM • Reduced hospital costs 399 (2.6%) (10) Surgeries for PSC (per 1,000/yr) 32 29 (9.9%) (3) Advanced imaging studies (per 1,000/yr) 400 393 (1.9%) (7) Standard imaging studies (per 1,000/yr) 1,488 1,458 (2.0%) (30) Northern New England Accountable Care Collaborative 7
  8. 8. Achieving Patient Engagement through Shared Decision Making March 15, 2012
  9. 9. High Value Healthcare Collaborative – 20 Members 9
  10. 10. Goals of the CMMI Innovation Grant• Enhance value by engaging patients to improve care experience, outcomes and costs: – Total Medicare costs = cost per episode x # of episodes• Process improvement within care episodes to improve outcomes and reduce costs• Reduce number of episodes and improve patient experience through informed choice
  11. 11. Cost = cost per episode x # of episodesVariation in cost per episode: Variation in # of episodes:Cost of TKRs across HVHC sites # of TKRs across HVHC sites $20# Part# Prof# B# $18# ($Thousands)% Home# $16# Health# $14# LTCH# Reimbursement% $12# IP# rehab# $10# SNF# $8# OP# Care% $6# IP# Acute% $4#Post% $2# $0# 4# 7# 0# C# A# a# t# rt# # C# # # o# 8# 2# 6# W ne C m ow 1 0 1 .8 ay DM M IH r. 7 r. 7 L Da S& UC ai IJ. IJ. IJ. au vid VM M ylo ylo UI M L L L BI Be NS NS NS o Ba Ba Pr 11
  12. 12. Timing of shared decision making (SDM) Referral for servicePrimary care MD Orthopedic surgeon• 2000 Medicare patients • 450 cases each year• 0.5% hip, 0.5%, 10% spine referrals • 1/3 each: TKA, THA, spine surgery Timing of referral for SDM Primary Care Specialist Earlier in decision process Later in decision process Common SDM pathways across conditions Density and focus No financial/professional incentives? Financial/professional incentives? Consensus slowly building for primary care SDM, but still point of debate
  13. 13. SUMMING IT UP NNEACC  Growing evidence that shared decision making can both lead to  Effective patient engagement  Change the care patients get based on their preferences  Improve the experience of care  Reduce utilization and costs  Next big questions are related to scale….. Northern New England Accountable Care Collaborative 13

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