MassTLC BCBSMA, Dana Safran Analytics presentation

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MassTLC BCBSMA, Dana Safran Analytics presentation

  1. 1. Getting to Safe, Affordable, Effective, Patient-Centered Care: Good Data Are Only the Beginning __________________________________ Dana Gelb Safran, Sc.D. Senior Vice President Performance Measurement & Improvement Blue Cross Blue Shield of Massachusetts Presented at: Massachusetts Technology Leadership Council Using Technology to Improve Care While Right-Sizing Costs Through Better Analytics 8 December 2010
  2. 2. Advancing Quality, Outcomes and Affordability: Role of Performance Measurement, Reporting and Incentives Reporting to Providers Provider Incentives Reporting to Public Provider Engagement Member Engagement Member Incentives & Benefits
  3. 3. Diabetes Care: Clinical Process Measures Nearing Perfection; Outcomes Are Far From It Source: MHQP, 2005 HEDIS process and outcomes measures
  4. 4. The Economic Imperative Source: CMS, Office of the Actuary, National Health Statistics Group Health care spending per capita is projected to nearly double over the next 10 years. Sources: BCBSMA, Bureau of Labor Statistics BCBSMA’s medical cost trend is growing five times faster than workers’ earnings, and nearly four times the rate of inflation. 8.2% 15.9% 13.8% 13.1% 12.1% 13.3% 12.8% BCBSMA Medical Trend Workers’ Earnings Overall Inflation
  5. 5. Key components of the Alternative Contract Model Expanded Margin Opportunity INITIAL GLOBAL PAYMENT LEVEL Savings Opportunity Quality Performance Trend <ul><li>Unique contract model : </li></ul><ul><li>Physicians & hospital contracted together as a “system” – accountable for cost & quality across full care continuum </li></ul><ul><li>Long-term (5-years) </li></ul><ul><li>Controls cost growth: </li></ul><ul><li>Global payment for care across the continuum </li></ul><ul><li>Annual inflation tied to CPI </li></ul><ul><li>Incentive to eliminate clinically wasteful care (“overuse”) </li></ul><ul><li>Improved quality, safety and outcomes: </li></ul><ul><li>Robust performance measure set creates accountability for quality, safety and outcomes across continuum </li></ul><ul><li>Substantial financial incentives for high performance (up to 10% upside) </li></ul>
  6. 6. PCP Referral for Low Back Pain: Example of Practice Pattern Variation Analysis to Improve Quality & Address Clinical Waste

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