Money in the Bank: The Why’s & How’s of Investing in Chronic Care


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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Donna Marshall

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  • Money in the Bank: The Why’s & How’s of Investing in Chronic Care

    1. 1. Presentation to: National Academy for State Health Policy Money in the Bank: The Why’s & How’s of Investing in Chronic Care Donna Marshall Executive Director Colorado Business Group on Health October 15, 2007
    2. 2. Colorado Business Group on Health The BEST Trust Public Employees’ Retirement Association City of Boulder (P. E.R.A.) City of Colorado Springs State of Colorado Colorado College Sun Microsystems Colorado Springs Utilities TIAA-CREF Colorado Springs SD #11 University of Colorado Denver Newspaper Agency Woodward Governor El Paso County Intel Poudre School District         303-922-0939 [email_address] 200 S. Sheridan Blvd. #105 Denver, CO 80226-8010
    3. 3. Colorado Business Group on Health We welcome these Associations: Rocky Mountain HealthCare Coalition Colorado Association of School Executives Colorado Education Association        
    4. 4. The Colorado Business Group on Health <ul><li>Member organization </li></ul><ul><li>Established in 1996 </li></ul><ul><li>Mission </li></ul><ul><li>To be a catalyst in promoting cost-effective delivery of quality health care to the benefit of our members and the community </li></ul><ul><li>One of over 70 coalitions in the U.S.; a proud member of the National Business Coalition on Health </li></ul>
    5. 5. WHY a Purchaser Coalition? <ul><li>Inability of any one purchaser to move the market </li></ul><ul><li>Inability of any one health plan to move the market </li></ul><ul><li>Importance of creating and supporting common sets of requirements and expectations </li></ul><ul><li>Create a presence in the marketplace </li></ul>
    6. 6. Elements of Gridlock in the System <ul><li>Purchasers — Not Buying Right </li></ul><ul><li>Plans — Not Letting Provider Value Show Through to Consumers </li></ul><ul><li>Providers — Not Seeing Business Case for Reengineering; or Transparency of Cost & Quality </li></ul><ul><li>Consumers/Patients — Not Yet Into Value Purchasing </li></ul><ul><li>Consultants/Brokers — Do They Drive Market-wide Improvement? </li></ul>
    7. 7. Why should purchasers drive quality? <ul><li>Purchasers — Not Buying Right </li></ul><ul><li>The Why’s the Wise Should: </li></ul><ul><li>Cost of chronic care: medical services for chronic care conditions are estimated to drive 80% of spending </li></ul><ul><li>The Rand Study illustrates The “Quality Chasm” and the opportunity cost to purchasers/ patients </li></ul>
    8. 8. What does the Expert Say? “ In theory there is no difference between theory and practice. In practice there is.” -- Yogi Berra
    9. 9. Half Rate Care <ul><li>The Quality of Health Care Delivered to Adults in the United States McGlynn E. A., Asch S. M., Adams J., Keesey J., Hicks J., DeCristofaro A., Kerr E. A.   New England Journal of Medicine 2003; 348:2635-2645, Jun 26, 2003. </li></ul><ul><li>“ Our results indicate, on average, Americans receive about half of recommended medical care processes. …the gap between what we know what works and what is actually done is substantial enough to warrant attention.” </li></ul><ul><li>pp 2643-2644 </li></ul>
    10. 10. Do We Get the Care We Need? 45.40% 13 Diabetes 48.60% 7 Hyperlipidemia 53.50% 25 Asthma 57.70% 14 Depression 68.00% 37 Coronary Artery Disease 73.00% 39 Prenatal Care % of Recommended Care # of Indicators Condition RAND STUDY Results, NEJM, 2003
    11. 11. NCQA Quality Dividend Calculator <ul><li>Employers reduce costs with better quality health plans </li></ul><ul><li>Using diabetes as an example: </li></ul><ul><li>A financial services company with 7,000 employees </li></ul><ul><li>avoids roughly 780 more days of sick leave: </li></ul><ul><ul><li>when enrolled in NCQA-accredited health plans than when enrolled in a non-accredited plan </li></ul></ul><ul><li>avoids paying out about: </li></ul><ul><ul><li>$155,000 in sick wages </li></ul></ul><ul><ul><li>$120,000 in temporary replacement worker costs </li></ul></ul><ul><li>experiences related benefits such as: </li></ul><ul><ul><li>lower direct medical expenses </li></ul></ul><ul><ul><li>higher employee morale </li></ul></ul><ul><ul><li>Visit for more information </li></ul></ul>
    12. 12. Physicians Attaining Recognition Show Improvement Physicians Achieving Diabetes Physician Recognition Show Substantial Improvement In Key Clinical Measures % of adult patients with Diabetes Physician Recognition Program, average performance of applicants, 1997-2003 data. * Lower is better for this measure.
    13. 13. Can We Relate Improvement to Savings? <ul><li>“ For every 1% reduction in blood glucose levels (HbA1c blood tests), the risk of developing eye, kidney/ESRD and nerve disease is reduced by 40 percent. </li></ul><ul><li>Improved control of cholesterol can reduce cardiovascular complications 20 to 50 percent. </li></ul><ul><li>Every 10 millimeters of mercury reduction in systolic blood pressure in diabetics results in a 12 percent reduction in diabetic complications .” </li></ul><ul><li>Source: The State of Health Care Quality, Industry Trends and Analysis, 2006. National Committee for Quality Assurance. </li></ul>
    14. 14. Do purchasers have tools? <ul><li>What can be done: Management, metrics and transparency </li></ul><ul><ul><li>◙ How can purchasers move the market? </li></ul></ul>
    15. 15. What is Bridges to Excellence (BTE)? <ul><li>Non-profit organization dedicated to improving health care quality through physician measurement, reporting, incentives, and education </li></ul><ul><li>Mission: </li></ul><ul><ul><li>encourage providers to deliver optimal care </li></ul></ul><ul><li>Focus: </li></ul><ul><ul><li>Diabetes care, cardiac care, information technology </li></ul></ul><ul><ul><li>A national program, built on national performance standards </li></ul></ul><ul><ul><li>Recognition of physicians conducted by the National Committee for Quality Assurance </li></ul></ul><ul><ul><li>Program costs paid by participating employers </li></ul></ul>
    16. 16. Concept behind Bridges to Excellence <ul><li>Employers are interested in achieving cost savings for patients seeing high-performing physicians </li></ul><ul><li>Willingness to share portion of projected cost savings per patient to physicians as reward for health care excellence </li></ul><ul><li>Rewards to top physicians act as incentives for other physicians to change their practice patterns and improve performance </li></ul><ul><li>Physicians receive rewards, employers realize cost savings, and consumers’ health is improved </li></ul>
    17. 17. Colorado’s Bridges to Excellence Program <ul><li>CBGH is one of four coalitions to receive technical assistance to implement this program </li></ul><ul><li>We have commitment from eight employers in the Colorado Springs, 50k lives </li></ul><ul><li>We have a commitment from one physician’s group and the endorsement of the local medical society to participate in the program. </li></ul><ul><li>Five health plans have joined: Anthem, CIGNA, Great West, United and Rocky Mountain Health Plans </li></ul>
    18. 18. Colorado’s Bridges to Excellence Program <ul><li>The program began January 1, 2006 </li></ul><ul><li>More program details can be found on the web at the Bridges to Excellence website. </li></ul><ul><li>Physicians attain the Diabetes Recognition status by submitting a sample of their patient data to NCQA and reaching goals for screening frequency and patient management . </li></ul><ul><li>We have moved the marketplace, with just a modest program. </li></ul><ul><li>We will expand the program to add more employers, more geographic areas and add the cardiovascular program to the diabetes recognition program. </li></ul>
    19. 19. Number of Diabetes Recognized Physicians in Colorado has been enhanced Total eligible physicians in the Colorado Springs Area is approximately 300 * = estimate made in January 2007 16 6 10 By March 2007 29 7 22 By June 30, 2007 63 13 50 By Sept 30, 2007 60* 10 4 Total # (cumulative) 25* 0 0 Colorado Springs # 35* 10 4 Other Colorado Locations By December 2007* July to December 2006 2003 to June 2006 Date
    20. 20. Purchaser Role: Influencing Gridlock <ul><li>Purchasers — Not Buying Right: Value Based Purchasing </li></ul><ul><li>Plans — Not Letting Provider Value Show Through to Consumers: Standard Reporting, Standard Metrics </li></ul><ul><li>Providers — Not Seeing Business Case for Reengineering: Leapfrog, Health Matters, BTE </li></ul><ul><li>Consumers/Patients — Not Yet Into Value Purchasing: Give them real data </li></ul>
    21. 21. Purchaser Role: “Value Based Purchasing” <ul><li>Buy on quality and cost…not just cost. </li></ul><ul><li>Identify quality providers using national data sources that are valid and reliable </li></ul><ul><li>Let’s standardize performance measures and buy more health, not more healthcare </li></ul><ul><li>Use incentives to change the landscape, to encourage accountability and health information technology </li></ul><ul><li>Educate and inform patients and employees using Health Matters and other resources </li></ul>
    22. 22. The Institute of Medicine The Committee’s Conclusion <ul><li>“ The American health care delivery system is in need of fundamental change. The current care systems cannot do the job. Trying harder will not work. Changing systems of care will. “ </li></ul><ul><li>How can we work together? Use a coalition to drive projects, market expectations and to reduce costs. </li></ul>