Sarah Woolsey, MD - Governor`s Health Summit

Report
Value-based Care Strategies in Utah:
Paying for Better Health Outcomes
Governor’s 2014 Health Summit
Afternoon Breakout Session
September 30, 2014
Utah Partnership for Value-driven
Health Care
• Who we are: A community collaborative of health
care purchasers, payers, providers, and the public
• Mission: We seek to advance higher value health
care in our community through shared strategies that
address
– transparency
– variation in cost and quality
– community approaches to improvement in health
care delivery
http://healthinsight.org/upv
Value in Health Care
“In health care, value is defined as the
patient health outcomes achieved per
dollar spent.”
Health Outcomes
$$
Porter ME. What is value in health care? N Engl J Med 2010; 363:2477-81
Value in Health Care
“Value should be the preeminent goal in the
health care system, because it is what
ultimately matters for customers (patients)
and unites the interests of all system actors.”
-Michael E. Porter, Ph.D
.
Porter ME. What is value in health care? N Engl J Med 2010; 363:2477-81
What the Focus Should Be: How
to Reduce Costs By Improving
Health
Patients
BETTER HEALTH
Lower
Costs
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Improving Health/Reducing Costs:
Prevention and Wellness
Healthy
Consumer
Continued
Health
Health
Condition
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Improving Health/Reducing Costs :
Avoiding Hospitalizations
Healthy
Consumer
Continued
Health
Health
Condition
No
Hospitalization
Acute Care
Episode
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Improving Health/Reducing Costs :
Efficient, Successful Treatment
Healthy
Consumer
Continued
Health
Health
Condition
No
Hospitalization
Acute Care
Episode
Efficient
Successful
Outcome
High-Cost
Successful
Outcome
Complications,
Infections,
Readmissions
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Improving Health/Reducing Costs :
Is Also Quality Improvement
Healthy
Consumer
Continued
Health
Health
Condition
Better Outcomes/Higher Quality
No
Hospitalization
Acute Care
Episode
Efficient
Successful
Outcome
High-Cost
Successful
Outcome
Complications,
Infections,
Readmissions
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Often, We Don’t Pay for the Things That
Support Value
CURRENT FEE FOR SERVICE PAYMENT SYSTEMS
Health Insurance Plan
Physician
Practice
$
$
$
Office
Visits
ER
Visits
Hospital
Stay
Avoidable
Avoidable
Lab Work/
Imaging
...No penalty or
reward for
high utilization
elsewhere
Phone
Calls
Nurse
Care Mgr
Avoidable
No payment for
services that
can prevent Adapted from Harold Miller, Center for Healthcare Quality and
utilization... Payment Reform
How About Different Ways to Pay?
Global Payment
Shared
Risk/Shared
Savings
Financial Risk
Bundled Payment,
Episode Payments
Warrantied/
Condition-based
payments
Care Management
Payment
Incentivize quality
and appropriate
utilization
Accountable Care
Organization
Centers of Excellence
Performance-Based
How Different Payment Might Alter the
Landscape
COMPREHENSIVE CARE/GLOBAL PAYMENT
Health Insurance Plan
$
ConditionAdjusted
Per Person
Payment
Physician
Practice/
ACO
$
Office
Visits
Phone
Calls
Nurse
Care Mgr
ER
Visits
Hospital
Stay
Avoidable
Avoidable
Lab Work/
Imaging
Avoidable
Flexibility and accountability
for a condition-adjusted budget
covering all services
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Barriers to Patients’ Access to Value
Information not
available
Do not promote costconscious choice
Meaningful co-pay,
deductibles
Services Unavailable or
Not Affordable
PATIENT
Information on best
value service
Non-Medical
Support
(e.g., weight loss)
Accessible PCP or
Medical Home
Lack of ability to
navigate
Multiple Days
Off Work
Accessible
Specialist
Lack of
Transportation
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Accessible
Lab/Radiology
Providers Will Need Alignment to
Allow Focus on Better Care
Payer
Payer
Better
Payment
System B
Better
Payment
System A
Payer
Better
Payment
System C
Provider
Patient Patient Patient
Even if every payer’s system is better than it was,
if they’re all different, providers will spend too much time
and money on administration rather than care improvement
Adapted from Harold Miller, Center for Healthcare Quality and
Payment Reform
Utah Payment Reform Initiatives:
Public and Private
• Medicaid ACO implementation
• Patient-centered Medical Home initiatives
• Provider and plan preparation for
Accountable Care or Shared Savings
• Direct contracting with providers by private
and public employers
• Payer, state, and community-led efforts to
measure and share pricing and quality
performance
• Onsite work clinics developed by providers
Panelists
• Linn Baker, CEO, ARCHES Health Plan
• Chuck Norlin, Chief of the Division of
General Pediatrics, University of Utah
• Gina Pola-Money, Director, Utah Family
Voices
• Scott Barlow, CEO, Central Utah Clinic,
Provo, Utah
Q and A
• Write a question on a 3X5 card on the table
• Take it to one of designated staff persons
Next Steps
• Contact swoolsey@HealthInsight.org to
continue the dialogue with the Utah
Partnership for Value
• Break begins at 2:45pm
• Sessions resume at 3:00pm

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