[PPT] - Health Care All Alliance Meeting July 10, 2013 Enabling the PowerPoint Presentation

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Advancing High Value Health Care

All Alliance Meeting July 10, 2013

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Enabling the Community to Change the Health Care Cost Trend

Alliance Mission and Vision

Mission: To build a strong alliance among patients, providers, purchaser, health plans and others to promote health and improve quality and affordability by reducing overuse, underuse and misuse of health care services. Vision: By 2015, physicians, other providers and hospitals in the region achieve top 10% performance in the nation in the delivery of quality, evidence-based care and in the reduction

f unwarranted variation, resulting in a significant reduction

in medical cost trend.

An Aligning Forces for Quality Community

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Strategic Goals to Achieve the Vision

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1. Reduce cost/price of health

care services

2. Reduce overuse of health care

services

3. Reduce underuse of effective

health care

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WHAT…Hospitalizations including professional care

Highest volume & most widespread hospitalizations for commercial patients
Includes the activities of all providers during inpatient stay

WHY…Varying (but aligned) reasons, depending on stakeholder

For Purchasers: Begin identifying higher value delivery systems for

particular treatments, procedures, and service lines

For Providers: Help delivery systems build stronger value-based business

cases for their buyers, and identify potential improvement opportunities

HOW…Assemble measure results from several ‘value variables’

Resource Use: variation in service intensity [commercial patients]
Outcomes: mortality & patient safety rates [Medicare patients]
Case Price: variation in transaction price [commercial patients]

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What, Why, and How

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Released as “Chapters”

First Resource Use, then Outcomes, and finally Buyer’s Cost

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Spring 2013 Commercial Patients Inpatient Intensity and Consistency …by delivery system Jan 2013 Medicare Patients Mortality and Adverse Event rates …by delivery system Summer 2013 Commercial Patients Inpatient Case Price Variation …by delivery system

Common Hospitalizations Report Release Sequence

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Released as “Chapters”

First Resource Use, then Outcomes, and finally Buyer’s Cost

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Spring 2013 Commercial Patients Inpatient Intensity and Consistency …by delivery system Jan 2013 Medicare Patients Mortality and Adverse Event rates …by delivery system Summer 2013 Commercial Patients Inpatient Case Price Variation …by delivery system

Common Hospitalizations Report Release Sequence

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Resource Use: differences in intensity for inpatient episodes What are we measuring?

Service Intensity: differences between delivery systems in the amount
f service delivered to hospital patients for similar treatments
Not cheap vs. expensive, but conservative vs. aggressive

Why measure service intensity?

Consistent, lower-intensity service profiles point to fewer unnecessary

services, or so-called ‘discretionary care’

All else equal, consistent, lower-intensity care can translate into:

 Lower overall cost  Less waste  Decreased clinical risks  Reduced patient cost share  More rapid return to work

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Resource Use: differences in intensity for inpatient episodes

Most common inpatient

admissions

Includes professional

services

Commercial patients in

the Alliance database

For each admitting

facility:

Severity-adjusted
Drilldown reports compare

service composition

Also: consistency of

resource use within a system

Shading denotes

significant differences from region

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Measures
10 inpatient service lines comprising 18 treatments
33 sets of results after accounting for patient severity
Results
No single delivery system stands out for all hospitalization types
However, patterns of higher or lower intensity emerge within

different service lines (e.g., cardiology, orthopedics, etc.)

Display
Delivery systems that have consolidated are grouped together
Extensive drill-down reports (not shown) allow providers and

purchasers to identify sources of variation between delivery systems

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Resource Use: differences in intensity for inpatient episodes

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Released as “Chapters”

First Resource Use, then Outcomes, and finally Buyer’s Cost

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Spring 2013 Commercial Patients Inpatient Intensity and Consistency …by delivery system Jan 2013 Medicare Patients Mortality and Adverse Event rates …by delivery system Summer 2013 Commercial Patients Inpatient Case Price Variation …by delivery system

Common Hospitalizations Report Release Sequence

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Results
Obtained through program of the National Business Coalition on

Health

Calculated by The Delta Group using non-proprietary measures

available in the public domain

26 measures
7 mortality measures for medical conditions
8 mortality measures for surgical conditions
11 patient safety measures for medical and surgical conditions
Reviewed/approved by Alliance’s Quality Improvement

Committee

Not always specific to a particular type of procedure, but

reasonable quality indicators for the care delivered in general

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Outcomes: differences in rates of mortality & patient safety

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Outcomes: differences in rates of mortality & patient safety

AHRQ tools, NQF vetted
Medicare FFS inpatients
For each admitting

facility:

Cases at risk
Actual rate, risk-adjusted
Expected rate, risk-adj.
Shading denotes

significant differences

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Blinded Sample of Adverse Event Results (aka Patient Safety Indicators)

Strong performance across delivery systems to reduce pressure ulcers and central line infections may reflect dedicated statewide initiatives.

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Released as “Chapters”

First Resource Use, then Outcomes, and finally Buyer’s Cost

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Spring 2013 Commercial Patients Inpatient Intensity and Consistency …by delivery system Jan 2013 Medicare Patients Mortality and Adverse Event rates …by delivery system Summer 2013 Commercial Patients Inpatient Case Price Variation …by delivery system

Common Hospitalizations Report Release Sequence

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Buyers and sellers get different reports
To encourage pro-competitive uses, purchasers and delivery

systems will receive reports with different formats and content

Same hospitalizations featured in resource use reports
Includes professional and other services – not just facility prices
These reports break new ground
Hospitals get a sense of how attractive their own combined

(hospital & professional) pricing appears to purchasers

Purchasers learn how much total case pricing can vary across the

region and by delivery system

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Buyer’s Cost: variation in transaction price per case

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Separate report for each kind of hospitalization, severity adjusted

1. Delivery system’s case prices compared against regional quartiles 2. Each delivery system’s average case price shown as a relative index 3. Magnitude of regional price variation is quantified

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Buyer’s Cost: reports for purchasers

PURCHASERS' REPORT (EMPLOYERS, UNION TRUSTS, and HEALTH PLANS) SAMPLE

Cesarean Delivery, minor severity

Overall Case Distribution Percent of Delivery System Cases Priced within Regional Quartiles Region Quartiles Alder Sytem Birch Sytem Cedar Sytem Dogwood Sytem Elm Sytem

(EXPECTED) (OBSERVED) (OBSERVED) (OBSERVED) (OBSERVED) (OBSERVED)

Highest Price Level 25% 5% 20% 25% 20% 45% Higher 25% 15% 20% 25% 40% 35% Lower 25% 30% 40% 25% 20% 15% Lowest 25% 50% 20% 25% 20% 5% 100% 100% 100% 100% 100% 100% Average Case Price Index 1.00 0.65 0.92 1.00 1.94 3.10 Magnitude of Regional Price Variation 6.1x (95th percentile case price / 5th percentile case price)

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Separate report for each kind of hospitalization, severity adjusted

1. Recipient’s case prices compared against regional quartiles 2. Magnitude of regional price variation is quantified

3. No relative index; no other delivery systems shown (to curb anti-competitive uses)

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Buyer’s Cost: reports for delivery systems

PROVIDER'S REPORT SAMPLE

Cesarean Delivery, minor severity

Overall Case Distribution Percent of Delivery System Cases Priced within Regional Quartiles Region Quartiles Delivery System 1 Birch Sytem Delivery System 3 Delivery System 4 Delivery System 5

(EXPECTED) (OBSERVED) (OBSERVED) (OBSERVED) (OBSERVED) (OBSERVED)

Highest Price Level 25% 20% Higher 25% 20% Lower 25% 40% Lowest 25% 20% 100% 0% 100% 0% 0% 0% Magnitude of Regional Price Variation 6.1x (95th percentile case price / 5th percentile case price)

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SLIDE 18

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Puget Sound Health Alliance

Value Portfolio Report for: Cardiology and Cardio-Vascular Surgery

Delvery System A Delvery System B Delvery System C Delvery System D Delvery System E Delvery System F Delvery System G Delvery System H Delvery System I Delvery System J Delvery System K Delvery System L Delvery System M Delvery System N Delvery System O Delvery System P

2008-2011 Severity-Adjusted Commercial Case Price Comparisons Hip Joint Replacement, minor severity [APR-DRG 301.1]