Advancing High Value Health Care All Alliance Meeting July 10, 2013
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 of unwarranted variation, resulting in a significant reduction in medical cost trend. 2 An Aligning Forces for Quality Community
Strategic Goals to Achieve the Vision 1. Reduce cost/price of health care services 2. Reduce overuse of health care services 3. Reduce underuse of effective health care 3
What, Why, and How 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] 4
Common Hospitalizations Report Release Sequence Released as “Chapters” First Resource Use, then Outcomes, and finally Buyer’s Cost Jan 2013 Summer 2013 Spring 2013 Medicare Patients Commercial Patients Commercial Mortality and Inpatient Case Price Patients Adverse Event Variation Inpatient Intensity rates and Consistency …by delivery …by delivery …by delivery system system system 5
Common Hospitalizations Report Release Sequence Released as “Chapters” First Resource Use, then Outcomes, and finally Buyer’s Cost Jan 2013 Summer 2013 Spring 2013 Medicare Patients Commercial Patients Commercial Mortality and Inpatient Case Price Patients Adverse Event Variation Inpatient Intensity rates and Consistency …by delivery …by delivery …by delivery system system system 6
Resource Use: differences in intensity for inpatient episodes What are we measuring? Service Intensity : differences between delivery systems in the amount of 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 7
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 8
Resource Use: differences in intensity for inpatient episodes 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 9
Common Hospitalizations Report Release Sequence Released as “Chapters” First Resource Use, then Outcomes, and finally Buyer’s Cost Spring 2013 Jan 2013 Summer 2013 Commercial Medicare Patients Commercial Patients Patients Mortality and Inpatient Case Price Inpatient Intensity Adverse Event Variation and Consistency rates …by delivery …by delivery …by delivery system system system 10
Outcomes: differences in rates of mortality & patient safety 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 11
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 12
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. 13
Common Hospitalizations Report Release Sequence Released as “Chapters” First Resource Use, then Outcomes, and finally Buyer’s Cost Jan 2013 Summer 2013 Spring 2013 Medicare Patients Commercial Patients Commercial Mortality and Inpatient Case Price Patients Adverse Event Variation Inpatient Intensity rates and Consistency …by delivery …by delivery …by delivery system system system 14
Buyer’s Cost: variation in transaction price per case 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 15
Buyer’s Cost: reports for purchasers 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 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 Alder Birch Cedar Dogwood Elm Sytem Quartiles Sytem Sytem Sytem 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 16 6.1x (95th percentile case price / 5th percentile case price) Price Variation
Buyer’s Cost: reports for delivery systems 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) PROVIDER'S REPORT SAMPLE Cesarean Delivery, minor severity Overall Case Distribution Percent of Delivery System Cases Priced within Regional Quartiles Region Delivery Birch Delivery Delivery Delivery Quartiles System 1 Sytem System 3 System 4 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 6.1x (95th percentile case price / 5th percentile case price) 17 Price Variation 17
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