Health Care Spending Benchmark and Opioid Response Kara Odom Walker, MD, MPH, MSHS Cabinet Secretary DELAWARE ACADEMY OF FAMILY PHYSICIANS March 14, 2018 John Ammon Education Center, Christiana Care Health System Join us on Twitter: @Delaware_DHSS 1 Delaware’s Road to Value Support patient ‐ centered, coordinated care. Prepare the health provider Improve health for workforce and infrastructure. special populations. Engage communities. Pay for Value Ensure data ‐ driven performance. Improved Quality and Cost 2 #ourhealthDE
Why the Benchmark Is Important • Delaware’s per ‐ capita health care costs are more than 25% above the U.S. average. • Delaware’s health care spending is expected to more than double by 2025 . • Health care costs consume at least 30 percent of Delaware’s budget. 3 #ourhealthDE Delaware’s Overall Health Is Poor • Our population is older and aging faster. • We are sicker than the average state. RANKED • Our investments have not led to better 30 outcomes — we are ranked 30 th in America’s Health Rankings. 4 #ourhealthDE
Increasing Health Care Costs DELAWARE GENERAL FUND EXPENDITURES 1 , FY2013 VS. FY2017 FY 2013 FY 2017 • During this same time frame, General Fund $1,400 revenue collection has $1,200 grown by just 7.6%. +$202M $1,000 (+22%) • Health care costs now $800 account for about 30% of the state’s budget . $600 $400 • Crowds out necessary investments in: $200 Salaries $ ‐ Education Salaries 2 Health Care 3 Public Ed Infrastructure Public Safety 4 Infrastructure SOURCE: Delaware Office of Management and Budget; DEFAC Expenditure Reports. 1- Infrastructure funds reported from Transportation Trust Fund expenditures, not General Fund. Public Safety 2- Salaries are not inclusive of public education salaries. 3- Healthcare includes employee health benefit expenditures and Medicaid expenditures. 5 #ourhealthDE 4- Public safety expenditures include expenditures by DSHS, DOC, and Youth Rehabilitative Services (DSCYF) Delaware Spends More on Health Care Than Most Other States PER CAPITA PERSONAL HEALTH CARE EXPENDITURES, 2014 $12,000 $10,000 NATIONAL AVERAGE $8,000 $6,000 $4,000 $2,000 $0 UT AZ GA NV CO ID TX NM NC AL HI SC TN AR CA VA OK MS KS LA WA KY OR MI FL MO IA MT IL IN WY NE MD WI OH NJ MN SD PA WV ME RI NH NY ND CT VT DE MA AK State NOTE: District of Columbia is not included. SOURCE: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence , CMS, 2017. 6 #ourhealthDE
Delaware’s Total Health Spending Will Double from 2015 to 2025 DELAWARE’S ACTUAL AND PROJECTED PERSONAL HEALTH CARE EXPENDITURES, 2007—2025 (BILLIONS OF DOLLARS) $21.5 ACTUAL $19.9 Growth PROJECTED $18.5 Target $17.2 2% 5% $16.0 3% $14.8 5% $13.8 3% $12.8 $11.9 2% $11.0 $10.2 $9.5 $9.0 $8.6 $8.4 $7.9 $7.5 $7.1 $6.7 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 Year SOURCES: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence , CMS, 2017; 7 #ourhealthDE Per Person Spending in Delaware Is Higher Than the National Average in Every Category of Service UNITED STATES AND DELAWARE PER CAPITA SPENDING BY SERVICE, 2014 UNITED STATES DELAWARE $4,078 $3,079 $2,259 $1,874 $1,525 $1,438 $1,216 $1,114 $757 $614 $197 $146 Hospital Care Physician and Drugs and Nursing Home, Dental and Other Medical Clinical Services Other Medical Home Health, and Professional Durables Nondurables Other Personal Care Services SOURCE: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence , CMS, 2017. 8 #ourhealthDE
Medicare and Medicaid Account for Nearly 40% of Delaware’s Health Spending TOTAL PERSONAL HEALTH EXPENDITURES BY PAYER IN DELAWARE, 2009 (MILLIONS OF DOLLARS) Medicaid $1.51 Private/Other 16% $6.1 Medicare $2.0 64% 20% Private Medicare Medicaid SOURCE: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence , CMS, 2017 . #ourhealthDE Opportunities and Threats to Better Health • We purchase health care for a greater share of the population than most other states. • We have made progress on moving to value ‐ based payment models. • The current pace of adoption of downside risk may not be sufficient to achieve our goals. 10 #ourhealthDE
Our Objectives: Improved Choice and Better Delivery • Give Delawareans choices and information to help them make better health care decisions. • Reinforce healthy choices via institution and neighborhood design. • Support primary care infrastructure that allows for improvements. 11 #ourhealthDE Strategy One Improve Health Care Quality and Cost • Establish a value ‐ based, health focused, public health framework. $ • Create systems of care centered on quality, patient experience and costs with a strong primary care foundation. • Reduce unnecessary and inappropriate care. 12 #ourhealthDE
Strategy Two Pay for Value • Establish a health care spending benchmark that can examine cost drivers. • Reorient data ‐ driven monitoring of cost toward value and put this information in the hands of physicians. • Require cost and quality thresholds in Medicaid Managed Care Organization contracts. 13 #ourhealthDE Strategy Three Support Patient ‐ Centered, Coordinated Care • Create all ‐ payer ACOs to facilitate integration of services and patient ‐ centered medical homes. • Support and pay for coordination of care across settings. • Create reimbursement approaches for safety ‐ net services. • Examine the Health Resources Board’s authority to both allow for system growth and right ‐ sizing. 14 #ourhealthDE
Strategy Four Support the Health Care Provider Workforce and Health Care Infrastructure Needs • Support primary care workforce, dental, behavioral health, and health ‐ professions education. • Increase racial and ethnic diversity of workforce. • Prepare for safety ‐ net providers’ increased needs. • Invest in telehealth and coordination of services for at ‐ risk populations. • Invest in provider ‐ readiness infrastructure. 15 #ourhealthDE Strategy Five Improve Health Care for Special Populations • Strengthen capacity to promote health equity for people with disabilities. • Continue to focus on maternal ‐ child health. • Establish a trauma ‐ informed system of care. • Use patient ‐ centered medical homes for prison ‐ reentry population. 16 #ourhealthDE
Strategy Six Engage Communities • Improve community ‐ based wellness initiatives, including ACEs, obesity prevention and tobacco cessation. • Create population ‐ health metrics and community data ‐ driven approaches. 17 #ourhealthDE Strategy Seven Ensure Data ‐ Driven Performance • Use public ‐ private collaboration to establish quality and cost targets. • Create methodology for ACOs to interpret quality and cost goals. • Align all payers with total ‐ cost ‐ of ‐ care models leveraging DHIN capacity and HCC ‐ ’like’ authority. • Use a multipronged approach to strengthen the exchange and Medicare ACO strategies. 18 #ourhealthDE
What’s Included in the Benchmark Integrat Int grated Deliv ed Deliver ery y Reform Re Managed Care Managed Care Pa Payment t Organizations ganizations Re Reform BASED ON Va Value-Based Payments Pa ts AFFORDABILITY, Pa Patient- t- Cent Centered ered QUALITY AND Bundled Bund led Medical Medical Homes Homes TOTAL COST OF Payments Pa ts HEALTH CARE Episodic Episodic Pa Payments ts Accou ccounta table e Care Care Managed Care Managed Care Organizations ganizations Pe Per M Member Per Mont r Month h All-Incl All-Inclusive e (PMPM) MPM) Population-Based Population-Ba sed 19 Pa Payments ts Benchmark and Quality: What’s Next 20
How You Can Get Involved • Visit ChooseHealthDE.com’s relaunched website to read more about the benchmark: https://www.choosehealthde.com/Health ‐ Care ‐ Spending ‐ Benchmark • Read more at the Health Care Commission website: http://dhss.delaware.gov/dhcc/global.html • Watch archived Facebook Live videos of benchmark summits: Facebook.com/DelawareDHSS or youtube.com/DelDHSS • View the DHSS report to JFC on the benchmark or Delaware’s Road to Value white paper, visit: http://dhss.delaware.gov/dhss/dhcc/global.html • Send public comments on either report via email to: OurHealthDE@state.de.us 21 #ourhealthDE SUBSTANCE USE DISORDER RESPONSE 22
IN 2016, OVERDOSE DEATHS MORE THAN DOUBLE TRAFFIC DEATHS Overdose Deaths in Delaware Traffic Deaths in Delaware 23 308 120 DELAWARE’S TREATMENT LANDSCAPE 8,150 public treatment admissions for addiction in 2016. Heroin was the most common primary drug listed at time of admission. Thousands more sought private treatment , in-state or out-of-state. In the past decade, the number of Delawareans with Substance Use Disorder nearly doubled from 6,000 to 11,000. During the same period, the number of people receiving SUD treatment increased by 500% from 1,000 to 5,000 – leaving a gap of 6,000 . 24
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