How data can improve health care What we don’t know can hurt us Gov 2.0 September 10, 2009 Elliott Fisher, MD, MPH Director, Population Health and Policy.

Slides:



Advertisements
Similar presentations
THE ACUTE NEED FOR DELIVERY SYSTEM REFORM MARGARET E. OKANE.
Advertisements

Variations in Spending Insights and Opportunities Elliott S. Fisher, MD, MPH Professor of Medicine and Community and Family Medicine Dartmouth Medical.
Safety Net Medical Home Initiative Ed Wagner, MD, MPH, MACP MacColl Center for Health Care Innovation Group Health Research Institute Safety Net Medical.
Figure 1. Rating the U.S. Health System Scores on major dimensions of system performance Source: Commonwealth Fund National Scorecard on U.S. Health System.
Quality Improvement: Lessons for Workers Compensation Quality of Care Linda Rudolph, MD, MPH Medi-Cal Managed Care Division CA Department of Health Services.
THE CHALLENGE: CHRONIC DISEASE CARE AND THE PROMISE OF HIT Health Care Information Technology 2004: Improving Chronic Care in California San Francisco.
Access to Care in The Medicaid Program Andrew B. Bindman, MD Professor of Medicine, Health Policy, Epidemiology & Biostatistics University of California.
A Quality Focused, Financially Responsible Approach to Medicaid Reform Jeffrey W. Runge, MD, FACEP NC Medical Society Board of Directors February 11, 2015.
PROVIDER CONSOLIDATION FTC-DOJ Public Workshop on U.S. Health Care Competition Washington, D.C. February 25, 2015 Kenneth W. Kizer, MD, MPH Distinguished.
Head CT Scans per 1,000 Children ( , age-sex-payer adj.) 14.7 to19.7 (13) 12.3 to
Improving Health Care Quality While Slowing Spending Growth: The Alternative Quality Contract (AQC) Dana Gelb Safran, Sc.D. Senior Vice President Performance.
Middle Atlantic Actuarial Club September 17, 2009 Baltimore, MD Shannon Brownlee, MS Senior Research Fellow, New America Foundation Overtreated: Why Too.
The 2010 Affordable Care Act and the Future of Provider Payment in the U.S.: New Urgency, New Ground Rules Meredith B. Rosenthal, Ph.D. Associate Professor.
One Union Station Providence, RI (401)
Health Care Reform Cost Savings Julie Sonier Director, Health Economics Program Minnesota Department of Health SCI Summer Meeting July 31, 2008.
What’s Next for Health Care
The Status of Patient Safety Donald M. Berwick, MD, President and CEO Institute for Healthcare Improvement 10 th Anniversary of To Err is Human The Commonwealth.
1 Emerging Provider Payment Models Medical Homes and ACOs.
American Association of Colleges of Pharmacy
Health Care Reform: Where are the Pharmacists? Opportunities and Challenges for Pharmacists in Health Care Reform Anthony D. Rodgers CMS Deputy Administrator.
MaineCare Value-Based Purchasing Strategy Quality Counts Brown Bag Forum November 22, 2011.
Health Policy Seminar on Sunday, April 19 th, 2009 Washington, D.C. Shannon Brownlee Visiting Scholar, NIH Clinical Center Dept. of Bioethics Schwartz.
2013 State Office of Rural Health Orientation September 11, 2013 Laura B. Hudson, MPA Manager, Program Services & Contracting /
Panel on Measuring Quality and Value Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality IOM Committee Meeting on Geographic Variation.
Excess cost growth in Medicare, Medicaid, and all other health care spending Source: CBO, A Federal Perspective on Health Care Policy and Costs, 2008.
Incentives & Outcomes Committee Draft Recommendations Public Employer Health Purchasing Committee October 25, 2010.
Slide 1 Bending the cost curve Addressing the problem of “supply-sensitive” care Elliott S. Fisher, MD, MPH Professor of Medicine Center for the Evaluative.
High Value Primary Care: New Evidence on the Excellent Return on Investment in Primary Care Commonwealth Fund and Alliance for Health Reform Briefing December.
E LLIOTT S. F ISHER, MD, MPH J AMES W. S QUIRES P ROFESSOR OF M EDICINE G EISEL S CHOOL OF M EDICINE AT D ARTMOUTH D IRECTOR T HE D ARTMOUTH I NSTITUTE.
Virginia Chamber of Commerce Health Care Conference Steve Arner SVP / Chief Operating Officer June 6, 2013.
Population Health The Road to 2020 & The Path to Value Dr. Matthew Wayne Chief Medical Officer, New Health Collaborative & Summa Physicians September 16,
Delivery System Reform Incentive Payment Program (DSRIP), Transforming the Medicaid Health Care System.
Stanford Medicine: A Financial Management Perspective Stanford Staff Leadership & Development Program Tina Darmohray Osman Akhtar May 6, 2009.
Practice Transformation: Using Technology to Improve Models of Care and Transitions in Care Mat Kendall, EVP Aledade DISCLAIMER: The views and opinions.
Payment and Delivery Reform Steve Arner Senior Vice President / Chief Operating Officer June 6, 2013.
In Healthcare, Is More Always Better? Thérèse Stukel Institute for Clinical Evaluative Sciences, Toronto Dartmouth Medical School, US Graham Woodward Cancer.
Delivering Health Care – and Savings? March 1, Health Policy Roundtables Cost Containment Through Accountable Care.
Steven E. Wegner, MD JD Chair, NCMS Accountable Care Task Force Paul Cunningham, MD NCMS Accountable Care Task Force 1.
The future of Medicare fee-for- service Mark E. Miller, Ph.D. Executive Director Medicare Payment Advisory Commission October 16, 2006.
Figure 1 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Dual Eligibles: The Basics Barbara Lyons, Ph.D. Director, Kaiser Commission on.
The Patient-Centered Medical Home: A Work in Progress Alliance for Health Reform Briefing Washington D.C. September 22, 2008 Diane R. Rittenhouse, MD,
1 Delivery System Reform: Developing Accountable Care Organizations John Bertko, F.S.A. Visiting Scholar Brookings Institution July 30, 2009 State Coverage.
A Journey Together: New Maryland Healthcare Landscape Baltimore County Forum Maryland Health Services Cost Review Commission June 2015.
Chronic Care in the 21 st Century Building an Infrastructure for Quality and Efficiency March 2, 2009 Philadelphia, PA John Tooker MD,MBA,FACP Chief Executive.
Improving Value in Health Care: Challenges and Potential Strategies Arnold M Epstein October 24, 2008 Congressional Health Care Reform Education Project.
State Trends in Premiums and Deductibles, : Eroding Protection and Rising Costs Underscore Need for Action Cathy Schoen Senior Vice President.
Transforming Maryland’s Health Care & Engaging Communities Charles County Forum on Maryland’s All Payer System Transformation Carmela Coyle President &
NASHP STATE HEALTH POLICY CONFERENCE OCTOBER 5, 2010.
FAMILY MEDICINE AT ITS PEAK Amy Russell, MD Medical Director MAHEC/MMA Primary Care Asheville, NC FAMILY MEDICINE AT ITS PEAK Amy Russell. MD Medical Director.
Accountable Care: The Challenge of the Decade Michigan’s Premier Public Health Conference October 13, 2011 Kim Horn President and CEO Priority Health.
A NEW REIMBURSEMENT STRUCTURE FOR AMERICA ADVANCED DISEASE CONCEPTS.
Primary Care Improvement Infrastructure: The Role of Practice Facilitation Michael L. Parchman, MD MPH MacColl Center for Health Care Innovation AHRQ Annual.
NORTHERN NEW ENGLAND ACCOUNTABLE CARE COLLABORATIVE NNEACC 1 LD 1818 WORK GROUP David Wennberg August 9, 2012.
Health Departments and HIV Screening Institute of Medicine Workshop 1: Screening and Access to Care April 15, 2010 Natalie Cramer, Associate Director,
Geographic Variation in Healthcare and Promotion of High-Value Care Margaret E. O’Kane November 10, 2010.
Sachin H. Jain, MD, MBA Office of the National Coordinator for Health IT United States Department of Health and Human Services The Nation’s Health IT Agenda:
All-Payer Model Update
A Foundation for Paul Grundy MD, MPH IBM Chief Medical Officer Director, Healthcare Transformation Healthcare Industry A Foundation.
The Elements of Health Care Quality and Current Improvement Efforts
Compensation Committee 2017 Goals – Updated
John Tooker MD,MBA,FACP Chief Executive Officer/EVP
High Performance Accountable Care: What Do We Need to Do?
Dual Eligibles Across the States
67th Annual HSFO Conference Louisville, KY
Speeding up Improvement in Chronic Care: What should be the Federal Role? Sandra M. Foote Senior Vice President, Capitol Health January 29, 2009.
All-Payer Model Update
Illustrative Health Reform Goals and Tracking Performance
Lisa M. Letourneau MD, MPH Quality Counts
Strategic Integration of. Non-MD Providers in a
Presentation transcript:

How data can improve health care What we don’t know can hurt us Gov 2.0 September 10, 2009 Elliott Fisher, MD, MPH Director, Population Health and Policy The Dartmouth Institute for Health Policy and Clinical Practice 1

The current conundrum Rising costs a serious threat Medicare Trust Fund – runs dry 2017 Cost of family coverage projected to double ($12,298 to $23,842 by 2020) Two million Americans affected by medical bankruptcy each year Barriers Fear of rationing, of change, that lower cost = lower quality Ignorance of where the money’s going in health care of how to do better Data can help: four examples Regional variations in spending and quality: where’s the waste? Identifying high-performing systems -- from whom we can learn Supporting change in clinical practice Motivating change in health systems

Per-capita Medicare Spending Trends: 1992 to 2006 Miami5.0 Salem, OR2.3 E. Long Island4.0 Boston3.0 San Francisco2.4 Annual Growth Rate Source: Slowing the Growth of Health Care Spending: Lessons from Regional Variation. Fisher, Skinner, Bynum, New England Journal of Medicine, February 26, 2009 US Avg3.5 3

What does higher spending buy? (1) Fisher et al. Ann Intern Med: 2003; 138: (2) Baicker et al. Health Affairs web exclusives, October 7, 2004 (3) Fisher et al. Health Affairs, web exclusives, Nov 16, 2005 (4) Skinner et al. Health Affairs web exclusives, Feb 7, 2006 (5) Sirovich et al Ann Intern Med: 2006; 144: (6) Fowler et al. JAMA: 299: Not better care or better outcomes 4 More “supply-sensitive services”

Lack of support for improvement, care management and coordination. Local organizational support: Develop virtual or real integrated systems to support practice. Payment system that rewards more care, increased capacity, high margin treatments, entrepreneurial behavior. Payment reform: foster accountability for capacity – and behavior: capitation or global shared savings. Underlying problemKey principles Moving forward Addressing the underlying causes of rising costs, poor quality 5 Failure to recognize role of local system (e.g. capacity) as cost-driver. Local accountability: Foster accountability for total costs – and capacity at local level. Assumption that more is better. Equating less care with rationing. Measurement: Comprehensive performance measures: outcomes, patient experience.

Data on regional performance Marked variations highlight opportunities to improve 6 Everett, WA Sacramento, CA La Crosse, WI Cedar Rapids, IA Temple, TX Portland, ME Sayre, PA Richmond, VA Asheville, NC Tallahassee, FL “How do they do that?” conference Lighter colors = lower spending Partici- pants Qualifying Regions All Others Medicare Spending $6,773$7,098$8,562 Hospital Days Spending for Imaging (last 2 yrs) $633$662$843 Hospital Quality Score 95% 93%

Benchmarks of efficiency Potential savings from achieving high performance 7 Everett, WA Sacramento, CA La Crosse, WI Cedar Rapids, IA Temple, TX Portland, ME Sayre, PA Richmond, VA Asheville, NC Tallahassee, FL Category of Care Potential Savings Medicare spending 16% Hospital days17% Specialist visits36% “How do they do that?” conference Lighter colors = lower spending

How do they do that? Some preliminary insights Common elements across regions Shared aims; “accountable” to the community; Physician engagement as leaders; support for professional values Strong primary care foundation Use of data to support work; professional feedback; peer review Data feedback – a critical component Organizational accountability – integrated systems to support feedback Data itself – actual performance of providers

Data to improve quality Support for process management Ch 7. BC James, JS Lazar. A health system’s use of clinical programs to build quality infrastructure. In: Practice-Based Learning and Improvement Second Edition. EC Nelson, PB Batalden, JS Lazar, Eds. Intermountain Health Care Focus on managing defined clinical populations Care pathways defined by multi-disciplinary team Protocols implemented through EHR with process, outcome tracking and feedback Scientific review / updating on monthly basis.

Data to address variations Partners Healthcare Stafford RS Am J Heart 2003, 145: Physician level (n = 117) Low: 0.0% High: 24.6% Practice level (n = 10) Low: 1.0% High: 8.1% Baseline variation in ordering Impact of Individualized Feedback and Education.

Data to address variations Partners Healthcare May 29, 2008 Presentation at Federal Trade Commission Tom Lee, MD (Partners Healthcare System) (with permission)

And, perhaps, to stimulate change McAllen vs El Paso