Bipartisan Congressional Health Policy Conference January 11 - 13, 2007 Miami, FL Aiming for the Best: Scorecard of U.S. Health Care System Performance.

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Presentation transcript:

Bipartisan Congressional Health Policy Conference January , 2007 Miami, FL Aiming for the Best: Scorecard of U.S. Health Care System Performance What Is Doable Now? Glenn D. Steele Jr., MD, PhD President and CEO Geisinger Health System

Strategic Targets – Can We Prioritize? Who? How?

Suggested Criteria What works now, somewhere? What is translatable? What can produce recognizable improvement?

Learn From Best Practice

Go for Perfection Model Reimbursement to Achieve: ▫ Optimum chronic care ▫ Optimum acute care ▫ Population health goal

Pay-for-Performance (P4P) Initiatives Chronic care (PGP demonstration and beyond) Episodic care (e.g., CABG, joint replacement, cataract surgery, EPO)

Highly-Reliable Diabetes Care (“All or None” Composite Measure)

ProvenCare SM - Diabetes (Comprehensive Care; System-wide; >20K patients) % of all diabetic patients # Components Received/Achieved (by patient) 20% 10% All 3/31/06 9/30/06 6/30/06 11/30/06

Diabetes Outcomes (resulting from ProvenCare SM ) % of all diabetic patients

Coronary Artery Bypass: Reliability % of patients who received all components of care Hired performance improvement clinician Documented current processes Engaged remaining stakeholders Confirmed the “ProvenCare CAB” processes & accountabilities Go-Live Feb 06 Oct 06 May 06 Nov 05 Jul 05

Coronary Artery Bypass: Outcomes Before With Improvement ProvenCare SM ProvenCare (% reduction) (n=143)(n=81) Patients with any complication38%30% 21% Patients with major complication9.8%6.2% 37% Atrial fibrillation22%19% 15% Any pulmonary comp6.3%2.5% 60% Re-admit ICU2.8%0.0%100% Blood use25%19% 27% Re-operation for bleeding4.2%3.7% 12% In-hospital mortality (death)1.4%0.0%100% Deep sternal wound infection0.7%0.0%100% Discharged not to home 19% 7% 63% Charges per patient$61,176$58,117 5%

Pay for best practice –Don’t pay for less than best practice First Principles

Focus on systems of care* as best model for testing new delivery incentives * Hehrotra A, Epstein A, Rosenthal B. Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?, Ann Intern Med, 2006, 145 (11): * Casalino L. Which Types of Medical Group Provides Higher-Quality, Ann Intern Med, 2006, 145 (11):