Building Quality and Cost Containment into Health Care Reform Betsy Imholz Special Projects Director Consumers Union Health Care Reform: The California Perspective ITUP –Washington Workgroup September 3, 2009

California Consumers Overview 1 in 7 uninsured Americans lives in CA 13% of nonelderly had medical debt 2/3 of those with medical debt were insured when the debt was incurred Californians less likely to have insurance through job 2 million buy through individual market Sources:UCLA Center for Health Policy Research Urban Institute and Kaiser Commission on Medicaid

California Reform Package Quality and Cost Containment Groundwork: Health IT Disease Management Community Makeover Grants Enhanced Insurer Efficiencies Prevention Incentives Tobacco Cessation and Obesity Prevention Transparency—Quality and Cost

HR 3200 (Bending the Curve) Prevention - $35 B Comparative Effectiveness Research Quality outcomes data Non-payment for hospital-acquired conditions Promoting competition Delivery system reforms Medicare & Medicaid incentive payments HIT enhancements

Quality and Cost Intersection: Two Consumers Union Priorities 1.Safety improvement incentives A.Transparency B.Non-payment for hospital-caused events 2.Closing the evidence gap A.Comparative effectiveness information B.Getting the right care, avoiding unnecessary intervention

What gets reported publicly gets improved! Transformation

Positive Clinical Impact of Public Performance Reports Hospitals whose performance data was publicly reported show statistically significant improvement in performance. Improvement appears related to post-report quality improvement efforts. Judith H. Hibbard, Jean Stockard, and Martin Tusler “Hospital Performance Reports: Impact on Quality, Market-Share, and Regulation” Health Affairs July/August 2005

8% Reduction in number of HAIs after 2 years of public reporting

Non pay Mistakes

Start with credible source of unbiased, rigorous analysis of clinical evidence about drug effectiveness (DERP) Intense medical input through consultants, internal CU review, and medical peer review Selections based on effectiveness, safety record, and price Identifying CR Best Buy Drugs

Closing the Evidence Gap Example: The “Perinatal Paradox – Doing More, Accomplishing Less” Childbirth/pregnancy a leading reason for hospital admissions and costs Caesarian rates rising dramatically (1/3 all births) Preterm births increasing 36% Low birthweight increasing 22% In 1 California county:  Vaginal delivery, at birthing center, by midwife $3,000  Vaginal delivery, in hospital, by physician $10,000  Caesarian delivery, in hospital $25,000+ Resource: “Evidence – Based Maternity Care,” Childbirth Connection, Milbank Memorial Fund, and Reforming States Group (Oct. 2008)

Building Quality and Cost Containment into Health Care Reform Betsy Imholz Special Projects Director Consumers Union Health Care Reform: The California Perspective ITUP –Washington Workgroup September 3, 2009