How Can Physicians Drive Change? Susan Turney, MD, MS, FACP, FACMPE President and CEO, MGMA-ACMPE Nov. 13, 2011

2 About MGMA-ACMPE MGMA-ACMPE 22,500 members… Who manage and lead 13,600 organizations With 280,000 physicians Providing about 40% of U.S. physician services

Which Providers Will Do Better? A practice needs to know: –Its revenue and costs –What it costs the purchaser –Whether it has optimized its use of technology –If it’s providing quality care –How to manage care Data is empowerment and should drive your decisions 3

Wisconsin Health Information Organization (WHIO) Providers, payers, employers and public entities created WHIO in 2005 to develop a statewide database of health insurance claims and to use healthcare data to improve the quality, affordability, safety and efficiency of healthcare in the state Mission: Reduce healthcare costs by determining areas of variation in utilization (over and under use) 4

WHIO 5 th Data Mart Version with 3.7 of 5.6 million residents and $29.9 billion in total standardized cost Wisconsin Medical Society/physician/employer/ consumer WHIO Data Study Teams demonstrate variation 5

Status of All-Payer Claims Databases 6

WHIO Physician Data Study Teams (Example) Physician Data Study Teams: Cardiology –10 cardiologists –5 primary care physicians –Employer –Consumer (Nurses Association, AARP) –National specialty representative Similar data study groups for orthopedics, GI, behavioral health. One-hour telephone conferences per month, January through May 2010 Repeat groups in

WHIO Findings Specialist is 10% or less for all episode treatment group studied Orthopedics, cardiology, behavioral health, and Gastroenterology comprise about 50% of total standard cost in the WHIO database Variation in the amount of resources used is a result of variable physician choices, risk of the patient, how quickly they are able to present to care, patient choice, but we cannot identify from the data which of these is the most prominent cause of variation. There is a significant employer role in messaging to the employee and adopting “smart” benefits design. 8

WHIO Findings 9 Episode Treatment Group: Ischemic Heart Disease with Angioplasty Inflammation of the Esophagus, without Surgery Joint Degeneration, localized - Knee and Lower Leg, with Surgery Mood Disorder, Depressed Total Episode Standard Cost, DMV4 $243 M$195 M$287 M$499 M SpecialistCardiologyGastroenterologyOrthopedic SurgeryPsychiatry Total $$23 M$10 M$28 M$23 M % of Episode $9.5%5.1%9.8%4.6% Facility, IP & OP Total $$187 M$76 M$229 M$149 M % of Episode77%39%80%30% Primary Care Total $$3 M$13 M$2 M$22 M % of Episode1%7%1%5% Prescription Drugs Total $$5 M$63 M$2 M$174 M % of Episode2%32%1%35%

Future Studies Are the WHIO efforts portable? What is the opportunity for information exchange? –Better quality –Lower cost –Better utilization 10

Physicians Must Drive Change Physicians are a small part of cost; but drive almost all healthcare expenditures To drive change, physicians must: 1.Identify use of resources that does not add value 2.Manage resource use to improve value (quality/cost) 3.Lead the discussion on shared decision making (especially regarding end-of-life care) 4.Coach patients to manage their lifestyle and health habits Physician practices (and MGMA-ACMPE members) support these efforts 11

Start with the Simple Things Simple changes in process can have a major impact –Appropriate transitions of care –Medication reconciliation –Patient safety protocols (hand washing) –Eliminate administrative waste –Let form follow function It’s ultimately about providing care, not receiving payment Decisions should be based on quality/clinical outcomes 12

What’s Your Plan? The healthcare environment is challenging –Difficult environment/economy –SGR –Debt crisis –Overwhelming demands for care Can we move fast enough before the system crashes? We can’t keep doing business as usual How will you lead change? 13

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