2. The State of Health Care Quality 2010 The “Suburban Legend” Harming Kids – Disturbing retreat on middle-class kids’ vaccination rates The Good News—Better Scores for: – Caring for heart attack patients – Colon cancer screening – Chlamydia screening Areas of Concern – High quality compromised by customer service concerns – Declining scores for falls prevention, imaging for low back pain and use of antibiotics for bronchitis – Disconnect between plan quality and spending on care

3. We now know about the quality of care for 118 million Americans!

4. Childhood Immunization Retreat in Private Plans, But Not in Medicaid

5. Vaccination Retreat—Response to “Suburban Legend?”

6. Good News! Continued Rise in Beta-Blockers After Heart Attacks

7. Good News! Rise in Colon Cancer Screening

8. Good News! Big Gains in Chlamydia Screening

9. Quality Improvement Saves Lives! MEASURELIVES SAVED*SINCE Beta-Blocker Treatment19,094 – 54,099 1996 Cholesterol Management145,448 – 585,1351999 Blood Pressure Control63,149 – 744,2562000 Diabetes—HbA1c Control44,714 – 397,2691999 TOTAL 272,405 – 1,780,759 * Gross estimate of lives saved; does not take into account comorbidities or expected mortality over time

10. ...Billions in Avoidable Hospital Costs... MEASUREAVOIDABLE HOSPITAL COSTS Breast Cancer Screening $329 million  $332 million Cholesterol Management $935 million  $2.1 billion Controlling High Blood Pressure $1.4 million  $2.5 billion Diabetes Care—HbA1c Control $294 million  $614 million Osteoporosis Management $12.4 million  $32 million Persistent Beta-Blocker Treatment $5.5 million  $30 million Smoking Cessation $831 million  $900 million TOTAL $2.4 billion  $6.5 billion

11. Fewer Patients Give Plans High Marks on Experience of Care

12. No Progress on Preventing Falls Among Medicare Patients

13. No Progress on Inappropriate Imaging for Low Back Pain

14. Decrease in Appropriate Use of Antibiotics for Bronchitis

15. Relative Resource Use (RRU) Measures Assess the Value of Care Plans report spending on 5 costly, common chronic illnesses – Asthma, cardiovascular disease, COPD, diabetes, hypertension Plan comparison is based on relative resource utilization – Costs are standardized, data are risk adjusted In concert with quality measures, we can assess relative health plan value (e.g., quality + resource use)

16. What Can We Learn From RRU? No correlation between quality and health plan resource use Tremendous variation from plan to plan High quality care for diabetics can be delivered at either high or low levels of resource use We can realize significant savings if we move the system to high-quality, low resource use

17. New York City Primary Care Information Project A promising approach using patient-centered medical homes, electronic records and decision support tools to improve quality Results: Marked improvement in cancer screening, blood pressure and cholesterol control, diabetes care, smoking cessation Could be a model for improving quality and reducing waste

18. What Reform Did QUALITY COSTS ACCESS DONE: 31 million new enrollees OPPORTUNITY: Let’s use RRU to gauge value DONE: Many provisions support quality

19. Additional Opportunities in Reform to Promote Quality Exchange choice architecture – “Nudge” consumers toward high-value plans while preserving freedom of choice Reward high-value plans – Medicare Advantage star rating bonuses – Exchange pay-for-performance opportunity

20. Speakers George Halvorson Chairman and CEO, Kaiser Permanente Jeffrey Kang, MD Chief Medical Officer, CIGNA Corporation Roberta Herman, MD Chief Operating Officer and Chief Medical Officer, Harvard Pilgrim Health Care Cristie Travis CEO, Memphis Business Group on Health Faruque Ahmed, PhD Senior Epidemiologist, Natl. Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC)

22. 22 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA