1. Community Dialogue: Health Care Waste, Overuse and High Cost November 29, 2012

2. 2 State Employee Group Insurance Program (SEGIP)  50,000 Employees  1120,000 lives covering Judicial, Executive & Legislative Branches  $1.5 billion biennial budget  Largest employer group in the state  1,200 clinics  55 care systems  90% Union

3. 3 What is Health Care Waste to an Employer? Anything that doesn’t result in a more productive employee! Why does an Employer offer Benefits? To recruit and retain employees To maintain a healthy and productive workforce 60% of MN citizens receive health care through an employer

4. 4 Where Does Waste Occur? As a purchaser waste occurs in 3 areas: 1.The care and management of a chronic condition 2.The care and management of acute care 3.The achievement of either by an employee

5. 5 * The Triple Aim: Care, Health, And Cost. Berwick DM, Nolan TW and Whittington J., Health Affairs, May 2008, Vol. 27, No. 3, 759-769. Never Events and Hospital-Acquired Conditions (e.g. falls, medication errors, infections) Other Potentially Preventable Events (Admits, ED visits) Increase best practices (ICSI Guidelines, LBP, elective inductions, C-sxns) Never Events and Hospital-Acquired Conditions (e.g. falls, medication errors, infections) Other Potentially Preventable Events (Admits, ED visits) Increase best practices (ICSI Guidelines, LBP, elective inductions, C-sxns) Care coordination, care management HealthCare Homes RARE “SuperUtilizers” Palliative Care, LiLLIE Shared Decision Making Primary-Specialty Care Communication & Coordination Care coordination, care management HealthCare Homes RARE “SuperUtilizers” Palliative Care, LiLLIE Shared Decision Making Primary-Specialty Care Communication & Coordination End of Life Care Decision support for HTDI “Choosing Wisely” Reduce redundant tests & procedures Address supply-driven behaviors End of Life Care Decision support for HTDI “Choosing Wisely” Reduce redundant tests & procedures Address supply-driven behaviors Support MN’s AUC work Redundancy in care coordination/management among providers and health plans Promote HIT Support MN’s AUC work Redundancy in care coordination/management among providers and health plans Promote HIT Wedge Model for US Health Care With Theoretical Spending Reduction Targets for 6 Categories of Waste Graph Source: Eliminating Waste in US Health Care, Berwick, D., Hackbarth, A. JAMA. 2012;307(14):1513-1516 Potential Waste Reduction Efforts

6. 6 The MN Advantage Plan?  Health Plan Intervention (Health Plan Focus)  Provider Efficiency (Member Focused)  Care Coordination (Provider Focus)  Transparency/Pay for Performance

7. 7 Health Plan Intervention  Disease/Case Management  Step Therapies  Telephonic/Pharmacy based MTM  Health Assessments/Wellness Original “waste management” strategies by employers

8. 8 Provider Efficiency Level 2 Level 4 Level 3 Level 1

9. 9 Provider Efficiency  Tiered Networks – rewards providers who demonstrate value  Center of Excellence – reward systems who out perform on certain conditions

10. 10 Care Coordination  Primary Care Based Tiered Networks – Every member selects a PC facility  Provide Specific Health Care Home payment for those that qualify  DIAMOND participant  ACO Contracting – care coordination part of ACO value

11. 11 Transparency/Pay for Performance  BTE/QIPS – Champions of Change  MNCM quality reporting integration  Consumer Reports  ICSI – Affordability Advisor  MDH – PPG Advisor

12. 12 Where do we go from here?  Continue to measure and reward provider performance  Expand BTE/QIPS  Publish PPG  Meaningful ACO discussions

13. 13 Where do we go from here?  Start to measure and reward health plan performance  Pay for completion, engagement and outcomes of health services  Measure impact on health of members  Health Task Force recommendation to only contract with result oriented health plans

14. 14 Where do we go from here? If costs are not contained and health not improved employers will have no choice but to select narrow networks of providers and question the value of health plans in the supply chain management of health care delivery. or stop offering employer benefits altogether

15. 15 Contact Nathan Moracco, Director nathan.moracco@state.mn.us (651) 259-3720