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A P A R T N E R S H I P F O R T H E F U T U R E O F H E A L T H C A R E

UPV Steering Committee Meeting Thursday, June 20, 2013 . 4-6 pm

HealthInsight Board Room

ATTENDEES 1. Aimee Whetman, HCA 2. Amy Sawaya, AUCH 3. Arlen Jarrett, Health Choice UT 4. Brenna Long-phone, Lync, VA 5. Courtney Pariera Dinkins, AUCH 6. David Clark, Zions Bank 7. Deborah Turner, UDOH 8. Dee Hill-Mey, Integrative Health Network 9. Gloria Nicholas, Humana 10. Henry Gardner, Zions Bank 11. Iona Thraen, UofU 12. Jaime Montuoro, Smiths Pharmacy 13. Jan Root, UHIN 14. Jean MacFarlane, SANOFI 15. Jennifer Daley, AAFP 16. John Berneike, FP Physician 17. John Neal, Consultant 18. John Oaks, IASIS 19. Joyce Kim, Health Choice Utah 20. Julie Day, UofU 21. Karen Coats, UDOH 22. Libby Chuy, AUCH 23. Linda Johnson, UofU Health Plans

24. Marc Babitz, UDOH 25. Mark Breisacher-phone, Intermountain 26. Marti Cohen, Avalon Healthcare 27. Maureen Keefe, UofU Nursing 28. Michelle Dunn, CNS 29. Patricia Carroll, Public Health Informatics 30. Philip Davis, UofU Informatics 31. Randy Cox, Pricing Healthcare 32. Richard Smith, Humana 33. Robert Huefner, Retired UofU 34. Steve Barlow, SelectHealth 35. Wu Xu-phone, UDOH

HEALTHINSIGHT STAFF 36. Clare Lence 37. Daniel Chipping 38. David Smith 39. Janet Tennison 40. Justin Edden 41. Kim Dunn 42. Korey Capozza 43. Marc Bennett 44. Sarah Woolsey 45. Sharon Donnelly 46. Suzy Wickens

Notes

1. Welcome/Introductions, Korey Capozza, HealthInsight The meeting’s purpose is to facilitate discussion RE: payment and delivery system reform and transparency across all participating agencies, enterprises, and stakeholders. There is a new UPV website, containing current events, hot topics, meeting dates and minutes, and community workgroups, accessible here: http://www.healthinsight.org/Internal/ValueDrivenHealthcareUT.html

2. Standing Item Updates, Sarah Woolsey, HealthInsight

a. Reporting Task Force Update Workgroup, in existence since 2009, on transparency and public reporting and oversees the Utah Healthscape website created to help consumers to use metrics on healthcare providers and plans, found here: http://www.utahhealthscape.org/ HB128, which focuses on creating quality measures for clinics, has selected a vendor—Trio Solutions, New York-based. Work may begin on the orthodpedics pilot discussed last December if the APCD is up and running soon.

b. Choosing Wisely Campaign

HealthInsight was awarded RWJF funds to address waste/overuse as far as certain medical procedures. All are invited to join in this discussion and to participate in education panels, link here: http://www.abimfoundation.org/News/ABIM-Foundation-News/2013/ABIM-Foundation-awards-grants-to-advance-Choosing-Wisely.aspx

3. Federal and State Health Policy – What’s Happening and What’s Next? a. Federal Update, Marc Bennett, HealthInsight

Key Areas Covered: Overview of Federal Direction(s) Measures, Analytics, and Data Infrastructure: Including National Quality

Forum, Qualified Entities, Meaningful Use, Health Information Exchange Payment Reform CMMI

(please see attached meeting slides)

Discussion included whether there are efforts by the Federal government, under ACA, to standardize some of these experiements. There is some consensus building around ACA. The banking industry has a valid point about competitors exchanging information. There is still an open window at the State level, opened by CMS, and every chance should be taken with this opportunity—rather than waiting for the Federal government.

The group referred to this slide from ONC regarding Meaningful Use:

b. State Innovation Plan, Deb Turner, UDOH Key Areas Covered:

Origin/Vision/Deadline of SIM in Utah Five Work Groups SIM Plan to Report at Governor’s Health Summit, September 26, 2013


Discussion included that the State would like a more robust APCD and CHIE. SIM is a great investment and will result in a state roadmap.

c. Medicaid ACO Progress and Demo of ACO Quality, Gail Rapp, Medicaid

Website review and found here: http://www.health.utah.gov/medicaid/

Gail Rapp plans to attend the next UPV quarterly meeting. There is a focus on streamlining—eliminating duplication. All but two measures have been approved by the State.

4. Recent Movement on Price Transparency

a. Media Coverage and Medicare Data, Clare Lence, HealthInsight Key Areas Covered:

Local and National Public Discussion Chargemaster Data Benefits of Cost Transparency Local Efforts at Cost Transparency

(please see attached meeting slides) Discussion included past concerns about price collusion and getting groups together around HIE.

b. Crowdsourcing Price Information, Randy Cox, Pricing Healthcare

Key Areas Covered: No existing resource for consumers on healthcare prices Site seeks to be The Online Marketplace for Healthcare Prices


Discussion Inclusion of private practitioner costs and black market costs for self-insureds. Lay term confusion on cost/price/charge/reimbursement. Calculating costs to the facilities. Medicare chargemasters based on region. Same episodes of care price out differently. Measuring and tracking quality. Number of procedures for comparison. Providers should be included in quality model discussions.

5. Medical Home Workgroups Report and Discussion a. Standards and Payment, Jenifer Lloyd, AUCH

Courtney Pariera Dinkins reported on the workgroup’s activities. Please see minutes here: http://www.healthinsight.org/Internal/docs/upv/medical_home_standards_workgroup_minutes-may_82013.pdf

b. HIE for Care Coordination, Jan Root, UHIN--minutes Jan Root reported on the workgroup’s activities. Please see minutes here: http://www.healthinsight.org/Internal/docs/upv/medical_home_hie_workgoup_minutes-may_212013.pdf

c. REC/Beacon Medical Home Pilot, Wyatt Packer, HealthInsight Janet Tennison, HealthInsight

TransforMED Partnership: The PCMH pilot, with support from TransforMED, is underway with six clinics (Canyon View, Copperview, Jordan Meadows, Tri-City Lindon, Ogden Clinic Grandview, Riverton Family Health). TransforMED came to Utah for a week and accompanied us to visit with each clinic team. HealthInsight facilitators developed the overall deployment strategy for the pilot. Facilitators are meeting with clinics regularly to assist them in PCMH transformation. Clinics are rapidly progressing in meeting goals—developed PDSAs for “early wins,” such as establishing staff huddles and developing referral-tracking mechanisms.

Communications Plan: Our PCMH Communications team is working with a private advertising company to develop a strategy to promote Medical Homes in Utah. The strategy will include a campaign for direct-to-consumer awareness around "What is a medical home and why should I want one." Also, our PCMH team is developing a series of PCMH webinars available to any provider in Utah geared to informing and educating medical staff and providers about the medical home model. The first one is July 18, 2013, from Noon-1 pm, and will provide attendees with a basic overview of PCMH—what it is and why it is important to Utah providers. Please let us know if you’d like to register for the event, and we can send you registration information.

6. Member Opportunities and Upcoming Meetings

Please let Korey Capozza or Sarah Woolsey know of interest in upcoming opportunities and leadership: [email protected]

[email protected] The next meeting will be held September 20, 2013, 4-6 pm.

Utah Partnership for Value Quarterly Meeting

June 20th, 2013

Federal Health Policy -- What’s

Next?

Improved System Performance Relationships

Better Outcomes & Health, and Lower Costs

Sharing Clinical Data

Across Providers &

Care Settings

Using HIT for Care

Coordination

Transparency & Continuous

Feedback Support

Work Flow & Care Process

Redesign

Consumer Engagement

Payment Alignment

Copyright HealthInsight2012 update

Engaged Community

Federal Directions Overview

• Measures, Analytics, and Data Infrastructure

• Payment Reform• CMMI (Systems Redesign

Experimentation)

Measures, Analytics, and Data Infrastructure

• National Quality Forum– Measures Applications Partnership– Consensus Process

• Qualified Entities– Community-based Entities (e.g., UPV)– State government

• Meaningful Use– Speed Up? Or Slow Down?– Real Meaningful Use? Clinically-enriched datasets

• Health Information Exchange: HIE– Community-based? or Market-based?– Beyond exchange: making sense of data

Payment Reform

• Medicare, Medicaid and Insurance Exchanges: Aligning all the federal levers

• Moving from the theoretical to the real world– More talk than action, so far, in ACO world– Many “toes” in the water; few are swimming– Multi-payer efforts ramping up; CMS

encouragement– Need supports to get there– Must reach 70% threshold for sustainability

• Market Types Characteristics Diagram

Payment Reform Recommendations by Market Type

CMMI

• CMMI as agent for innovation and transformation– HENs, million hearts, Partnership for Patients– Innovation Grants– SIMs grants

• CMMI as implementer of ACA policy and programs– ACO programs– Dual-eligibles programs– Taking tests to scale; experiments to programs

• The future of CMMI– Pressure for faster movement– Fiscal pressure– Integration of experiments with programs and policy

State Innovations Model Plan

June 20, 2013

What is the SIM Model Design Program?

• The State Innovation Models Initiative – supports the development of a State Health

Care Innovation Plans– the aim of the plans is to improve health system

performance for residents of participating states – projects must be broad based with a focus on

people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Origin’s of Utah’s State Health Care Innovation (SIM) Plan

• 2011 – First Governor’s Health Summit– Outlined state actions in five key health policy

areas• Health Information• Health Workforce• Payment Reform• Medical Malpractice• Wellness

• 2012 Governor’s Summit Report outlined strategies to address the key areas identified at the 2011 Summit.

How will the Utah Innovation Plan be developed?

• Innovation Planning requires the development of specific and measureable “aims” to create models to test performance improvements in five key areas:

• Health Information• Health Care Workforce• Prevention and Wellness Services• Payment Reform• Quality and Patient Safety

Utah’s SIM Vision Statement

• The Utah State Innovation Plan seeks to improve Utah’s overall health system performance leading to :

»Better health»Better care»Lower costs

SIM GOVERNANCE

SIM Leadership is the Executive Policy Group• Chaired by Lt. Governor Greg Bell• The role of the Executive Policy Group (EPG

is to:– guide the development of the Innovation Plan – refine and approve the aims identified by

by the work groups.

Work Group #1: Health Information

• Identify how innovations in health information technology can support improved access to quality care.

• Co-Chairs– Mark Munger, Chair of the Digital Health

Service Commission– Sharon Donnelly, Member of the Health Data

Committee• Staff: Wu Xu, Center for Health Data

Work Group #2: Health Care Workforce

• Develop specific recommendations for a plan to insure that Utah has the right type and numbers of trained health care professionals to meet the health care needs of Utah citizens.

• Co-Chairs– Vivian Lee, MD – Charles Sorensen, MD (or designee)(invited)

• Staff: Marc Babitz and Iona Thraen, Division of Family Health and Preparedness

Work Group #3: Prevention and Wellness Services

• Develop recommendations for policy changes that will enable Utah citizens to achieve health lifestyles and management of chronic illnesses.

• Co-Chairs:– George Meyers, Zions Bank– Greg Jones, Pharmacy Director, Harmons

Grocery Stores • Staff: Teresa Garrett and Heather Borski,

Division of Disease Control and Prevention

Work Group #4: Payment Reform

• Develop recommendations to move Utah’s health care system to one that pays for value rather than volume:

• Chair: – Jim Dunnigan

• Staff: Norm Thurston, Division of Medicaid and Health Finance

Work Group #5: Quality and Patient Safety

• Innovation approaches to system improvement through increased patient communication and safety which includes a dispute resolution program focusing on patient disputes following unanticipated outcomes.

• Honorary Co-Chair - Lt. Governor Bell– Chair: Ed Clark, M.D.

• Staff: Victoria Wilkins and Elisabeth Guenther

SIM Plan Development Timeline

• Work Groups will be meeting from May –August

• Preliminary recommendations for EPG review will be developed

• Final work group recommendations will be forwarded for review and approval by the EPG before August 31st

SIM Plan Report to Governor Herbert

• The aims identified by the EPG for inclusion in the plan will be included in a report to the Governor.

• The report will be delivered by the EPG to the Governor at the Governor’s Summit on September 26

Healthcare Cost TransparencyLocal and National Discussion

Clare Tobin LenceHealthInsight

Utah Partnership for ValueJune 20, 2013

Public Discussion

• National buzz– Time Magazine article Bitter Pill: Why Medical Bills Are Killing Us

– CMS releases chargemaster data• Downloaded 100,000 times in the first week

– Robert Wood Johnson Foundation Challenge– Senate Finance Committee Hearing

• Local buzz– Salt Lake Tribune article Obama Administration Lifts Veil Off Hospital Pricing

What is chargemaster data?

• A hospital’s price list– Medicare pays much less, paying an amount they consider to be the cost of providing care (including operating overhead, administration, etc.)

– Commercial insurers negotiate certain percentage discounts based on the chargemaster or the Medicare rates – they pay more than Medicare but less than the chargemaster

– Uninsured or under‐insured patients are the most likely to be charged the chargemaster rates

What can be done with these data?

• Limitations– Not actual amount paid– Insured consumers are insulated from cost by co‐pays, co‐insurance, etc.

– Hospitals may set prices higher to offer larger percentage discounts to payers, for example

• Potential– HealthInsight starting to look at this data using adjustment by casemix index

Benefits of Cost Transparency

• Reduced variation in cost – Increased equity of cost burden

• Reduced market power in “the ultimate seller’s market”– More competition and lower prices– Greater consumer empowerment

• Reduced overall system costs– Ability to assess “how and why we are overspending, where the money is going and how to get it back”

– The real problem is that prices are too high

Local Efforts at Cost Transparency

• One of the goals of UPV• All Payer Claims Database

– UPV orthopedic pilot from last year, currently on hold

• Price Point System• IBIS Database• Start‐up called Pricing Healthcare

This Doesn’t ExistAnywhere Else

Online Marketplace for Healthcare PricesOnline Marketplace for Healthcare Prices



Bringing Contributors Together



Bringing Contributors Together

Healthcare Prices in Full View

Pricing Data for All to SeePricing Data for All to See

Medicare rates (by region)

List (charge-master) prices Insurance-negotiated rates (by plan)

Cash payer/uninsured discounts

Comparing facility-level prices by procedure

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