research-driven solutions for innovative state policy
DESCRIPTION
Dr. Joe Thompson, Surgeon General of Arkansas, used this presentation at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality."TRANSCRIPT
Health Services Research:
Helps Us Get Our Money’s Worth
What works?
For whom?
Under what circumstances?
At what cost?
Research-Driven Solutions for
Innovative State Policy
Joseph W. Thompson, MD, MPH
Surgeon General, State of Arkansas September 27, 2012
Health Care’s Iron Triangle
Access Cost
Quality
4
Arkansas Health System Improvement
Agency Organizational Structure
State Leadership
State Leadership
Implementation
& Coordination
Implementation
Workgroup
Participation
Steering Group: DHS, ADH, BCBS,
QualChoice, United, ACHI
AID (Exchange)
DHS (Mcd
eligibility &
expansion) EBD
UAMS ADH & ACHI
Higher Ed (2- & 4 yr)
AFMC UAMS
DIS Medicaid
Governor Mike Beebe
Payment & Quality Improvement Mr. John Selig
Insurance Exchange
Commissioner Jay Bradford
Workforce Chancellor Dan Rahn & Dr. Paul Halverson
Health Information
Technology Mr. Ray Scott
Governor’s Policy Staff & Dr. Joe Thompson
ACHI
National and Arkansas Childhood Obesity Trends
NHANES data sources: Ogden et al. Prevalence of Obesity Among Children and Adolescents: United States,
Trends 19631965 Through 20072008. NCHS Health E-Stat, June 2010. Available at
http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Accessed 04/18/11.
Arkansas data source: Arkansas Center for Health Improvement, Little Rock, AR, September 2010.
0
5
10
15
20
25
Pe
rce
nt O
be
se
US 6–11 yr
US 12–19 yr
AR grades K, 2, 4, 6
AR grades 8 & 10
1963-65 1971-74 1988-94 01-02
1966-70 1976-80 99-00 03-04 05-06
07-08
20
21
22
23
2004 2005 2006 2007 2008 2009 2010
Per
cen
t O
bes
e
Arkansas Assessments
Grades 8 & 10Grades K, 2, 4, 6
Preliminary working draft; subject to change
6
Our vision to improve care for Arkansas is a comprehensive, patient-
centered delivery system…
Episode-based care
▪ Acute, procedures or
defined conditions
How care is
delivered
Population-based care
▪ Medical homes
▪ Health homes
Objectives
▪ Improve the health of the population
▪ Enhance the patient experience of care
▪ Enable patients to take an active role in their care
Four aspects
of broader
program
▪ Results-based payment and reporting
▪ Health care workforce development
▪ Health information technology (HIT) adoption
▪ Expanded access for health care services
For
patients
For
providers
▪ Reward providers for high quality, efficient care
▪ Reduce or control the cost of care
Preliminary working draft; subject to change
7
Payers recognize the value of working together to improve our system, with
close involvement from other stakeholders…
Coordinated multi-payer leadership…
▪ Creates consistent incentives and standardized reporting rules and tools
▪ Enables change in practice patterns as program applies to many patients
▪ Generates enough scale to justify investments in new infrastructure and operational models
▪ Helps motivate patients to play a larger role in their health and health care
1 Center for Medicare and Medicaid Services
Spending Breakdown for CHF 30-day Episodes with and without a Readmission
8
Number ofEpisodes
$5,936
$0
$2,510
$288 $337 $368
Index Readmits PAC OPD Physician Other
$6,305
$10,569
$3,975
$379 $1,453 $832
Index Readmits PAC OPD Physician Other
% Total Costs
63% 0% 27% 3% 4% 4%
% Total Costs
27% 45% 17% 2% 6% 4%
24%
76%
N=4,992 CHF
episodes
Source: Medicare FFS claims data, 2010
Avg Total Episode Cost = $23,511
Avg Total Episode Cost = $9,440
Preliminary working draft; subject to change
9 9
$12,000
10,000
8,000
6,000
4,000
2,000
0
$120
100
80
60
40
20
0
Case for change: variation in costs by episode are substantial even after
adjusting for risk
Total average cost per episode post-risk adjustment by Principal Accountable Provider, 2008-2010
Total hip replacement
Pregnancy2
ADHD3
Simple upper respiratory infection1
Total episodes
Median cost
10% percentile
90% percentile
~30,000
$3,608
$3,208
$4,071
Total episodes
Median cost
10% percentile
90% percentile
~20,000
$1,641
$1,073
$7,046
Total episodes
Median cost
10% percentile
90% percentile
~80,000
$57
$44
$76 4,000
500
3,000
$5,000
2,500
0
Total episodes
Median cost
10% percentile
90% percentile
1 Episode costs for children less than 10 risk-adjusted by a historically-derived multiplier.
2 Individual episode costs risk-adjusted for clinical drivers of severity based upon historically-derived multipliers.
3 Eligible defined as ADHD without comorbidities between ages 6 and 17.
SOURCE: Arkansas Medicaid claims data; Team analysis
0
$20,000
15,000
10,000
5,000
Total episodes
Median cost
10% percentile
90% percentile
140
$7,953
$5,867
$12,814
Preliminary working draft; subject to change
10.5
▪ Surgical procedure plus all
related claims from 30 days
prior to procedure to 90 days
after
▪ Pregnancy-related claims for
mother from 40 weeks before
to 60 days after delivery
▪ Excludes neonatal care
▪ 21-day window beginning with
initial consultation
▪ Excludes inpatient costs and
surgical procedures
▪ Hospital admission
▪ Care within 30 days of discharge
▪ 12-month episode
▪ Includes all ADHD services +
pharmacy costs (with exception of
initial assessment)
Principle Accountable Provider
Wave 1 episodes
Orthopedic surgeon
Delivering provider
First provider to diagnose
patient in-person
Admitting hospital
Depends care pathway
• Physician
• Licensed clinical
psychologist, and/or
• RSPMI provider
Total Hip/ Knee
replacement
ADHD
Acute/post-
acute heart
failure
Ambulatory URI
Perinatal
(non-NICU1)
Preliminary working draft; subject to change
What’s next
• Stents
• Pacemakers
Hip/ knee
replacements
Perinatal • Include NICU
Ambulatory URI • Urinary tract infections
• Ear infections
Acute / post-acute
CHF
• Pneumonia
• Myocardial infarction
ADHD • Depression
Developmental
disabilities
• Long-term care
• Severe and persistent mental
illness
Examples
