the commonwealth fund why not the best? how states can lead us toward a high performance health...
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THE COMMONWEALTH
FUND
Why Not the Best? Why Not the Best? How States Can Lead Us Toward a High How States Can Lead Us Toward a High
Performance Health SystemPerformance Health System
Karen DavisPresident, The Commonwealth Fund
National Academy for State Health PolicyAnnual Policy Conference
October 16, 2006
2
THE COMMONWEALTH
FUND
The Commonwealth FundThe Commonwealth Fund Commission on a High Performance Health Commission on a High Performance Health
SystemSystem
Objective:
• Move the U.S. toward a higher-performing health care system that achieves better access, improved quality, and greater efficiency, with particular focus on the most vulnerable due to income, gaps in insurance coverage, race/ethnicity, health, or age
Commission Members, including James J. Mongan, MD, Chairman; Alan Weil, JD; and others
3
THE COMMONWEALTH
FUND
Vision:Vision:What Constitutes a High What Constitutes a High
Performance Health System?Performance Health System?
4
THE COMMONWEALTH
FUND
The Commonwealth FundThe Commonwealth Fund Commission on a High Performance Health System Commission on a High Performance Health System
EFFICIENT CARE
HIGH QUALITY CARE
EQUITY
ACCESS FOR ALL
LONG,HEALTHY, ANDPRODUCTIVE
LIVES
SYSTEM INNOVATION AND IMPROVEMENT
5
THE COMMONWEALTH
FUND
Achieving a High Performance Health Achieving a High Performance Health System Requires:System Requires:
• Committing to a clear national strategy and establishing a process to implement and refine that strategy
• Delivering care through models that emphasize coordination and integration
• Establishing and tracking metrics for health outcomes, quality of care, access, disparities, and efficiency
6
THE COMMONWEALTH
FUND
State Performance:State Performance:Where We Are Now and Where We Are Now and Achievable BenchmarksAchievable Benchmarks
7
Mortality Amenable to Health CareMortality Amenable to Health Care
97 97 99106 107 109 109
115 115
129 130 132
7584
88 88 8881
92
0
50
100
150
* Countries’ age-standardized death rates, ages 0–74; includes ischemic heart disease.See Technical Appendix for list of conditions considered amenable to health care in the analysis.Data: International estimates—World Health Organization, WHO mortality database (Nolte and McKee 2003);State estimates—K. Hempstead, Rutgers University using Nolte and McKee methodology.
Deaths per 100,000 population*
110
8490
103
119
134
International Variation, 1998 State Variation, 2002
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
LONG, HEALTHY & PRODUCTIVE LIVES
8
7.0
5.3
6.0
7.1
8.1
9.1
Infant Mortality RateInfant Mortality Rate
* 2001.Data: International estimates—OECD Health Data 2005;State estimates—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2005a).
2.2
3.0 3.03.3 3.5
4.1 4.1 4.1 4.2 4.2 4.4 4.4 4.5 4.55.0 5.0 5.0 5.0 5.1 5.2 5.4 5.6
7.0
0
5
10
Infant deaths per 1,000 live births
International variation, 2002 State variation, 2002
LONG, HEALTHY & PRODUCTIVE LIVES
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
9
States Vary In Quality of CareStates Vary In Quality of Care
First
Third
Fourth
Source: S.F. Jencks, E.D. Huff, and T. Cuerdon, “Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998–1999 to 2000–2001,” Journal of the American Medical Association 289, no. 3 (Jan. 15, 2003): 305–312.
Second
WA
OR
ID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SC
TNNC
KY
FL
VA
OH
MI
WV
PA
NY
AK
MD
MEVT
NH
MA
RI
CT
DE
DCCO
GAMS
OK
NJ
SD
Quartile Rank
Note: State ranking based on 22 Medicare performance measures.
2000–20012000–2001
10
Percent of children (ages <18) who received BOTH a medical and dental preventive care visit in past year
Preventive Care Visits for Children, by Top and Bottom States, Preventive Care Visits for Children, by Top and Bottom States, Race/Ethnicity, Family Income, and InsuranceRace/Ethnicity, Family Income, and Insurance
35
63
70
58
62
48
73
59
48
49
0 50 100
Uninsured
Private insurance
<100% of poverty
400% + of poverty
Hispanic
Black
White
Bottom 10% states
Top 10% states
U.S. average
Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource Center for Child and Adolescent Health database at http://www.nschdata.org).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
QUALITY: THE RIGHT CARE
11
89
81 7977
69
77
0
50
100
White Black Hispanic
400%+ of poverty <100% of poverty
Immunizations for Young Children, by Top and Bottom States, Immunizations for Young Children, by Top and Bottom States, Race/Ethnicity, and Family IncomeRace/Ethnicity, and Family Income
75
87
79
83
89
79
77
77
73
71
0 50 100
<100% of poverty
400%+ of poverty
AI/AN
Asian/PI
Hispanic
Black
White
Bottom 10% states
Top 10% states
U.S. average
* Recommended vaccines include: 4 doses of diphtheria-tetanus-pertussis (DTP), 3+ doses of polio, 1+ dose of measles-mumps-rubella, 3+doses of Haemophilus influenzae type B, and 3+ doses of hepatitis B vaccine.PI = Pacific Islander; AI/AN = American Indian or Alaskan Native. Data: National Immunization Survey (AHRQ 2005a, 2005b). Data is from 2003.
Percent of children (ages 19–35 months) who received all recommended doses of five key vaccines*
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
QUALITY: THE RIGHT CARE
12
13
89
1618
19
1415
2223
0
15
30
High-risk residents
Pressure Sores Among High-Risk and Short-Stay Residents in Pressure Sores Among High-Risk and Short-Stay Residents in Nursing Facilities Nursing Facilities
Percent of nursing home residents with pressure sores
Data: Nursing Home Minimum Data Set (AHRQ 2005a).
Short-stay residents
High-risk residents
Short-stay residents
White 13% 21%
Black 17 26
Hispanic 15 25
Asian 12 22
AI/AN 17 23
State distribution, 2004 By race/ethnicity, 2003
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
QUALITY: SAFE CARE
13
Percent of Adults Ages 18–64 Uninsured by StatePercent of Adults Ages 18–64 Uninsured by State
Data: Two-year averages 1999–2000 and 2004–2005 from the Census Bureau’s March 2000, 2001 and 2005, 2006 Current Population Surveys. Estimates by the Employee Benefit Research Institute.
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
MD
MEVTNH
MARI
CT
DE
DC
HI
CO
GAMS
OK
NJ
SD
WA
ORID
MT ND
WY
NV
CAUT
AZ NM
KS
NE
MN
MO
WI
TX
IA
ILIN
AR
LA
AL
SCTN
NCKY
FL
VA
OH
MI
WV
PA
NY
AK
ME
DE
DC
HI
CO
GAMS
OK
NJ
SD
19%–22.9%
Less than 14%
14%–18.9%
23% or more
1999–2000 2004–2005
MA
RI
CT
VTNH
MD
NH
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
ACCESS: UNIVERSAL PARTICIPATION
14States with Highest and LowestStates with Highest and LowestAdjusted Health Plan PremiumsAdjusted Health Plan Premiums
Employee-only adjusted premiumsEmployee-only adjusted premiums
3,582
2,9812,717
2,8332,9543,203
3,5443,621
4,001
0
1,000
2,000
3,000
4,000
5,000
Wyoming Maine Wiscons in Wes t
V irginia
U.S .
average
A labama Oregon C ali fornia Hawaii
Adapted from J. Gabel, R. McDevitt, L. Gandolfo et al., “Generosity and Adjusted Premiums in Job-BasedInsurance: Hawaii Is Up, Wyoming Is Down,” Health Affairs, May/June 2006 25(3):832–43. Data is from 2002.
Dollars
15
Ambulatory Care Sensitive (Potentially Preventable)Ambulatory Care Sensitive (Potentially Preventable)Hospital Admissions for Select ConditionsHospital Admissions for Select Conditions
498
241188
258
13774
631
299 297
0
100
200
300
400
500
600
700
Congestive heart failure Diabetes Pediatric asthma
National average Top 10% states Bottom 10% states
Adjusted rate per 100,000 population
* Combines four diabetes admission measures: uncontrolled, short-term complications, long-term complications, and lower extremity amputations. Data: National estimates—Healthcare Cost and Utilization Project, Nationwide Inpatient Sample; State estimates—State Inpatient Databases; not all states participate in HCUP (AHRQ 2005a). Data is from 2002.
*
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
EFFICIENCY
16
Hospital Admission RatesHospital Admission RatesAmong Nursing Home Residents, by StateAmong Nursing Home Residents, by State
16
8 9
12
1921
0
10
20
30
M edian B es t s tate 10th %ile 25th %ile 75th %ile 90th %ile
Percent
16
Data: V. Mor, Brown University analysis of Medicare enrollment data and Part A claims data for all Medicare beneficiaries who entered a nursing home and had a Minimum Data Set assessment during 2000.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
QUALITY: COORDINATED CARE
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* Child had 1+ preventive visit in past year; access to specialty care; personal doctor/nurse who usually/always spent enough time and communicated clearly, provided telephone advice or urgent care and followed up after the child’s specialty care visits.Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource Center for Child and Adolescent Health database at http://www.nschdata.org).
23
53
58
39
53
36
60
46
30
31
0 50 100
Uninsured
Private insurance
<100% of poverty
400% + of poverty
Hispanic
Black
White
Bottom 10% states
Top 10% states
U.S. average
Children with a Medical Home, by Top and Bottom States, Children with a Medical Home, by Top and Bottom States, Race/Ethnicity, Family Income, and InsuranceRace/Ethnicity, Family Income, and Insurance
Percent of children who have a personal doctor or nurse and receive care that is accessible, comprehensive, culturally sensitive, and coordinated*
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
QUALITY: COORDINATED CARE
18
Diabetes: Receipt of All Three Recommended Services,Diabetes: Receipt of All Three Recommended Services,by Race/Ethnicity, Family Income, Insurance, and Residenceby Race/Ethnicity, Family Income, Insurance, and Residence
45
55
54
46
50
61
55
53
54
47
24
38
0 40 80
Rural
Urban
Uninsured
Private
<100% of poverty
100% –199% of poverty
200% –399% of poverty
400% + of poverty
Hispanic
Black
White
Total
Percent of diabetics (ages 18+) who received HbA1c test, retinal exam, and foot exam in past year
* Insurance for people ages 18–64.** Urban refers to metropolitan area >1 million inhabitants; Rural refers to noncore area <10,000 inhabitants.Data: Medical Expenditure Panel Survey (AHRQ 2005a). Data is from 2002.
*
**
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
EQUITY: THE RIGHT CARE
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• Environmental scan of state-level policies that promote or impede high performance
– Qualitative companion to Commission's quantitative National Scorecard
– Mechanism for identifying innovative states for future Commission site visits
– Four Commission members serve on advisory committee
• Products to date– Data information collection plan completed– Survey drafted -- will probe broadly the policy
domains of coverage, quality/efficiency/value, and infrastructure supports
– Data collection to begin September 2006 – Health policy community notified at Academy Health
June 25, 2006
State Health Policies Aimed at Promoting State Health Policies Aimed at Promoting Excellent Systems (SHAPES)Excellent Systems (SHAPES)
Alan Weil,NASHP
Catherine Hess,
NASHP
20Keys to Transforming the U.S. Health Care Keys to Transforming the U.S. Health Care
SystemSystem1. Guarantee affordable health insurance coverage2. Implement major quality and safety improvements3. Work toward a more organized delivery system that
emphasizes patient-centered primary and preventive care 4. Increase transparency and reporting on quality and costs5. Expand the use of interoperable information technology6. Reward performance for quality and efficiency 7. Encourage public-private collaboration to achieve
simplification, more effective change
21
THE COMMONWEALTH
FUND
Guarantee Affordable Health Insurance Guarantee Affordable Health Insurance CoverageCoverage
1. Guarantee Affordable Health Insurance Coverage
22
THE COMMONWEALTH
FUND
Massachusetts Health PlanMassachusetts Health Plan
• MassHealth expansion for children up to 300% FPL; adults up to 100% poverty
• Individual mandate, with affordability provision; subsidies between 100% and 300% of poverty
• Employer mandatory offer, employee mandatory take-up
• Employer assessment ($295 if employer doesn’t provide health insurance)
• Connector to organize affordable insurance offerings through a group pool
Source: John Holahan, “The Basics of Massachusetts Health Reform,” Presentation to United Hospital Fund, April 2006.
23
THE COMMONWEALTH
FUND
Retaining and Expanding Employer Retaining and Expanding Employer Participation: Maine’s Dirigo HealthParticipation: Maine’s Dirigo Health
• New insurance product; $1250 deductible; sliding scale deductibles and premiums below 300% poverty
• Employers pay fee covering 60% of worker premium
• Began Jan 2005; Enrollment 14,700 as of 4/30/06
* After discount and employer payment (for illustrative purposes only).
300600
8881188
1488
1250
0
1000
750
500
250
0$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
MaineCare <150% <200% <250% <300% >300%
Deductible amountEmployee share of annual premium
Annual expenditures on deductible and premium
$550
$0
$1,100
$1,638
$2,188
$2,738
24
THE COMMONWEALTH
FUND
Vermont Health Care Affordability Act Vermont Health Care Affordability Act Enacted May 2006Enacted May 2006
• Coverage expansion– Catamount Health Plans
• Targets those w/o access to work-based coverage • Premium subsidies based on sliding scale up to 300% FPL • Comprehensive benefit package including primary, chronic,
acute care & other services • No patient cost-sharing for preventive or chronic care• Builds upon Wagner’s Chronic Care Model
• Financing– Employer assessment– Increase in tobacco taxes– Federal matching funds from Medicaid waiver
• Quality improvement initiatives– Public-private collaboration– Collection of health care data from all payers
– Rules to publicly report price & quality information
25
THE COMMONWEALTH
FUND
Illinois All-KidsIllinois All-Kids
• Effective July 1, 2006• Available to any child uninsured for 6 months or more• Cost to family determined on a sliding scale• Linked to other public programs - FamilyCare & KidCare • Federal and state funds
– Children <200% of FPL covered by federal funds– Children 200%+ of FPL funded by state savings from
Medicaid Primary Care Case Management Program • All-Kids Training Tour
– Public outreach program to highlight new and expanded healthcare programs
26
THE COMMONWEALTH
FUND
New Jersey Raises Age of Dependent Status New Jersey Raises Age of Dependent Status for Health Insurancefor Health Insurance
• As of 5/2006, NJ requires all state insurers to raise dependent age limit to 30
– Highest age limit in country – Covers uninsured, unmarried
adults with no dependents who are NJ residents or FT students
– Premium capped at 102% of amount paid for dependent’s coverage prior to aging out
• 200,000 young adults expected to receive coverage under the law
11.2 11.812.7 13.4 13.7
0
5
10
15
2000 2001 2002 2003 2004
Source: S.R. Collins, C. Schoen, J.L. Kriss, M.M. Doty, B. Mahato, “Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help,” Commonwealth Fund issue brief, May 2006. (Analysis of the March 2001–2005 Current Population Surveys)
Millions uninsured, adults ages 19–29
27
THE COMMONWEALTH
FUND
Implement Major Quality and Safety Implement Major Quality and Safety ImprovementsImprovements
2. Implement Major Quality and Safety Improvements
1. Guarantee Affordable Health Insurance Coverage
28
THE COMMONWEALTH
FUND
Rhode Island:Rhode Island:Five-Point StrategyFive-Point Strategy
1. Creating affordable plans for small businesses & individuals2. Increasing wellness programs 3. Investing in health care technology 4. Developing centers of excellence 5. Leveraging the state’s purchasing power
• RI Quality Institute – Non-profit coalition -- hospitals, providers, insurers, consumers, business,
academia & government– Partnered with “SureScripts” to implement state-wide electronic
connectivity between all retail pharmacies and prescribers in the state• Health Information Exchange Initiative
– Statewide public/private effort– AHRQ contract 5 yr/ $5M– Connecting information from physicians, hospitals, labs, imaging & other
community providers
29
THE COMMONWEALTH
FUND
Work Toward a More Organized Delivery System Work Toward a More Organized Delivery System that Emphasizes Patient-Centered Primary and that Emphasizes Patient-Centered Primary and
Preventive CarePreventive Care3. Emphasize Patient-
Centered Primary, and Preventive
Care
1. Guarantee Affordable Health Insurance Coverage
2. Implement Major Quality and Safety Improvements
30
THE COMMONWEALTH
FUND
Helping Patients Become Informed and Helping Patients Become Informed and Active Partners in Their CareActive Partners in Their Care
Patient-centered care:
• www.howsyourhealth.org
• PCDC – advanced access collaborative
• Shared decision-making
• Resident-centered care in nursing homes
• Family-centered care in Healthy Steps & ABCD
31
Resident-Centered Nursing Home Care for Resident-Centered Nursing Home Care for Frail EldersFrail Elders
• Green House in Tupelo, Mississippi, featured in New York Times and AARP Bulletin; Commonwealth supported evaluation in progress
• Ohio project finds high correlation between resident and family satisfaction and nursing home clinical quality
• New York state – analysis of use of hospitals by nursing home residents
32
Utah’s Primary Care Network Utah’s Primary Care Network Section 1115 Medicaid Waiver Section 1115 Medicaid Waiver
• Targets uninsured adults (19–54) with family income less than 150% FPL
• Provides primary care and preventive care services– Physician office visits– Immunizations– Emergency care– Lab, X-ray, medical equipment & supplies– Basic dental care– Hearing & vision screening– Prescription drugs
• Hospitals provide $10 million in charity care for PCN participants
33
State Initiatives Investing in Children’s Preventive State Initiatives Investing in Children’s Preventive CareCare
MN
CA
IA
ILUT
WA
NC
NY
ABCD I States (4) Improvement Partnership States (5)
BCAP States (10))ABCD II States (5)
AZ
GA
FL
SC
DC
WI
ARNM
MO
TN
MN
NE
TX
OK
NV
VT
RI
NC Model States(5)
MI
CO
PHDS SLN States (4)
OH
MI
LA
VA
34
THE COMMONWEALTH
FUND
Increase Transparency and Reporting on Increase Transparency and Reporting on Quality and CostsQuality and Costs
4. Increase Transparency and Reporting on Quality and Costs
3. Emphasize Primary,
Preventive, and Patient-Centered
Care2. Implement Major Quality and Safety Improvements
1. Guarantee Affordable Health Insurance Coverage
35
THE COMMONWEALTH
FUND
WisconsinWisconsin
• Wisconsin Collaborative for Healthcare Quality – Voluntary consortium formed in 2003 -- physician groups, hospitals,
health plans, employers & labor
– Develops & publicly reports comparative performance information on physician practices, hospitals & health plans
– Includes measures assessing ambulatory care, IT capacity, patient satisfaction & access
• Wisconsin Health Information Organization– Coalition formed in 2005 to create a centralized health data
repository based on voluntary sharing of private health insurance claims, including pharmacy & laboratory data
– Wisconsin Dept of Health & Family Services and Dept of Employee Trust Funds will add data on costs of publicly paid health care through Medicaid
36
THE COMMONWEALTH
FUND
Expand the Use of Interoperable Information Expand the Use of Interoperable Information TechnologyTechnology
5. Expand the Use of Interoperable Information Technology
4. Increase Transparency and Reporting on Quality and Costs
3. Emphasize Primary,
Preventive, and Patient-Centered
Care2. Implement Major Quality and Safety Improvements
1. Guarantee Affordable Health Insurance Coverage
37
THE COMMONWEALTH
FUND
Value of Electronic Medical Records Value of Electronic Medical Records and Information Systemsand Information Systems
• Reduce duplicate tests• Reduce hospital admissions by
having information accessible to ER physicians
• Improve patient care• Decision support for physicians
and patients• Facilitate “referrals”, secure
transfer of responsibility• Reduce medical errors• Better management of chronic
conditions and care coordination– Registries– Performance information– Facilitated by interoperability
38
THE COMMONWEALTH
FUND
Information Exchange:Information Exchange:States Leading the WayStates Leading the Way
• Rhode Island Quality Institute Information Exchange – Provide access to patient data (as permitted) to all providers initially through secure
web-based portal – future integration into EHRs– Create the ability to aggregate and utilize data for public health purposes (e.g.,
population-based analysis, biosurveillance)
• MidSouth e-health Alliance: Memphis, TN– State-wide data exchange with initial focus on EDs
• Utah Health Information Network– Secure exchange of health care data using standardized transactions through a single
portal
• New York State Health Information Technology (HIT) initiative– Under the Health Care Efficiency and Affordability Law for New Yorkers, $52.9 million
awarded to 26 regional health networks to expand technology in NY health care system and support clinical data exchange; Commonwealth Fund-supported evaluation underway
Source: Evolution of State Health Information Exchange, AHRQ, Publication No. 06-0057, January 2006.
39
THE COMMONWEALTH
FUND
Reward Performance for Quality and Reward Performance for Quality and EfficiencyEfficiency
6. Reward Performance for Quality and Efficiency
4. Increase Transparency and Reporting on Quality and Costs
3. Emphasize Primary,
Preventive, and Patient-Centered
Care2. Implement Major Quality and Safety Improvements
1. Guarantee Affordable Health Insurance Coverage
5. Expand the Use of Interoperable Information Technology
40
THE COMMONWEALTH
FUND
Building Quality Into RIte CareBuilding Quality Into RIte CareHigher Quality and Improved Cost TrendsHigher Quality and Improved Cost Trends
• Quality targets and $ incentives
• Improved access, medical home
– One third reduction in hospital and ER
– Tripled primary care doctors
– Doubled clinic visits
• Significant improvements in prenatal care, birth spacing, lead paint, infant mortality, preventive care
Source: Silow-Carroll, Building Quality into RIte Care, Commonwealth Fund, 2003. Tricia Leddy, Outcome Update, Presentation at Princeton Conference, May 20, 2005.
Cumulative Health Insurance Cost Trend
Comparison
0
20
40
60
80
100
120
140
160
RI Commercial Trend
RIte Care Trend
Percent
41
THE COMMONWEALTH
FUND
New York State Medicaid New York State Medicaid Pay-for-PerformancePay-for-Performance
• 1997 — NYS began transition to mandatory statewide Medicaid managed care. Currently > 2.5 million enrollees (including Family Health Plus)
• 2002 — NYS DOH incorporated quality incentive into computation of Medicaid managed care capitation rates– Incentive tied to performance on 10 quality of care measures and
5 consumer satisfaction measures– Initial incentive up to an additional 1% of monthly premium; as of
April 2005, maximum incentive increased to 3%
• 2005 — incentive payments totaled $40 million
• Commonwealth Fund supporting Dr. Robert Berenson (Urban Institute) to evaluate impact of quality incentive program — qualitative analysis (interviews/site visits of participating plans) and quantitative analysis of measures
42
THE COMMONWEALTH
FUND
Assisting States in the Design of Medicaid Assisting States in the Design of Medicaid Pay-for-Performance ProgramsPay-for-Performance Programs
CHCS/Stephen Somers, Jul 06–Jun 08CHCS/Stephen Somers, Jul 06–Jun 08
OverviewOverview
StatusStatus
• Develop Pay-for-Performance Purchasing Institute Technical Assistance Series for 6 state Medicaid teams
– Two in-person training institutes– Follow-up technical assistance
• Conduct environmental scan on P4P lessons learned in the public/private sectors focusing on the provider level
– Draft report expected Sep 2006
• Synthesis of lessons learned and best practices– Draft report expected May 2008
• 1st training institute scheduled for October 12–13, 2006• State Participants: Arizona, Connecticut, Idaho, Massachusetts,
Missouri, Ohio, & West Virginia
43
THE COMMONWEALTH
FUND
Encourage Public-Private CollaborationEncourage Public-Private Collaborationto Achieve Simplification, to Achieve Simplification,
More Effective ChangeMore Effective Change
7. Encourage Public-Private Collaboration to Achieve Simplification, More Effective Change
4. Increase Transparency and Reporting on Quality and Costs
3. Emphasize Primary,
Preventive, and Patient-Centered
Care2. Implement Major Quality and Safety Improvements
1. Guarantee Affordable Health Insurance Coverage
6. Reward Performance for Quality and Efficiency
5. Expand the Use of Interoperable Information Technology
44
THE COMMONWEALTH
FUND
Minnesota Smart-Buy Minnesota Smart-Buy AllianceAlliance
• Initiated in 2004 – alliance between state, private businesses & labor groups
• Purchase health insurance for 70% of state residents ~3.5 million people
• Pool purchasing power to drive value in health care delivery system
• Set uniform performance standards, cost/quality reporting requirements & technology demands
• Four key strategies:1. Reward or require “best in class” certification2. Adopt and utilize uniform measures of quality and
results3. Empower consumers with easy access to
information4. Require use of information technology
45
THE COMMONWEALTH
FUND
Washington State Washington State Puget Sound Health AlliancePuget Sound Health Alliance
• Founded in 2004 as independent non-profit organization
• Five-county partnership among employers, physicians, hospitals, consumers, health plans and others
• Multi-prong approach to improving care and “systemness”
– Developing evidence-based guidelines for physicians, hospitals and other health care professionals
– Designing tools for consumers and patients to support decision making & self management of chronic conditions
– Producing regional reports on quality, cost & value to be made publicly available by end of 2006
– Promoting data sharing across health plans & providers with the goal of a shared data repository
– Building regional infrastructure to support and sustain QI, including workforce development & training
46
THE COMMONWEALTH
FUND
West Virginia Small Business PlanWest Virginia Small Business PlanLeveraging Purchasing PowerLeveraging Purchasing Power
• West Virginia (WV) Small Business Plan– Enacted March 2004– Partnership between WV Public Employees
Insurance Agency (PEIA) & private market insurers
– Small business insurers pay providers at same rates negotiated by PEIA
47
Moving ForwardMoving Forward
48
THE COMMONWEALTH
FUND
What States Can Do to Promote a High Performance What States Can Do to Promote a High Performance Health System: Health System:
Strategies to Expand CoverageStrategies to Expand Coverage
• Expand public programs• Provide financial assistance to workers and employers
to afford coverage• Promote partnerships with employers• Pool purchasing power and promote new benefit
designs to make coverage more affordable• Mandate that employers offer, and/or individuals
purchase, coverage; subsidize those with low incomes• Develop reinsurance programs to make coverage
more affordable in the small group and individual markets
49
THE COMMONWEALTH
FUND
What States Can Do to Promote a High Performance What States Can Do to Promote a High Performance Health System: Health System:
Strategies to Improve Quality and EfficiencyStrategies to Improve Quality and Efficiency
• Promote evidence-based medicine• Promote effective chronic care management• Promote transitional care post-hospital discharge• Encourage data transparency and reporting on performance• Promote/practice value-based purchasing• Promote the use of health information technology• Promote wellness and healthy living• Encourage selection of medical home and improved access to
primary care and preventive services• Simplify and streamline public program eligibility and re-
determination
50
THE COMMONWEALTH
FUND
Continue to Lead the Way to Continue to Lead the Way to Achieving a High Performance Achieving a High Performance
Health System!Health System!
51
THE COMMONWEALTH
FUND
Selected Commonwealth Fund PublicationsSelected Commonwealth Fund Publications
• The Commonwealth Fund Commission on a High Performance Health System, Framework for a High Performance Health System for the United States, The Commonwealth Fund, August 2006
• C. Schoen et al., “U.S. Health System Performance: A National Scorecard,” Health Affairs Web Exclusive, September 20, 2006.
• S. Silow-Carroll and F. Pervez, States in Action: A Quarterly Look at Innovations in Health Policy, The Commonwealth Fund, Summer 2006, Vol. 5.
• Forthcoming –– State Scorecard on Health System Performance
52
THE COMMONWEALTH
FUND
Thank You!Thank You!Stephen C. Schoenbaum, M.D., Executive Vice President and Executive Director, Commission on a High Performance Health System
Anne Gauthier, Senior Policy Director, Commission on a High Performance Health System
Karen B. Adams, Program Officer, State Innovations Program
Alyssa L. Holmgren, Research Associate
Cathy Schoen, Senior Vice President for Research and Evaluation
Sign up for States in Action newsletter and forward to colleagues – www.cmwf.org
Jennifer L. Kriss, Program Assistant