Moving Toward ValueBased Purchasing How Coalitions are Leading Change

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Moving Toward Value-Based PurchasingHow
Coalitions are Leading Change

• September 14, 2006
• Virginia Business Coalition on Health
• Cristie Upshaw Travis
• CEO, Memphis Business Group on Health

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MBGH Overview
Our mission is to facilitate the purchase of
effective and efficient health care for the
Memphis community.

• Celebrated our 20th Anniversary in 2005
• Represent 30 members affiliates with 100,000
  covered lives in Mid-South
• Focus on the health of health care provided to
  employees their families
• Moving toward value-based purchasing, which is a
  function of outcomes, satisfaction, cost
• Accomplish mission by
• Focusing on what the purchaser (employer) CAN do
• Adopting proven national initiatives for local
  implementation
• Collaborating locally to achieve spread enhance
  effectiveness

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What Employers NeedBottom Line

• Effective, efficient, affordable health care for
  our employees their families

But to achieve this, significant change is
needed..
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Why Now? The Cost Crisis
Source Center for Studying Health System Change,
Data Bulletin 21 Revised, September
2001 Kaiser/HRET Survey of Employer-Sponsored
Health Benefits, 2005 Summary of Findings,
September 2005.
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Why Now? The Quality CrisisUnder-use
Source Schuster, M. et al. 1998. The Milbank
Quarterly, Vol.. 76, No. 4

• In 2003, researchers confirmed that patients
  receive recommended care only 54.9 of the time
• McGlynn, EA, The Quality of Healthcare Delivered
  to Adults in the United States, N England J Med
  2003 348 2635-2645.

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The Quality CrisisOver-useMore is not
better..Its just MORE
Health Affairs April 7, 2004
?VA
_at_25 states higher quality, lower spending
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The Quality CrisisMis-use/Waste

• Up to 98,000 deaths/year in hospitals due to
  preventable medical mistakes
• 30 of the healthcare spend due to poor quality
• Results in 487.5 billion nationally, 5.6
  million in Memphis
• For every 1 increase in costs, 300,000 lose
  health insurance nationally

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The Change Model
High
Enabled by IT
Quality ? Costs ê
Clinical Re-engineering by MDs, Hospitals
Suppliers
Value of Health Expenditures

• Key stakeholders to engage
• Hospitals
• Physicians
• Employer Purchasers
• Health Plans
• Consumers

Low
Key Evolutionary Steps
Adapted from the Disclosure Group
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Where Change Can Happen ..
Implementation
Feedback
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Where Change Can Happen ..
Transparency
Implementation
Feedback
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Where Change Can Happen ..
Incentives Rewards
Implementation
Feedback
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Where Change Can Happen ..
Re-engineering
Implementation
Feedback
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Where Change Can Happen ..
The Coalitions Role to create a supportive
environment for individual employer change
Implementation
Feedback
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How Change Can HappenThe Memphis Experience
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Evolution of MBGH-VBP
1987 Quality reporting in group purchase contract
1994 New mission explicit re effectiveness
efficiency

• 1997 Philosophy statement explicit re
• Provider accountability for cost quality
• Needs desires of purchasers users drive the
  system
• Purchaser user right to information

1998 First hospital health plan report cards
2002 Joined The Leapfrog Group implemented
hospital quality safety survey
2003 100 hospital reporting on Leapfrog
progress in Hospitals meeting the leaps
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TransparencyMemphis Hospital Activity

• Active since 2002
• 100 metro hospitals publicly report
• Differentiation in leap progress

• Leapfrog Hospital Survey
• 17 of 19 hospitals reporting
• 3 fully meet ICU physician staffing
• Another 2 have made substantial progress since LF
  implemented
• Will have at least 2 more fully meet by May 2007
• 14 fully meet NQF Safe Practices
• 3 meet two leaps

• Regional Market Change
• Nurtured a culture of transparency
• Created a focus on goal-oriented patient safety
  improvement
• Introduced a collaborative spirit

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TransparencyVirginia Hospital Activity

• Active since 2003
• 51.7 Urban hospitals publicly report
• Differentiation in leap progress

• Leapfrog Hospital Survey
• 30 of 58 Urban (55 of beds) and 6 of 31 Rural
  (27 of beds) hospitals reporting
• 1 fully met CPOE Leap - Computerized Physician
  Order Entry
• 6 fully meet ICU Leap - physician staffing of
  Intensivist
• 16 fully meet NQF (National Quality Forum) Safe
  Practices Leap
• 8 hospitals fully met one or more of the six
  leaps within the High Risk Treatment (Evidence
  Based Hospital Referral)

• Regional Market Change
• Nurtured a culture of transparency
• Created a focus on goal-oriented patient safety
  improvement
• Introduced a collaborative spirit of all
  purchasers (employers) and stakeholders

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TransparencyMemphis Physician Activity

• Conducting baseline evaluation project to
• Provide physicians feedback on whether they would
  qualify for recognition
• Prepare physicians for pay-for-performance
  public reporting
• Collaborating with hospitals, physician
  organization, the CMS quality improvement
  organization, Healthy Memphis Common Table and
  pharmaceutical companies

• Regional Market Change
• Provided a first collaborative physician
  measurement initiative
• Had an Aha moment re electronic medical
  records
• Provided a vehicle for many physicians to start
  analyzing practice patterns

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TransparencyMemphis Health Plan Activity

• Active since 2005
• Collaborate with Healthcare 21
• 6 TN Health Plans Participating in 2006
• Aetna
• BCBS of TN
• Cariten
• CIGNA
• Humana
• United

• Regional Market Change
• Created a direct structured dialogue between
  MBGH health plans
• Resulted in health plan focus on change in
  Memphis Tennessee
• Got plans involved in community collaboration
• Realized that market change requires multi-plan
  collaboration

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TransparencyVirginia Health Plan Activity

• Active since 2006
• 9 Health Plans Participating in 2006
• Anthem HMO and PPO
• CIGNA HMO
• Optima HMO and PPO
• MAMSI HMO
• Kaiser HMO
• CareFirst HMO
• Aetna Mid-Atlantic HMO

• Regional Market Change
• Created a direct structured dialogue between
  VBCH, VBCH members health plans
• Resulted in health plan focus on change in
  Virginia
• Realized that market change requires multi-plan
  collaboration
• GOAL Get plans involved in community
  collaboration and work toward national benchmark

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Incentives RewardsMemphis Hospital Activity

• Active since 2004
• Pilot phase with one system, one employer
• Rolling out to entire community now
• Multi-plan approach to common measure set
  reporting for Memphis hospitals
• Each plan establishes unique IR program with
  their hospital network

The Leapfrog Hospital Reward Program TM

• Regional Market Change
• Gained experience with the mechanics of
  pay-for-performance programs
• Had an aha moment re improvements made due to
  even the promise of performance-based pay
• Realized that health plans can be good partners
  have broad community impact
• Recognized that it is not all about the money
• Increased commitment to transparency

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Re-EngineeringMemphis Activity

• Improving Diabetes Treatment in Memphis
• Engaging Employers around effective disease
  management
• Engaging Providers around practice of
  evidence-based medicine in a team environment
• Engaging both around payment reform

• Regional Market Change
• Created a focus on evidence-based clinical
  administrative decision making
• Indicated there is a willingness to pilot
  clinical interventions measure effectiveness
• Challenged us to consider payment changes
• Pushed us to do more, more quickly

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Building Community SupportMemphis Activity

• Active since 2003
• 150 Community Partners
• Table 1 Reduce the trend in obesity diabetes
  by 2008
• 32 projects in 6 work groups, including MBGH
• Table 2 RWJF Regional Market Project to
  dramatically improve ambulatory care for the
  chronically ill through
• Physician performance measurement public
  reporting
• Physician practice quality improvement
• Consumer engagement

• Regional Market Change
• Spreads health improvement, quality
  improvement, consumer engagement throughout
  Memphis
• Reaches people where they live schools, faith
  organizations, social agencies, neighborhoods,
  employers
• Builds a collaborative spirit

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Memphis Regional Market Project

• To dramatically improve ambulatory care for the
  chronically ill
• 4 pilot communities Memphis, Detroit,
  Minneapolis, Seattle
• Up to 6 additional communities will be added
• Aligning 3 key drivers to see more faster
  improvement
• Consumer engagement
• Performance measurement/reporting
• Practice Improvement

• Regional Market Change
• Actively engages physician leaders, both formal
  informal
• Takes advantage of ground broken by NCQA project
• Elevates HMCT consumer engagement strategy
  activities
• Focuses on specific quality improvement
  objectives
• Furthers collaborative spirit

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Regional Market Activity At a Glance
Transparency
X primary o secondary
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Audience

• Q A
• Whats in it for me?
• Next steps

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Thank You

• Cristie Upshaw Travis
• CEO
• Memphis Business Group on Health
• 5050 Poplar Avenue, Suite 509
• Memphis, TN 38157
• [phone], ext. 224
• ctravis_at_memphisbusinessgroup.org