Community Leaders Meeting on Health Care

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• Community Leaders Meeting on Health Care
• July 13, 2009

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Fact or Fantasy?

• West Michigan is on the leading edge but there
  is no documented evaluation of community-wide,
  multi-faceted initiatives that put it all
  together
• But, heres a sample of what we do know
• Impacts of implementing parts of what we want to
  do

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Health Systems Evidence

• Using quality management methods (standardized
  processes based upon evidence-based medicine
  Toyota Production System to eliminate waste and
  build in quality)
• Virginia Mason Medical Center in Seattle
• For treatment of back pain
• Wait times for appt from 31 days to 1 day, now
  only 6 of employees miss work
• Per case cost to employer from 2,353 to 845
  modest increase in payment for physical therapy
• Conclusion by Virginia Mason 50 of health care
  costs are avoidable

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Employer Evidence

• Using comprehensive total health strategy to
  manage health spending including
• Evidence based benefit design transparency of
  performance metrics and benefit tiering of
  providers
• Care management embedded in the provider supply
  chain
• Building culture of healtheducation, incentives,
  information
• Moving to paying for outcomes, not units of
  service
• Hanneford, an international grocery store chain,
  over several years
• Averaging near 0 trend for past several years
• 5 decrease in per capita health spending for
  2007
• Every 1 saved in direct medical costs saved 2
  more in related productivity and absenteeism
  costs

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Physician Evidence

• E Prescribing initiative in another part of
  Michigan including
• Financial incentives to physicians to install and
  use e-prescribing
• Pharmacy Benefit Managers provide consulting,
  support
• Infrastructure vendors selected and engaged
• Results
• 6 of every 100 prescriptions changed due to
  drug-drug alert
• 0.6/100 changed due to drug-allergy alertquality
  and safety
• gt 70 of physicians highly satisfied with
  e-prescribing
• Savings of 1.65/Rx retail 15.75/Rx mail order
• ROI of 35 for every 1 spent

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Our VisionFuture State

• A healthy West Michigan population that exceeds
  national objectives
• A regional health care environment that
  consistently performs in the top 1 nationally,
  in terms of VALUE
• Continuously improving quality AND continuously
  decreasing costs
• Health care excellence becomes a reason why
  people and business locate in West Michigan

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Current Statethe Problems

• Health insurance premium for families now about
  13,000/year
• U.S. spends about twice most other developed
  countries for health care gt 7,000/person
• Outcomes, e.g., infant mortality and life
  expectancy, worse than most other developed
  countries
• Well documented variance in quality of care,
  based on who we are, where we go for care
• 5-fold difference in White v Black leg amputation
  rates.
• 40 diabetic patients say no foot exam last year
• Growing access problems, fueled by cost trends

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Commonwealth Fund Report
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Health Care Vision 2020How we will get from
here to there

• Two major componentsAligning Forces for Quality
  (AF4Q) Health Information Exchange (HIE)
• Sponsored by the Alliance for Health neutral
  balanced
• Covers 13 counties of West Michigan 1.5M people
• HIE planning grant (670K) from State of Michigan
• AF4Q funded by Robert Wood Johnson Foundation
• 1.6M into this region from RWJ over 3 years
• West Michigan one of only 15 communities
  nationwide
• Brings national visibility to West Michigan for
  health care transformation
• Desire to improve quality drives HCV 2020 agenda
• Lesson learned repeatedly from other
  industriesreduce costs by improving quality

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Fundamental Principles

• Transformation of health care is required
• Working harder not the answer nor incremental
  change. New systems of care are needed (IOM)
• Must happen here in West Michiganwhere health
  care delivered
• Everyone must work together toward shared vision
• Those who provide, purchase, pay for, get care
  all of us
• No single stakeholder can achieve this vision
  alone the region must improvetogether
• Align the forces of what providers do, what and
  how purchasers pay, what consumers/patients do

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Value
Health Care Vision 2020 A Regional and
Collaborative Solution

• A Framework for a Transformed Health Care System
  
• Performance Measurement/ Reporting
• Quality Improvement
• Consumer Engagement/ Wellness
• Aligned Benefits Financing
• Health Information Exchange

Leadership
Adopted from California HealthCare Foundation, It
Takes a Region Creating a Framework to Improve
Chronic Disease Care, 2006.
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West MichiganHealth Information Exchange

• A tool, means to the endquality and value
• Secure access to important patient health
  information by providers across the region i.e.
  clinical information in the hands of clinicians
  at the time they make clinical decisions
• Business plan completed
• Phased in approach to implementation, beginning
  with clinical messaging
• Push results from hospitals/labs to physicians
• Retrieval and distribution of health information
• Storage of longitudinal patient records for
  quality, research, population health improvement
• Future community potential such as clinical
  trials, research, etc.

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WMHIE Business Plan

• Initiation and start-up from donations, grants,
  contributionsestimated 1.5M
• Ongoing operations to be funded through a variety
  of stakeholder contributions commensurate with
  value received.
• Annual membership fees transaction fees Board
  membership fees
• Participation by providers, plans and others.
  Includes public and safety net providers
• Hospitals and physicians projected to experience
  cost savings through HIE participationtransaction
  costs, labor costs.
• Estimated 2M/yr for Clinical Messaging phase.

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Performance Measurement

• Conducted a pilot project to aggregate analyze
  self-reported clinical data from POs/PHOs and
  physicians
• Production of clinically rich all patient/all
  payer reports, using nationally accepted
  performance metrics
• Initial focus area is diabetes
• First iteration of reports have been prepared and
  vetted
• Next steps
• Continuously increase of participating POs/PHOs
• Add conditions and preventive metrics to reports
• Maintain strong physician input, leadership and
  trust
• Create a data auditing capability
• Use system to rationally address requirements for
  public reporting of provider performance

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Public Reporting

• Be a known, trusted, utilized local source for
  health care information
• First inventory, analyze existing available
  rating programs websites
• Hospital Compare, Leapfrog, Quality Check, Health
  Grades
• Re-package, publicize information meeting our
  criteria
• Next create consumer friendly public reports for
  locally generated physician and hospital
  performance measurement initiatives
• Disseminate and promote reports

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Consumer Engagement

• Increase the number of West Michigan residents
  who
• Understand what high quality health care is
• Understand that behavior choices affect health
• Use health information and/or comparative
  performance information to make key decisions
• Actively engage in self-management of their
  chronic condition(s)
• Brand Rethink Healthy Learn. Ask. Act.
• Two audiences and fundamental strategies
• Build awareness with the general public
• Grassroots and community outreach media
  worksites
• Work with identified groups of chronic disease
  patients
• Pilot project with 10-12 physician practices to
  embed Rethink Healthy at point of care

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West Michigan Center for Health Improvement

• Will be a regional infrastructure
• To assist support physician organizations/physic
  ians to improve quality and efficiency of
  ambulatory care become Patient-Centered Medical
  Homes
• Roles
• Bring valued programming to West Michigan
• Fill gaps
• Leverage/augment current efforts to take to scale
• Consensus building
• Proposed initial activities/functions
• Learning collaboratives
• Lean/QMS consultation
• Manage culture change, leadership development
  programming
• Facilitate install/use of registries/EHRs

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West Michigan Center Plan

• Incubated by Lakeshore Health Network, under
  direction of Paul Ponstein, DO, Medical Director
• Two-year demonstration to show value
• To physicians, plans
• 300K for each of the 2 years
• 1 FTE Director/Subject Matter Expert
• Consultants/other Subject Matter Experts
• Website development
• Funding being solicited from health plans, others
• Business model after demo period
• Ongoing health plan support in return for value
  received membership fees service fees

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Inpatient Component Goal To increase the quality
of health care provided by reducing disparities
that exist for minority populations.

• Trinity Health and Spectrum Health are
  participating Mercy Health Partners and
  Butterworth/Blodgett
• GVSU support with data analyses and evaluation
• GRAAHI support for consumer engagement
• Four main goals
• Improve the reliability of race, ethnicity
  primary language data
• Use improved data to determine if disparities
  exist
• Perform rapid cycle quality improvement
• Develop publicly report data re race,
  ethnicity primary language
• Currently working on first goalexcellent
  progress
• Over 3 years will move into office/clinic care
  settings
• Focus upon transitions across settings
  coordination of care

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HCV 2020 Summary

• Setting up information infrastructure/foundation
• Secure network for pushing retrieving clinical
  information (HIE)
• Aggregation, analysis of data to measure provider
  performance, beginning with physician groups and
  hospitals
• Reporting quality other performance aspects to
  providers the publicweb, print
• Using performance information, by Race, Ethnicity
  Language to identify disparities undertake
  quality improvement interventions in hospitals
• Launching West Michigan Center for Health
  Improvement to assist physician groups and
  physicians improve quality efficiency
• Value-added services QI sustainability extend
  efforts across region
• Engaging consumers through Rethink Healthy to
  become more effective partners with their health
  care teamsLearn.Ask.Act.
• Looking forward to payment reform, benefit
  re-design

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HCV 2020 Financial Requirements

• Contributions, user fees, member fees, in-kind
• HIE operation 2,000,000/yr
• AF4Q 2,050,000/yr
• TOTAL 4,050,000/yr

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Call to Action

• We know what to do we have a vision and a plan
• Far-reaching, bold agenda for transformation
• Developed by almost 200 volunteers
• We have organized conducted pilots and
  prototypes
• Its time to ramp it up and accelerate
  implementation
• We must marshal the will and the resources to
  execute
• It takes a region. All of us must get
  involvedas caregivers or service providers, as
  purchasers and payers, as consumers/patients

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Embrace Change
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Thank You

• For more information
• Robert Parrish, Project Director
• bob.parrish_at_afh.org
• 616.248.3820