Download - Pay-for-Value in Healthcare & Equity
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Policy Readings Pay-for-Value in Healthcare & Equity
PBL 891 Health Policy S.B. ChatterjeeFall 2014
POLICY READINGS Pay-for-Value in Healthcare & Equity
Agenda
Defining Value in Healthcare
Connecticut Innovation Plan Proposal
Payment, Costs & Delivery Systems
Strategies for Value-based
Alternate Payment Systems
Volume-based to Value-based
Massachusetts P4P & Equity Lessons Learned
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Defining Value
In Healthcare
Mayo Clinic
New England Journal of Medicine
(Swensen, S. et al (2010))
Variables For Which The Provider Is At Risk Under Alternative Payment Systems.
Miller H D Health Aff 2009;28:1418-1428
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Miller H D Health Aff 2009;28:1418-1428
How Different Payment Systems Solve Different Cost/Quality Problems.
Miller H D Health Aff 2009;28:1418-1428
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Transition In Both The Payment And The Delivery Systems.
Miller H D Health Aff 2009;28:1418-1428
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First Curve to Second Curve MarketsVolume-Based to Value-Based Markets
Source: HRET - Second Curve of Health Care http://www.hpoe.org/resources/hpoehretaha-guides/1360
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Second Curve Evaluation Metrics:
SummaryValue-Based Strategies
Strategy #1: Aligning Hospitals, Physicians and OtherProviders Across the Continuum of Care
Strategy #2: Utilizing Evidence-Based Practices to
Improve Quality and Patient Safety
Strategy #3: Improving Efficiency through
Productivity and Financial Management
Strategy #4: Developing Integrated InformationSystems
Source: HRET - Second Curve of Health Care http://www.hpoe.org/resources/hpoehretaha-guides/1360
Other Must-Do Health Care Transformation
Strategies (Strategies #5-10)
5. Joining and growing integrated provider networks and care
systems
6. Educating and engaging employees & physicians to create
leaders
7. Strengthening finances to facilitate reinvestment and innovation
8. Partnering with payers
9. Advancing an organization through scenario-based strategic,financial and operational planning
10. Seeking population health improvement through pursuit of the
Triple Aim (improving patient experience of care including
quality and satisfaction, improving the health of populations, and
reducing the per capita cost of health care)
Other Value-Based Strategies
Source: HRET - Second Curve of Health Care http://www.hpoe.org/resources/hpoehretaha-guides/1360
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Strategy #1: Aligning Hospitals, Physicians and Other Providers Across
the Continuum of Care
First-Curve
Me
trics
Second-Curve
Metrics
Percentage of aligned andengaged physicians
Percentage of physician and
other provider contracts with
quality and efficiency incentives
Availability of non-acute
services
Distribution of shared savings /
gains to aligned clinicians
Number of accountable
covered lives
Percentage of clinicians in
leadership
Number of physicians
on staff
Financial profit and
loss from employed
physicians
Hospitalist utilization
Number of contracts
for non-acute services
Strategy #1: Aligning Hospitals, Physicians and Other Providers
Across the Continuum of Care
Source: HRET - Second Curve of Health Care http://www.hpoe.org/resources/hpoehretaha-guides/1360
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATIONMARCH 2012
MassachusettsSpends More on Health Care than Any Other State
12
PER CAPITA PERSONAL HEALTH CARE EXPENDITURES, 2009
NOTE: District of Columbia is not included.
SOURCE: Centers for Medicare & Medicaid Services,Health Expenditures by State of Residence , CMS, 2011.
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
UT AZ GA ID NV TX CO AR CA AL VA SC TN NC OK MS OR KY MI MTNM IN IL KS WA LA HI IA MOWY NE SD OH FL WI MNMD NJ VT WV PA ND NH RI NY DE ME CT AK MA
State
NATIONAL AVERAGE
https://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asphttps://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asphttps://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asp -
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BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION
Massachusetts
Total Health Spending Will Double from 2009 to 2020
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ACTUAL AND PROJECTED MASSACHUSETTS TOTAL PERSONAL HEALTH CARE EXPENDITURES, 1991-2020
(BILLIONS OF DOLLARS)
SOURCES: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence , CMS, 2011; Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost
Trends, Historical (1991-2004) and Projected (2004-2020), November 2009.
$20 $21$23 $24 $25
$27 $28$30 $31
$33$36
$39$42
$45$48
$52$56 $58
$61
$68$72
$77$81
$86$92
$97$103
$109
$116
$123
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
A CTU AL P ROJ EC TED
Year
Source: Alberti, et al. Making Equity a Value in Value-Based Health Care - Acad Med. 2013;88:16191623.
Health equity metrics in Pay-for-Performance
Population diversity unsupported
assumptions for target hospitals
Metrics burdensome adding to regularreporting
Top-down compliance ineffective structural
changes
MassachusettsLessons learned for Health Equity
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttp://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CD0QFjAC&url=http://www.mass.gov/eohhs/docs/dhcfp/r/pubs/09/cost-trends-nov-2009.ppt&ei=0y5nT7-nOoaNgweU7LTSAg&usg=AFQjCNEVYY7imPHLbmXUlYNXa0Z_L0FOfAhttps://www.cms.gov/NationalHealthExpendData/05_NationalHealthAccountsStateHealthAccountsResidence.asp -
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Source: Connecticut Healthcare Innovation Plan
http://www.healthreform.ct.gov/ohri/lib/ohri/sim/plan_documents/ct_ship_2013_12262013_v82.pdf
Connecticut
Two tracks
Pay-for-Performance (P4P) rewards for
quality & care experience
Shared Savings Program (SSP) - share the
savings
Alignment of payers to reward structurestied to common scorecard (of P4P & SSP)
Value-based Payment Proposal
Thank you!
POLICY READINGS
Pay-for-Value in Healthcare & Equity