Transformation: Collective Impact, Data and Innovation

PriME Health Collaborative and Society of Physician Entrepreneurs Meet-UpOctober 4, 2012

• Healthcare Economics Primer- Fiscal Cliff• Megatrends• CIVHC: Triple Aim and Collective Impact • Transparency and Performance Measurement:

– Metrics and All Payer Claims Database (APCD)

• Disruptive Innovation• Discussion/Q&A

Today’s Discussion

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$3,353 $3,470$3,677 $3,696 $3,737

$3,970 $4,063 $4,079

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$7,538

Total Health Expenditure per Capita, U.S. and Selected Countries, 2008

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Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011).Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.

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What does $2.8 Trillion Buy?

• Quality: U.S. 37th in overall quality, between Costa Rica and Slovenia (World Health Organization, 2000)

• Medical Inflation 2-3 X the general rate of inflation

• Experience: Patient Satisfaction inversely correlated with regional spending

Note: Estimated waste of $750 Billion (25% of spend) per Institute of Medicine, 2012

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Megatrends: Disruptive Innovation not Incremental Change

• Consumerism/free markets (health care as service industry):

– Retail clinics /Commercial telemedicine/Concierge medicine

• Disruptive Technology Supports Disruptive Innovation• Marketplace won’t be recognizable in 5-7 years

• Transparency and Big Data- Business Intelligence Becomes Critical

A Fiscal Cliff Changes Everything

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Backbone Organization for Collective Impact

• Consensus on statewide common agenda• Metrics and data to measure progress on agenda• Non-Partisan connector, convener and communicator• Promote business case for change• Drive implementation and create sense of urgency• Do (e.g., All Payer Claims Database)

CIVHC: Catalyst for Transformation

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Our Vision: Achieving The Triple Aim + 1

Improve Population Health

Reduce Per Capita

Costs

Improve Patient

Experience

Triple Aim

Vibrant, Integrated Public/Community

Health System

Risk-adjusted, Performance-based

Global Payments

Highly Integrated Delivery SystemFully Engaged,

Informed and Empowered

Consumer/Patient Partners

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Essential Elements for Improving Quality and Lowering Costs

• Data is Key Driver – Market can’t work without data. Identify Provider Cost/Quality Variation

Data

• Payment Drives Change – Carriers Pay Providers for Value, NOT Volume

Payment

• Prevention is Key – Coordinate Care and Use Evidence-based Guidelines

Care Redesign

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CIVHC’s “+1” : Data and Performance Reporting

Big Data and Informed/Demanding Consumer Will Transform Healthcare

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Bending the cost curve Metric Source

Annual percent change in per capita personal health expenditures

All payer claims database (APCD)

(Interim source: National Health Expenditure Accounts, CMS)

Personal health care spending in Colorado relative to gross state product (GSP)

APCD

(Interim source: National Health Expenditure Accounts, CMS)

Annual medical trend relative to the Consumer Price Index (CPI)

Colorado Division of Insurance

Percent of health care expenditures associated with outcomes-based models of payment

APCD

Utilization of health care services per 1,000 Coloradans (hospital admissions and emergency room visits)

APCD

(Interim source: Kaiser State Health Facts and AHA)

Hospice utilization and annual growth of health care expenditures during last six months of life

APCD

(Interim source: Hospice Analytics using Medicare claims data)

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Medical Trend Relative to CPI – Large Group Market

Historical TrendDashboard

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Sample Metrics: Improved population health

Metrics Source

Percentage of Colorado population ages 0-64 who have any type of health insurance coverage

American Community Survey (ACS)

Percentage of adults who report they needed to see a doctor within the last 12 months but could not because of cost.

Behavioral Risk Factor and Surveillance System (BRFSS)

Prevalence of obesity among children, ages 6 – 11

Child Health Survey

Prevalence of obesity among adults, 18 and older

BRFSS

Percentage of physician practices with electronic medical records/linked with health information exchange

CORHIO

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Patient-centered experience Metric SourcePatients’ average rating of health care over past 12 months (scale of 1 – 10)

Question added to BRFSS (available in 2013)

When more than one choice of treatment or care was available, patients' assessment of whether a doctor or other health provider asked which choice they thought was best

Colorado Health Access Survey (CHAS – conducted every other year starting in 2011)

Percentage of Coloradans with advanced directives

Added to BRFSS (2013)

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Colorado’s All Payer Claims Database (APCD)

• State mandate • CIVHC- Administrator; Private Non-Profit• Collect claims data from all public/private

payers • Generate first aggregated public reports

in Q4 2012• Build towards increased transparency of

the data over the next 2 years• No general funds… sustainability model• Utilize Treo Solutions technology and

analytics

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Files submitted to the APCD• Medical Claims:

• Pharmacy Claims:

• Medical Eligibility File:

• Provider File: Name, ID numbers; Organization, Specialty, Location

• Payer info• Insurance type• Patient info/demographics• Admission type

• Discharge status• Service provider info• Type of bill and facility• Diagnosis codes• Payment amounts

• Payer/Plan info• Patient info/demographics• Pharmacy info

• Prescriptions details• Payment details• Physician info

• Payer• Insurance type

• Patient info/demographics• Coverage type/category• Subscriber info

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Schedule for Adding Data to the APCD

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

Commercial Carriers Group 1966,000

Medicaid550,000

Medicare600,000

Self-Funded Plans1,311,000

Small Group 289,000

Medicare

June 2012

June 2013

December 2013

Total 3,780,000

By 2014, the APCD will have collected

claims data for 90% of Colorado’s 4.2 million

insured individuals.

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Resources for Patients

SOURCE: New Hampshire APCD

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Consumer Reports- Patient Survey

Consumer Reports MQHP Health Insert July 2012

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Possible Public Reporting of Relevant Cost and Quality Information – Minnesota

Medical Group

Electronic Records

Quality of Care

Patient Experienc

e

Total Cost of Care

Comparison

Resource Use

Comparison

High Value (High

Quality and Low Resource

Use)

Evergreen

  YES

  

 

 

 

Lakestreet

  YES

  

 

Woodland

  YES

  

 

 

Parkdale   NO

  

 

 

Vista   YES

  

 

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Colorado Health Data Initiative

Creating an Ecosystem of Innovation for Colorado

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Health Data InitiativeA self propelled, open ecosystem of innovation using data to improve health and create jobs of the future

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Transformation Opportunity

Moving beyond Kano III to offer solutions to enhance health care experiences, contain costs, and improve the health of Coloradans.

Less of: More of:

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Opportunities for Innovation

Coverage + Coordination + Collaboration

Clinica Family Health Services | Access 1. Providing high-quality treatment in small

groups, plus:• Education• Screening• Answers• Support

2. 90-minute session with coordinated team of caregivers

3. Improved outcomes, better adherence

+ Connection?What would it take to offer a new level of interactions and support to patients using the channels they’re already using?

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Opportunities for Innovation

Connection + Performance Improvement

Adherence is a $290

Billion/year problem*

1. Interventions impact adherence

2. Medication adherence leads to lower health care costs

* New England Healthcare Institute. Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease, 2009.

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Impact of Disruptive Innovation

• Look beyond disintermediation…the entire market and value chain is transforming

• Most of core skills of the traditional insurer will go the way of the horse and buggy

– Integrated systems provide the networks– Traditional underwriting disappears

• Technology will put many of the medical management tools in the hands of consumers and providers (think iPhones)

• Business Intelligence and Big Data Will Rule…still and opportunity

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Contact Information

• Phil Kalin, President and CEOpkalin@civhc.org

Join our Voices on Value blog www.civhc.orgFollow us on Facebook and Twitter (@CIVHC_News)

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