Research-Driven Solutions for Innovative State Policy
1 like695 views
This document discusses health services research and its goals of determining what works best, for whom, under what circumstances, and at what cost. It outlines Arkansas' efforts to improve its health system, including establishing a governance structure and setting objectives around improving population health, patient experience, and controlling costs. It also presents data on variation in costs between providers for different medical conditions/procedures, showing opportunities for improving value through care standardization.
Research-Driven Solutions for Innovative State Policy
- 1. Health Services Research: Helps Us Get Our Money’s Worth What works? For whom? Under what circumstances? At what cost?
- 2. Research-Driven Solutions for Innovative State Policy Joseph W. Thompson, MD, MPH Surgeon General, State of Arkansas September 27, 2012
- 3. Health Care’s Iron Triangle Quality Cost Access
- 4. Arkansas Health System Improvement Agency Organizational Structure Governor State Leadership Mike Beebe State Leadership Governor’s Policy Staff Implementation & Dr. Joe Thompson & Coordination ACHI Workforce Insurance Chancellor Payment & Quality Health Information Exchange Implementation Dan Rahn Improvement Technology Commissioner & Dr. Paul Mr. John Selig Mr. Ray Scott Jay Bradford Halverson UAMS Steering Group: AFMC AID (Exchange) Workgroup ADH & ACHI DHS, ADH, BCBS, UAMS DHS (Mcd Participation Higher Ed QualChoice, DIS eligibility & (2- & 4 yr) United, ACHI Medicaid expansion) EBD 4
- 5. National and Arkansas Childhood Obesity Trends 23 Arkansas Assessments Percent Obese 22 25 Grades 8 & 10 Grades K, 2, 4, 6 21 AR grades 8 & 10 AR grades K, 2, 4, 6 20 20 2004 2005 2006 2007 2008 2009 2010 Percent Obese 15 10 US 12–19 yr US 6–11 yr 5 0 1963-65 1971-74 1988-94 01-02 05-06 1966-70 1976-80 99-00 03-04 07-08 NHANES data sources: Ogden et al. Prevalence of Obesity Among Children and Adolescents: United States, Trends 19631965 Through 20072008. NCHS Health E-Stat, June 2010. Available at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Accessed 04/18/11. Arkansas data source: Arkansas Center for Health Improvement, Little Rock, AR, September 2010.
- 6. Preliminary working draft; subject to change Our vision to improve care for Arkansas is a comprehensive, patient- centered delivery system… For ▪ Improve the health of the population patients ▪ Enhance the patient experience of care Objectives ▪ Enable patients to take an active role in their care For ▪ Reward providers for high quality, efficient care providers ▪ Reduce or control the cost of care Population-based care Episode-based care How care is delivered ▪ Medical homes ▪ Acute, procedures or ▪ Health homes defined conditions ▪ Results-based payment and reporting Four aspects ▪ Health care workforce development of broader program ▪ Health information technology (HIT) adoption ▪ Expanded access for health care services 6
- 7. Preliminary working draft; subject to change Payers recognize the value of working together to improve our system, with close involvement from other stakeholders… Coordinated multi-payer leadership… ▪ Creates consistent incentives and standardized reporting rules and tools ▪ Enables change in practice patterns as program applies to many patients ▪ Generates enough scale to justify investments in new infrastructure and operational models ▪ Helps motivate patients to play a larger role in their health and health care 1 Center for Medicare and Medicaid Services 7
- 8. Spending Breakdown for CHF 30-day Episodes with and without a Readmission N=4,992 CHF $10,569 episodes Avg Total Episode Cost = $23,511 $6,305 $3,975 24% $1,453 $832 $379 Index Readmits PAC OPD Physician Other % Total 27% 45% 17% 2% 6% 4% Costs 76% $5,936 Avg Total Episode Cost = $9,440 $2,510 Number of $0 $288 $337 $368 Episodes Index Readmits PAC OPD Physician Other % Total 63% 0% 27% 3% 4% 4% Costs 8 Source: Medicare FFS claims data, 2010
- 9. Preliminary working draft; subject to change Case for change: variation in costs by episode are substantial even after adjusting for risk Total average cost per episode post-risk adjustment by Principal Accountable Provider, 2008-2010 Simple upper respiratory infection1 Pregnancy2 $120 Total episodes ~30,000 Total episodes ~80,000 $5,000 Median cost $3,608 100 Median cost $57 10% percentile $3,208 10% percentile $44 90% percentile $4,071 80 90% percentile $76 4,000 60 3,000 40 2,500 20 500 0 0 ADHD3 Total hip replacement $12,000 $20,000 Total episodes 140 10,000 Median cost $7,953 Total episodes ~20,000 10% percentile $5,867 8,000 Median cost $1,641 15,000 90% percentile $12,814 10% percentile $1,073 6,000 90% percentile $7,046 10,000 4,000 5,000 2,000 0 0 1 Episode costs for children less than 10 risk-adjusted by a historically-derived multiplier. 2 Individual episode costs risk-adjusted for clinical drivers of severity based upon historically-derived multipliers. 3 Eligible defined as ADHD without comorbidities between ages 6 and 17. SOURCE: Arkansas Medicaid claims data; Team analysis 9 9
- 10. Preliminary working draft; subject to change Wave 1 episodes Principle Accountable Provider Total Hip/ Knee ▪ Surgical procedure plus all replacement related claims from 30 days Orthopedic surgeon prior to procedure to 90 days after ▪ Pregnancy-related claims for Perinatal mother from 40 weeks before (non-NICU1) to 60 days after delivery Delivering provider ▪ Excludes neonatal care ▪ 21-day window beginning with Ambulatory URI initial consultation First provider to diagnose ▪ Excludes inpatient costs and patient in-person surgical procedures Acute/post- ▪ Hospital admission Admitting hospital acute heart failure ▪ Care within 30 days of discharge Depends care pathway ▪ 12-month episode • Physician ADHD ▪ Includes all ADHD services + • Licensed clinical pharmacy costs (with exception of psychologist, and/or initial assessment) • RSPMI provider 10.5
- 11. Preliminary working draft; subject to change What’s next Examples Hip/ knee • Stents replacements • Pacemakers Perinatal • Include NICU • Urinary tract infections Ambulatory URI • Ear infections Acute / post-acute • Pneumonia CHF • Myocardial infarction ADHD • Depression Developmental • Long-term care disabilities • Severe and persistent mental illness