Why Not the Best? How States Can Lead Us Toward a

THE
COMMONWEALTH
FUND
Why Not the Best?
How States Can Lead Us Toward a
High Performance Health System
Karen Davis
President, The Commonwealth Fund
National Academy for State Health Policy
Annual Policy Conference
October 16, 2006
2
The Commonwealth Fund
Commission on a High Performance
Health System
Objective:
Commission Members,
including James J. Mongan,
MD, Chairman; Alan Weil, JD;
and others
• Move the U.S. toward a
higher-performing health
care system that achieves
better access, improved
quality, and greater
efficiency, with particular
focus on the most
vulnerable due to income,
gaps in insurance
coverage, race/ethnicity,
health, or age
THE
COMMONWEALTH
FUND
3
Vision:
What Constitutes a High
Performance Health System?
THE
COMMONWEALTH
FUND
The Commonwealth Fund
Commission on a High Performance Health System
HIGH QUALITY
CARE
4
ACCESS FOR
ALL
LONG,
HEALTHY, AND
PRODUCTIVE
LIVES
EFFICIENT CARE
EQUITY
SYSTEM INNOVATION
AND IMPROVEMENT
THE
COMMONWEALTH
FUND
5
Achieving a High Performance Health
System Requires:
• Committing to a clear national strategy
and establishing a process to implement
and refine that strategy
• Delivering care through models that
emphasize coordination and integration
• Establishing and tracking metrics for
health outcomes, quality of care,
access, disparities, and efficiency
THE
COMMONWEALTH
FUND
6
State Performance:
Where We Are Now and
Achievable Benchmarks
THE
COMMONWEALTH
FUND
7
LONG, HEALTHY & PRODUCTIVE LIVES
Mortality Amenable to Health Care
Deaths per 100,000 population*
State Variation,
2002
International Variation, 1998
150
134
129 130 132
106 107 109 109
119
115 115
110
103
97 97 99
100
75
81 84
92
88 88 88
84
90
50
ve
ra
10 ge
th
%
25 i le
th
%
il
M e
ed
i
75 a n
th
%
90 i le
th
%
i le
U
.S
.
A
Fr
an
ce
Ja
pa
n
Sp
a
Sw in
ed
en
I
Au taly
st
ra
Ca lia
na
d
No a
Ne
r
th w a
y
er
la
nd
G s
re
G e ce
er
m
an
Ne Au y
s
w
Ze tria
al
a
De nd
Un
n
ite ma
rk
d
St
at
e
Fi s
nl
an
Un
ite Ire d
l
d
Ki and
ng
d
P o om
rtu
ga
l
0
* Countries’ age-standardized death rates, ages 0–74; includes ischemic heart disease.
See Technical Appendix for list of conditions considered amenable to health care in the analysis.
Data: International estimates—World Health Organization, WHO mortality database (Nolte and McKee 2003);
State estimates—K. Hempstead, Rutgers University using Nolte and McKee methodology.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
8
LONG, HEALTHY & PRODUCTIVE LIVES
Infant Mortality Rate
Infant deaths per 1,000 live births
International variation, 2002
State variation, 2002
10
9.1
8.1
7.0
6.0
5.4 5.6
5.2
5.1
5.0 5.0 5.0 5.0
5
7.1
7.0
5.3
4.4 4.4 4.5 4.5
4.1 4.1 4.1 4.2 4.2
3.0 3.0
3.3 3.5
2.2
U.
S.
av
ge
r
10 age
th
%
il
25
th e
%
il
M e
ed
75 ian
th
%
il
90
th e
%
ile
Ic
el
a
nd
Ja
pa
Fi n
nl
an
Sw d
ed
e
No n
rw
ay
Sp
ai
Fr n
an
ce
Cz
A
ec
us
h
Re tria
pu
b
Ge lic
rm
a
Be ny
lg
i
De um
nm
ar
k
Sw
Ita
ly
itz
Ne erla
nd
th
er
la
n
Au ds
st
ra
Po lia
rtu
ga
Ire l
la
nd
Un
G
ite
re
d
ec
Ki
ng e
do
m
C
an
Ne
ad
w
a
Z
Un eal
a
ite
nd
d
St *
at
es
0
* 2001.
Data: International estimates—OECD Health Data 2005;
State estimates—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
9
States Vary In Quality of Care
2000–2001
WA
VT
MT
ND
WI
SD
NY
RI
PA
IA
OH
NE
IL
UT
CA
CO
MA
MI
WY
NV
ME
MN
OR
ID
NH
KS
MO
CT
NJ
DE
IN
MD
WV
VA
DC
KY
NC
TN
OK
AZ
NM
AR
SC
MS
TX
AL
GA
LA
FL
AK
Quartile Rank
First
Second
Third
Fourth
Note: State ranking based on 22 Medicare performance measures.
Source: S.F. Jencks, E.D. Huff, and T. Cuerdon, “Change in the Quality of Care Delivered to Medicare Beneficiaries,
1998–1999 to 2000–2001,” Journal of the American Medical Association 289, no. 3 (Jan. 15, 2003): 305–312.
10
QUALITY: THE RIGHT CARE
Preventive Care Visits for Children, by Top and Bottom States,
Race/Ethnicity, Family Income, and Insurance
Percent of children (ages <18) who received BOTH a
medical and dental preventive care visit in past year
59
U.S. average
73
Top 10% states
48
Bottom 10% states
62
White
58
Black
49
Hispanic
70
400% + of poverty
48
<100% of poverty
63
Private insurance
35
Uninsured
0
50
Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource
Center for Child and Adolescent Health database at http://www.nschdata.org).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
100
11
QUALITY: THE RIGHT CARE
Immunizations for Young Children, by Top and Bottom
States, Race/Ethnicity, and Family Income
Percent of children (ages 19–35 months) who received all recommended doses of five key vaccines*
U.S. average
400%+ of poverty
79
<100% of poverty
100
89
89
Top 10% states
77
71
Bottom 10% states
81
79
77
69
White
83
73
Black
50
77
Hispanic
Asian/PI
79
AI/AN
77
87
400%+ of poverty
75
<100% of poverty
0
50
0
100
White
Black
* Recommended vaccines include: 4 doses of diphtheria-tetanus-pertussis (DTP), 3+ doses of polio, 1+ dose
of measles-mumps-rubella, 3+doses of Haemophilus influenzae type B, and 3+ doses of hepatitis B vaccine.
PI = Pacific Islander; AI/AN = American Indian or Alaskan Native.
Data: National Immunization Survey (AHRQ 2005a, 2005b). Data is from 2003.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
Hispanic
12
QUALITY: SAFE CARE
Pressure Sores Among High-Risk and Short-Stay
Residents in Nursing Facilities
Percent of nursing home residents with pressure sores
State distribution, 2004
30
By race/ethnicity, 2003
22
16
14
13
8
Short-stay
residents
White
13%
21%
Black
17
26
Hispanic
15
25
Asian
12
22
AI/AN
17
23
23
19
18
15
Highrisk
resident
s
15
9
0
ta
To
l
s
%
%
5%
25
10
ate p 2
t
m
m
S
To
tto
tto
%
o
o
10
B
B
p
To
High-risk residents
ta
To
p
To
l
%
10
at
St
es
p
To
%
%
%
25
25
10
m
m
tto
tto
o
o
B
B
Short-stay residents
Data: Nursing Home Minimum Data Set (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
13
ACCESS: UNIVERSAL PARTICIPATION
Percent of Adults Ages 18–64 Uninsured by State
1999–2000
2004–2005
NH
NH ME
VT
WA
NH
WA
ND
MT
VT
MT
MN
OR
ID
NY
WI
SD
MI
WY
PA
IA
NE
CA
OH
IN
NV
UT
IL
CO
MA
KS
MO
WV
VA
KY
NJ
RI
CT
MN
OR
ID
MI
PA
IA
NE
CA
IL
CO
KS
MO
AZ
NM
MS
TX
AL
NC
AZ
GA
NM
OK
LA
TX
AL
GA
LA
FL
FL
AK
HI
SC
AR
MS
AK
VA
TN
SC
AR
WV
KY
TN
OK
OH
IN
NV
UT
MA
NY
WI
SD
WY
DE
MD
DC
NC
ME
ND
23% or more
19%–22.9%
HI
14%–18.9%
Less than 14%
Data: Two-year averages 1999–2000 and 2004–2005 from the Census Bureau’s March 2000, 2001 and
2005, 2006 Current Population Surveys. Estimates by the Employee Benefit Research Institute.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
NJ
RI
CT
DE
MD
DC
14
States with Highest and Lowest
Adjusted Health Plan Premiums
Employee-only adjusted premiums
Dollars
5,000
4,000
4,001
3,621
3,582
3,544
3,203
3,000
2,981
2,954
2,833
Alabama
Oregon
California
2,717
2,000
1,000
0
Wyoming
Maine
Wisconsin
West
U.S.
Virginia
average
Hawaii
Adapted from J. Gabel, R. McDevitt, L. Gandolfo et al., “Generosity and Adjusted Premiums in Job-Based
Insurance: Hawaii Is Up, Wyoming Is Down,” Health Affairs, May/June 2006 25(3):832–43. Data is from 2002.
15
EFFICIENCY
Ambulatory Care Sensitive (Potentially Preventable)
Hospital Admissions for Select Conditions
Adjusted rate per 100,000 population
National average
700
Top 10% states
Bottom 10% states
631
600
498
500
400
300
258
299
297
241
188
200
137
74
100
0
Congestive heart failure
Diabetes *
Pediatric asthma
* Combines four diabetes admission measures: uncontrolled, short-term complications, long-term
complications, and lower extremity amputations.
Data: National estimates—Healthcare Cost and Utilization Project, Nationwide Inpatient Sample; State
estimates—State Inpatient Databases; not all states participate in HCUP (AHRQ 2005a). Data is from 2002.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
16
QUALITY: COORDINATED CARE
Hospital Admission Rates
Among Nursing Home Residents, by State
Percent
30
20
19
21
16
12
10
8
9
Best state
10th %ile
0
Median
25th %ile
75th %ile
90th %ile
Data: V. Mor, Brown University analysis of Medicare enrollment data and Part A claims data for all Medicare
beneficiaries who entered a nursing home and had a Minimum Data Set assessment during 2000.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
16
17
QUALITY: COORDINATED CARE
Children with a Medical Home, by Top and Bottom States,
Race/Ethnicity, Family Income, and Insurance
Percent of children who have a personal doctor or nurse and receive care that is accessible,
comprehensive, culturally sensitive, and coordinated*
46
U.S. average
60
Top 10% states
36
Bottom 10% states
53
White
39
Black
30
Hispanic
58
400% + of poverty
31
<100% of poverty
53
Private insurance
23
Uninsured
0
50
100
* Child had 1+ preventive visit in past year; access to specialty care; personal doctor/nurse who usually/always spent enough
time and communicated clearly, provided telephone advice or urgent care and followed up after the child’s specialty care visits.
Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource Center for Child and Adolescent
Health database at http://www.nschdata.org).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
18
EQUITY: THE RIGHT CARE
Diabetes: Receipt of All Three Recommended Services,
by Race/Ethnicity, Family Income, Insurance, and Residence
Percent of diabetics (ages 18+) who received HbA1c test, retinal exam, and foot exam in past year
Total
53
55
White
54
Black
38
Hispanic
61
400% + of poverty
200% –399% of poverty
50
100% –199% of poverty
47
46
<100% of poverty
Private*
54
24
Uninsured
Urban**
55
45
Rural
0
40
* Insurance for people ages 18–64.
** Urban refers to metropolitan area >1 million inhabitants; Rural refers to noncore area <10,000 inhabitants.
Data: Medical Expenditure Panel Survey (AHRQ 2005a). Data is from 2002.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006
80
State Health Policies Aimed at
Promoting Excellent Systems (SHAPES)
• Environmental scan of state-level policies that
promote or impede high performance
– Qualitative companion to Commission's
quantitative National Scorecard
– Mechanism for identifying innovative states for
future Commission site visits
– Four Commission members serve on advisory
committee
• Products to date
– Data information collection plan completed
– Survey drafted -- will probe broadly the policy
domains of coverage, quality/efficiency/value,
and infrastructure supports
– Data collection to begin September 2006
– Health policy community notified at Academy
Health June 25, 2006
Alan Weil,
NASHP
Catherine
Hess,
NASHP
19
Keys to Transforming the U.S. Health
Care System
1.
2.
3.
4.
5.
6.
7.
20
Guarantee affordable health insurance coverage
Implement major quality and safety improvements
Work toward a more organized delivery system that
emphasizes patient-centered primary and preventive care
Increase transparency and reporting on quality and costs
Expand the use of interoperable information technology
Reward performance for quality and efficiency
Encourage public-private collaboration to achieve
simplification, more effective change
Guarantee Affordable Health Insurance
Coverage
21
1. Guarantee Affordable Health
Insurance Coverage
THE
COMMONWEALTH
FUND
Massachusetts Health Plan
22
• MassHealth expansion for
children up to 300% FPL;
adults up to 100% poverty
• Individual mandate, with
affordability provision;
subsidies between 100% and 300% of poverty
• Employer mandatory offer, employee
mandatory take-up
• Employer assessment ($295 if employer
doesn’t provide health insurance)
• Connector to organize affordable insurance
offerings through a group pool
Source: John Holahan, “The Basics of Massachusetts Health Reform,” Presentation to United Hospital
Fund, April 2006.
THE
COMMONWEALTH
FUND
23
Retaining and Expanding Employer
Participation: Maine’s Dirigo Health
Annual expenditures on deductible and premium
$3,000
Deductible amount
$2,738
Employee share of annual premium
$2,500
$2,188
1250
$2,000
$1,638
$1,500
1000
• Employers pay fee
covering 60% of
worker premium
$1,100 750
$1,000
$500
$0
$550
$0
0
MaineCare
250
300
<150%
500
600
<200%
888
<250%
1188
<300%
• New insurance
product; $1250
deductible; sliding
scale deductibles
and premiums
below 300% poverty
1488
• Began Jan 2005;
Enrollment 14,700
as of 4/30/06
>300%
THE
COMMONWEALTH
FUND
* After discount and employer payment (for illustrative purposes only).
Vermont Health Care Affordability Act
Enacted May 2006
24
• Coverage expansion
– Catamount Health Plans
• Targets those w/o access to work-based coverage
• Premium subsidies based on sliding scale up to 300% FPL
• Comprehensive benefit package including primary,
chronic, acute care & other services
• No patient cost-sharing for preventive or chronic care
• Builds upon Wagner’s Chronic Care Model
• Financing
– Employer assessment
– Increase in tobacco taxes
– Federal matching funds from Medicaid waiver
• Quality improvement initiatives
– Public-private collaboration
– Collection of health care data from all payers
– Rules to publicly report price & quality
information
THE
COMMONWEALTH
FUND
25
Illinois All-Kids
•
•
•
•
Effective July 1, 2006
Available to any child uninsured for 6 months or more
Cost to family determined on a sliding scale
Linked to other public programs - FamilyCare &
KidCare
• Federal and state funds
– Children <200% of FPL covered by federal funds
– Children 200%+ of FPL funded by state savings from
Medicaid Primary Care Case Management Program
• All-Kids Training Tour
– Public outreach program to highlight new and
expanded healthcare programs
THE
COMMONWEALTH
FUND
New Jersey Raises Age of Dependent
Status for Health Insurance
26
• As of 5/2006, NJ requires all
Millions uninsured, adults ages
state insurers to raise
19–29
dependent age limit to 30
13.7
15
13.4
12.7
– Highest age limit in country
11.8
11.2
– Covers uninsured,
unmarried adults with no
10
dependents who are NJ
residents or FT students
– Premium capped at 102% of
amount paid for dependent’s 5
coverage prior to aging out
• 200,000 young adults
expected to receive
coverage under the law
0
2000 2001 2002 2003 2004
Source: S.R. Collins, C. Schoen, J.L. Kriss, M.M. Doty, B. Mahato, “Rite of Passage? Why Young
Adults Become Uninsured and How New Policies Can Help,” Commonwealth Fund issue brief, May
2006. (Analysis of the March 2001–2005 Current Population Surveys)
THE
COMMONWEALTH
FUND
27
Implement Major Quality and Safety
Improvements
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
THE
COMMONWEALTH
FUND
Rhode Island:
Five-Point Strategy
1.
2.
3.
4.
5.
•
Creating affordable plans for small businesses & individuals
Increasing wellness programs
Investing in health care technology
Developing centers of excellence
Leveraging the state’s purchasing power
RI Quality Institute
–
–
•
28
Non-profit coalition -- hospitals, providers, insurers, consumers,
business, academia & government
Partnered with “SureScripts” to implement state-wide electronic
connectivity between all retail pharmacies and prescribers in the
state
Health Information Exchange Initiative
–
–
–
Statewide public/private effort
AHRQ contract 5 yr/ $5M
Connecting information from physicians, hospitals, labs, imaging &
other community providers
THE
COMMONWEALTH
FUND
Work Toward a More Organized Delivery
System that Emphasizes Patient-Centered
Primary and Preventive Care
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
29
3. Emphasize PatientCentered Primary,
and Preventive
Care
THE
COMMONWEALTH
FUND
30
Helping Patients Become Informed and
Active Partners in Their Care
Patient-centered care:
• www.howsyourhealth.org
• PCDC – advanced
access collaborative
• Shared decision-making
• Resident-centered care
in nursing homes
• Family-centered care in
Healthy Steps & ABCD
THE
COMMONWEALTH
FUND
31
Resident-Centered Nursing Home Care for
Frail Elders
•
Green House in Tupelo,
Mississippi, featured in
New York Times and
AARP Bulletin;
Commonwealth supported
evaluation in progress
•
Ohio project finds high
correlation between
resident and family
satisfaction and nursing
home clinical quality
•
New York state – analysis
of use of hospitals by
nursing home residents
Utah’s Primary Care Network
Section 1115 Medicaid Waiver
• Targets uninsured adults (19–54) with family income
less than 150% FPL
• Provides primary care and preventive care services
– Physician office visits
– Immunizations
– Emergency care
– Lab, X-ray, medical equipment & supplies
– Basic dental care
– Hearing & vision screening
– Prescription drugs
• Hospitals provide $10 million in charity care for PCN
participants
32
State Initiatives Investing in Children’s
Preventive Care
WA
MN
MN
WI
MI
UT
OH
IL
DC
VA
CO
CA
RI
IA
NE
NV
VT
NY
MO
NC
OK
AZ
NM
TN
SC
AR
MI
TX
GA
LA
FL
PHDS SLN States
(4)
NC Model States
(5)
ABCD I States (4)
ABCD II States (5)
Improvement Partnership
States (5)
BCAP States (10))
33
34
Increase Transparency and Reporting on
Quality and Costs
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
4. Increase
Transparency and
Reporting on
Quality and Costs
THE
COMMONWEALTH
FUND
35
Wisconsin
• Wisconsin Collaborative for Healthcare Quality
– Voluntary consortium formed in 2003 -- physician groups,
hospitals, health plans, employers & labor
– Develops & publicly reports comparative performance
information on physician practices, hospitals & health plans
– Includes measures assessing ambulatory care, IT capacity,
patient satisfaction & access
• Wisconsin Health Information Organization
– Coalition formed in 2005 to create a centralized health data
repository based on voluntary sharing of private health
insurance claims, including pharmacy & laboratory data
– Wisconsin Dept of Health & Family Services and Dept of
Employee Trust Funds will add data on costs of publicly paid
health care through Medicaid
THE
COMMONWEALTH
FUND
36
Expand the Use of Interoperable
Information Technology
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
5. Expand the Use of
Interoperable Information
Technology
4. Increase
Transparency and
Reporting on
Quality and Costs
THE
COMMONWEALTH
FUND
Value of Electronic Medical
Records and Information Systems
Reduce duplicate tests
Reduce hospital admissions by
having information accessible
to ER physicians
• Improve patient care
• Decision support for physicians
and patients
• Facilitate “referrals”, secure
transfer of responsibility
• Reduce medical errors
• Better management of chronic
conditions and care
coordination
– Registries
– Performance information
– Facilitated by
interoperability
37
•
•
THE
COMMONWEALTH
FUND
38
Information Exchange:
States Leading the Way
•
Rhode Island Quality Institute Information Exchange
– Provide access to patient data (as permitted) to all providers initially
through secure web-based portal – future integration into EHRs
– Create the ability to aggregate and utilize data for public health
purposes (e.g., population-based analysis, biosurveillance)
•
MidSouth e-health Alliance: Memphis, TN
– State-wide data exchange with initial focus on EDs
•
Utah Health Information Network
– Secure exchange of health care data using standardized transactions
through a single portal
•
New York State Health Information Technology (HIT) initiative
– Under the Health Care Efficiency and Affordability Law for New Yorkers,
$52.9 million awarded to 26 regional health networks to expand
technology in NY health care system and support clinical data
THE
COMMONWEALTH
exchange; Commonwealth Fund-supported evaluation underway
FUND
Source: Evolution of State Health Information Exchange, AHRQ, Publication No. 06-0057, January 2006.
39
Reward Performance for Quality
and Efficiency
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
5. Expand the Use of
Interoperable Information
Technology
4. Increase
Transparency and
Reporting on
Quality and Costs
6. Reward Performance for
Quality and Efficiency
THE
COMMONWEALTH
FUND
40
Building Quality Into RIte Care
Higher Quality and Improved Cost Trends
Percent
160
Cumulative Health
Insurance Cost Trend
Comparison
140
120
100
RI Commercial Trend
80
60
• Improved access,
medical home
– One third reduction
in hospital and ER
– Tripled primary care
doctors
– Doubled clinic visits
40
20
• Quality targets and $
incentives
RIte Care Trend
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
0
• Significant improvements
in prenatal care, birth
spacing, lead paint,
infant mortality,
preventive care
Source: Silow-Carroll, Building Quality into RIte Care, Commonwealth Fund, 2003. Tricia Leddy,
Outcome Update, Presentation at Princeton Conference, May 20, 2005.
THE
COMMONWEALTH
FUND
41
New York State Medicaid
Pay-for-Performance
• 1997 — NYS began transition to mandatory statewide
Medicaid managed care. Currently > 2.5 million enrollees
(including Family Health Plus)
• 2002 — NYS DOH incorporated quality incentive into
computation of Medicaid managed care capitation rates
– Incentive tied to performance on 10 quality of care measures
and 5 consumer satisfaction measures
– Initial incentive up to an additional 1% of monthly premium;
as of April 2005, maximum incentive increased to 3%
• 2005 — incentive payments totaled $40 million
• Commonwealth Fund supporting Dr. Robert Berenson
(Urban Institute) to evaluate impact of quality incentive
program — qualitative analysis (interviews/site visits of
participating plans) and quantitative analysis of measures
THE
COMMONWEALTH
FUND
Assisting States in the Design of Medicaid
Pay-for-Performance Programs
42
CHCS/Stephen Somers, Jul 06–Jun 08
Overview
• Develop Pay-for-Performance Purchasing Institute Technical
Assistance Series for 6 state Medicaid teams
– Two in-person training institutes
– Follow-up technical assistance
• Conduct environmental scan on P4P lessons learned in the
public/private sectors focusing on the provider level
– Draft report expected Sep 2006
• Synthesis of lessons learned and best practices
– Draft report expected May 2008
Status
• 1st training institute scheduled for October 12–13, 2006
• State Participants: Arizona, Connecticut, Idaho,
Massachusetts, Missouri, Ohio, & West Virginia
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COMMONWEALTH
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Encourage Public-Private Collaboration
to Achieve Simplification,
More Effective Change
1. Guarantee Affordable Health
Insurance Coverage
2. Implement Major
Quality and Safety
Improvements
5. Expand the Use of
Interoperable Information
Technology
4. Increase
Transparency and
Reporting on
Quality and Costs
6. Reward Performance for
Quality and Efficiency
43
3. Emphasize
Primary,
Preventive, and
Patient-Centered
Care
7. Encourage
Public-Private
Collaboration
to
Achieve
Simplification,
More
Effective
Change
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COMMONWEALTH
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Minnesota Smart-Buy
Alliance
• Initiated in 2004 – alliance between state, private
businesses & labor groups
• Purchase health insurance for 70% of state
residents ~3.5 million people
• Pool purchasing power to drive value in health
care delivery system
• Set uniform performance standards, cost/quality
reporting requirements & technology demands
• Four key strategies:
1. Reward or require “best in class” certification
2. Adopt and utilize uniform measures of quality and
results
3. Empower consumers with easy access to
information
4. Require use of information technology
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COMMONWEALTH
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Washington State
Puget Sound Health Alliance
45
• Founded in 2004 as independent non-profit organization
• Five-county partnership among employers, physicians,
hospitals, consumers, health plans and others
• Multi-prong approach to improving care and “systemness”
– Developing evidence-based guidelines for physicians,
hospitals and other health care professionals
– Designing tools for consumers and patients to support
decision making & self management of chronic conditions
– Producing regional reports on quality, cost & value to be
made publicly available by end of 2006
– Promoting data sharing across health plans & providers with
the goal of a shared data repository
– Building regional infrastructure to support and sustain QI,
including workforce development & training
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COMMONWEALTH
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West Virginia Small Business Plan
Leveraging Purchasing Power
46
• West Virginia (WV) Small Business Plan
– Enacted March 2004
– Partnership between WV Public
Employees Insurance Agency (PEIA) &
private market insurers
– Small business insurers pay providers at
same rates negotiated by PEIA
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COMMONWEALTH
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Moving Forward
What States Can Do to Promote a High
Performance Health System:
Strategies to Expand Coverage
• Expand public programs
• Provide financial assistance to workers and
employers to afford coverage
• Promote partnerships with employers
• Pool purchasing power and promote new
benefit designs to make coverage more
affordable
• Mandate that employers offer, and/or
individuals purchase, coverage; subsidize
those with low incomes
• Develop reinsurance programs to make
coverage more affordable in the small group
and individual markets
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THE
COMMONWEALTH
FUND
What States Can Do to Promote a High
Performance Health System:
Strategies to Improve Quality and Efficiency
•
•
•
•
•
•
•
•
•
49
Promote evidence-based medicine
Promote effective chronic care management
Promote transitional care post-hospital discharge
Encourage data transparency and reporting on
performance
Promote/practice value-based purchasing
Promote the use of health information technology
Promote wellness and healthy living
Encourage selection of medical home and improved
access to primary care and preventive services
Simplify and streamline public program eligibility and redetermination
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COMMONWEALTH
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50
Continue to Lead the Way to
Achieving a High
Performance Health System!
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COMMONWEALTH
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Selected Commonwealth Fund Publications
• The Commonwealth Fund Commission on a
High Performance Health System, Framework
for a High Performance Health System for the
United States, The Commonwealth Fund,
August 2006
• C. Schoen et al., “U.S. Health System
Performance: A National Scorecard,” Health
Affairs Web Exclusive, September 20, 2006.
• S. Silow-Carroll and F. Pervez, States in
Action: A Quarterly Look at Innovations in
Health Policy, The Commonwealth Fund,
Summer 2006, Vol. 5.
• Forthcoming –
– State Scorecard on Health System
Performance
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Thank You!
Stephen C. Schoenbaum,
M.D., Executive Vice
President and Executive
Director, Commission on a
High Performance Health
System
Karen B. Adams,
Program Officer,
State Innovations
Program
Cathy Schoen, Senior
Vice President for
Research and
Evaluation
Alyssa L. Holmgren,
Research Associate
Anne Gauthier, Senior
Policy Director,
Commission on a High
Performance Health
System
Jennifer L. Kriss,
Program Assistant
Sign up for States in Action newsletter and
forward to colleagues – www.cmwf.org
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COMMONWEALTH
FUND