MMS State of the State Conference: Susan Dentzer - Rationalizing Health Spending and Getting Top Value in Health Care

Rationalizing Health Spending and Getting Top Value in Health Care: Challenges and Opportunities for Massachusetts and Beyond by Susan Dentzer Editor-in-Chief, Health Affairs The Massachusetts Medical Society State of the State Health Care Conference October 23, 2008

This presentation at a glance ,[object Object],[object Object],[object Object],[object Object]

Massachusetts’ Health Reforms: NewsHour with Jim Lehrer on PBS, April 28, 2008 ,[object Object],[object Object],[object Object]

Massachusetts’ Health Reforms: NewsHour with Jim Lehrer on PBS, April 28, 2008 ,[object Object],[object Object]

“ An Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality Health Care” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Copyright ©2008 by Project HOPE, all rights reserved. Sean Keehan, Andrea Sisko, Christopher Truffer, Sheila Smith, Cathy Cowan, John Poisal, M. Kent Clemens the National Health Expenditure Accounts Projections Team, Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare, Health Affairs, Vol 27, Issue 2, w145-155w

Pros and cons ,[object Object],[object Object],[object Object]

Pros and Cons ,[object Object],[object Object],[object Object]

Pros and Cons ,[object Object],[object Object],[object Object],Michael E. Chernew, Department of Health Care Policy, Harvard Medical School

Copyright ©2003 by Project HOPE, all rights reserved. Michael E. Chernew, Richard A. Hirth, and David M. Cutler, Increased Spending On Health Care: How Much Can The United States Afford?, Health Affairs, Vol 22, Issue 4, 15-25

Strengths of U.S. health care: a sampling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Health Care: We’re Getting Value ,[object Object],[object Object],[object Object],David Cutler, Harvard (top); Mark McClellan, Brookings Source: David M. Cutler and Mark McClellan Is Technological Change In Medicine Worth It? Health Affairs , September/October 2001; 20(5): 11-29.

Health Care: We’re Getting Value ,[object Object],[object Object],[object Object],[object Object],David Cutler, Harvard (top); Mark McClellan, Brookings

We don’t pay for goods and services with “value,” but with dollars: See It’s a Wonderful Life ,[object Object],[object Object],[object Object],[object Object]

The Value Equation? U.S. versus the rest of the Organization of Economic Cooperation and Development Countries* ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],U.S. health spending: Public vs. private

Backdrop of Fiscal Concerns: The Nation’s Implied Promises about Medicare ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

“ Excess” U.S. Spending on Health Care: Where Does It Go? ,[object Object],[object Object],[object Object],[object Object],[object Object]

“ Excess” U.S. Spending on Health Care: Where Does It Go? ,[object Object],[object Object],[object Object]

What’s Happening in Massachusetts? Hospital utilization of chronically ill Medicare beneficiaries, last 6 months of life ,[object Object],[object Object],[object Object],[object Object],[object Object]

“ Excess” U.S. Spending on Health Care: Where Does It Go? Prescription Drugs ,[object Object],[object Object],[object Object],[object Object]

The Value Equation? U.S. versus the rest of the Organization of Economic Cooperation and Development Countries* ,[object Object],[object Object],[object Object],[object Object]

What are the key drivers of long-term increases in health spending? ,[object Object],[object Object],[object Object]

What is Driving the Growth in Health Care Spending? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Example: Imaging ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What is driving the growth in health spending ? ,[object Object],[object Object],[object Object],[object Object],[object Object],Real health care: It’s not like on “House”

What is Not Driving Health Spending to a Substantial Degree ,[object Object],[object Object],[object Object],Source: The Synthesis Project

Minimize unnecessary variations in supply-sensitive health care: The Dartmouth Institute Agenda

Variations in Chronic Disease Care ,[object Object],[object Object],[object Object],[object Object]

Inexplicably wide range in care and cost ,[object Object],[object Object],[object Object],[object Object],[object Object]

Physician visits in last 6 months of life ,[object Object],[object Object],[object Object]

Commonwealth Fund’s “Bending the Curve” report, Dec. 2007 ,[object Object],[object Object],[object Object],[object Object],[object Object],Source: C. Schoen, S. Guterman, A. Shih, J. Lau, S. Kasimow, A. Gauthier, and K. Davis, Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending, The Commonwealth Fund, December 2007. www.cmwf.org Commonwealth Fund President Karen Davis

Commonwealth Fund Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Commonwealth Fund Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object]

The Solutions? It’s partly the payment system, dummy! ,[object Object],[object Object],[object Object],[object Object]

RAND Health’s Advice to State ,[object Object],[object Object],[object Object],Elizabeth McGlynn, PhD RAND Corp.

Synthesis Project Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Source: Synthesis Project report posted at www.hschange.org

Price Transparency ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Americans and Chronic Illness ,[object Object],[object Object],[object Object],[object Object],Source: Partnership to Fight Chronic Disease, Policy Platform, September 2007

The Solutions? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Solutions? ,[object Object],[object Object],[object Object],[object Object]

The Patient-Centered Medical Home ,[object Object],[object Object],[object Object],[object Object]

How Geisinger Does It ,[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Geisinger Health System

Targets for the Geisinger Transformation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Managing to Success

Transformation Initiatives* ,[object Object],[object Object],[object Object],[object Object],[object Object]

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ProvenHealth Navigator ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Admission Metrics -13.8% 232/1,000 269/1,000 Lewisburg -20% 291/1,000 365/1,000 Lewistown 0% 311/1,000 311/1,000 GHP MC Medicare Percent Reduction First Year of Pilot Jan-Oct. 2007 Baseline Pre-Program Jan – Oct. 2006

Readmission Metrics -48.0% 7.9% 15.2% Lewisburg (645 pts) -12.3% 17.8% 20.3% Lewistown (2,120 pts) -18.5% 15.9% 19.5% All Medical Home Sites -2.3% 16.6% 17.0% GHP MC Medicare GHS Sites 0% 16.5% 16.6% GHP Managed Care (MC) Medicare % Reduction First Year: Pilot 2006 Q4 – 2007 Q3 Readmission Rate Baseline: Pre-Program 2005 Q4 – 2006 Q3 Readmission Rate

“ Supply-chain” management ,[object Object],[object Object],[object Object],[object Object],[object Object],John Agwunobi, President, Health & Wellness Business Unit, Wal-Mart Stores Division. Former U.S. Assistant Secretary of Health, HHS

Conclusions ,[object Object],[object Object],[object Object],[object Object]

The Lessons? ,[object Object],[object Object],[object Object],[object Object],[object Object]

The Verdict on Reforming Health Care? “ Somebody has to do something, and it’s just incredibly pathetic that it has to be us.” --the late Jerry Garcia of the Grateful Dead

MMS State of the State Conference: Susan Dentzer - Rationalizing Health Spending and Getting Top Value in Health Care

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MMS State of the State Conference: Susan Dentzer - Rationalizing Health Spending and Getting Top Value in Health Care