... for Medical Home Improvement, the Oregon Medical Hom

1
Trends in Healthcare for the 2007 Vision
ElementsPublic Employees Benefit Board
Meeting of the Board of DirectorsTuesday,
November 21, 2006
2
Purpose of Todays Presentation

• To present a high level overview of the trends in
  the PEBB Vision elements over the recent past
• To provide feedback and an assessment of PEBBs
  plan to accelerate change and improvement in the
  health of their members and the health care
  system in Oregon

3
Consensus Has Developed for the Role of the
Medical Home Provider

• Agreement(1) on the essential elements of the
  Patient-Centered Medical Home includes
• A primary care team of healthcare professionals
• Partnership between the primary care team, the
  patient and the family
• Use of a care plan developed with the patient and
  team
• Coordinates care and information across the
  providers and community organizations
• Uses a proactive approach to management of
  chronic condition care
• PEBB is contributing to the growth of the
  Patient-Centered Medical Home through its carrier
  initiatives
• (1) Between the Center for Medical Home
  Improvement, the Oregon Medical Home Project, The
  National Quality Forum, the American College of
  Physicians, the American Academy of Family
  Physicians, and the American Academy of Pediatrics

4
Evidence-based Care/Practice Guidelines Slow
Growth Continues - Where Strong Provider
Relationships Exist, Growth is Faster

• Strong physician leadership among peers is
  required to obtain buy-in
• Cost of roll-out can be prohibitive to implement
  across multiple settings of care
• Guidelines from credible sources abound
• OHSUs Oregon Evidence-based Practice Center
  (EPC) provides systematic evidence reviews on
  guidelines related to screening and prevention
  services dozens are available
• OHSU and Kaiser Permanentes Center for Health
  Research are currently working on a dozen more
• HHS provides dozens on its website

5
Evidence-based Care Spread of Other Elements is
Starting to Accelerate

• Pay for Performance Programs using Evidence-based
  criteria begins to spread
• Premier/CMS Hospital Quality incentive
  Demonstration Project
• First year results in five clinical areas shows
  significant improvement in quality results
• Bridges to Excellence Pay for Performance
• Designed to re-engineer physician office
  practices
• Focused on producing better outcomes for patients
  with diabetes and cardiovascular disease

6
Member Self-Management Efforts Have Been
Historically Disease-Specific

• Pittsburg Business Group on Health LivingMyLife
  program (Diabetes)
• The Pittsburgh Business Group on Health (PBGH),
  an employer-only coalition, has joined with the
  American Pharmacists Association (APhA)
  Foundation for the program
• Physicians, diabetic educators and pharmacists
  act as coaches to help the diabetic patient to
  gain knowledge needed to manage their care

7
The Scope of Member Self-Management Efforts is
Widening Beyond Clinical Support for a Specific
Disease

• Pacific Business Group on Health Breakthrough
  Strategy
• The program includes a variety of strategies in
  addition to clinical teaching and support such as
  general health promotion, lifestyle behavioral
  change, and consumer decision support
• HMOs, PPOs and consumer driven models are
  included and some employ consumer incentives

8
State Agencies Lead Developments in Service
Integration

• Most efforts are being sponsored by state
  Departments of Human Services
• They combine formal coordination of delivery
  systems and use a service brokering program in
  which staff coordinate services for physical or
  mental health, substance abuse, housing,
  childrens services, and domestic violence

9
Developments in Infrastructure Make Steady
Progress

• The federal government takes an affirmative step
  by Executive Order in August, 2006
• Federal agencies administering insurance directed
  to improve interoperability of agency information
  systems dealing with health insurance
• Spread of Electronic Medical Records continues
  despite lack of financial incentives to
  physicians at the federal level
• Gap widens between small and large practices for
  adoption of EMRs

10
Steady Progress In Infrastructure

• Overlap begins to appear between organizations
  utilizing clinical systems and Health Information
  Exchanges (Shared Health)
• Medical and pharmacy claims/encounter data is
  pulled from two information exchanges backed by
  business coalitions and fed into a Health
  Information Exchange made available online to all
  the physicians contracted to BlueCross BlueShield
  of Tennessee
• Oregons Health Information Security and Privacy
  Collaborative
• Is a joint initiative between OHPR and the
  private sector to identify solutions and an
  implementation plan to address business practices
  and state laws that affect privacy and security
  practices and permit interoperable health
  information exchange
• comment from the group is expected within a year

11
Federal Support of Transparency Develops

• The federal government takes initiative by
  Executive Order
• Sharing cost information
• CMS posts costs for hospitals for 30 elective
  procedures as inpatient admissions
• CMS will post costs for Ambulatory Surgery
  Centers, hospital outpatient and physician
  services next
• The federal government will develop measures of
  quality at the provider and health plan level
• Federal agencies were directed to develop
  approaches that facilitate high quality,
  efficient care

12
States Accelerate Developments in Transparency

• The creation of The Oregon Patient Safety
  Commission was a turning point
• Implemented voluntary and confidential reporting
  of medical errors in hospitals in 2003 and most
  Oregon hospitals have joined
• Advocates disclosure of the medical error to the
  patient and family and analysis and process
  improvement as follow up to the error
• Implementation is next for nursing homes and
  pharmacies
• Last month OHPR released the second annual report
  on death rates in hospitals for selected
  procedures and medical conditions

13
Purchasers and the States Take the Lead in
Developments in Transparency

• Health Information Exchanges sponsored by
  business coalitions of purchasers are
  proliferating at an almost exponential rate
  sharing regional claims based data to report cost
  and quality information

14
Managing for Quality Modest Progress

• The National Healthcare Quality Report concludes
  improvement in Quality is moving at a modest
  pace
• Improvement is variable with some areas of high
  performance for example
• The 100,000 Lives Campaign efforts to reduce the
  number of lives lost to medical errors by 100,000
  a year include
• The development of rapid response team for
  clinical assessment in hospitals
• Significant reduction of medication errors in the
  inpatient setting
• Computerized physician order entry (CPOE) reduces
  transcription errors
• Implementation of CPOE is spreading quickly
  because the technology is available now to
  support its use in real time

15
Developments in Managing Quality Purchasers
Prove They Can Drive Change

• TheLeapfrogGroup
• Regional Roll-Out leaders include local
  hospitals, health plans, physicians, unions, and
  consumer groups
• The Regional Roll-Outs encourage the
  implementation of Leapfrogs four recommended
  quality and safety practices or leaps
• Implementation of computer physician order entry
  (CPOE) systems
• Staffing ICUs with intensivists
• Referring patients to hospitals with the best
  results for treating certain high risk conditions
• Implementation of The National Quality
  Forum-endorsed Leapfrog Safe Practices

16
Developments in Managing Quality Purchasers
Prove They Can Drive Change

• TheLeapfrogGroup - continued
• Western Oregon is one of 28 Roll-Out Regions
• 11 out of 57 Oregon hospitals have shared data
  for public disclosure with TheLeapfrogGroup
• Providence Milwaukie and McKenzie-Willamette were
  the two new members from Oregon in 2006

17
Assessment

• The lines between initiatives to achieve the
  Vision elements are beginning to blur and efforts
  overlap as change in healthcare and benefit
  coverage accelerates
• PEBBs plan for Implementation of the Vision is
  keeping pace with developments in the industry
• Aon recommendation is to continue to implement
  from the individual carrier work plans (matrices)
  to execute the Vision stretch goals
• Consistency in collaboration produces results
• The satisfaction of successful achievement is the
  best motivator for your collaborating partners to
  participate in future efforts