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Bipartisan Congressional Health Policy Conference January 11 - 13, 2007 Miami, FL

Bipartisan Congressional Health Policy Conference January 11 - 13, 2007 Miami, FL Aiming for the Best: Scorecard of U.S. Health Care System Performance What Is Doable Now? Glenn D. Steele Jr., MD, PhD President and CEO Geisinger Health System. Strategic Targets – Can We Prioritize?

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Bipartisan Congressional Health Policy Conference January 11 - 13, 2007 Miami, FL

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  1. Bipartisan Congressional Health Policy Conference January 11 - 13, 2007 Miami, FL Aiming for the Best: Scorecard of U.S. Health Care System Performance What Is Doable Now? Glenn D. Steele Jr., MD, PhD President and CEO Geisinger Health System

  2. Strategic Targets – Can We Prioritize? Who? How?

  3. Suggested Criteria What works now, somewhere? What is translatable? What can produce recognizable improvement?

  4. Learn From Best Practice

  5. Go for Perfection Model Reimbursement to Achieve: ▫ Optimum chronic care ▫ Optimum acute care ▫ Population health goal

  6. Pay-for-Performance (P4P) Initiatives • Chronic care (PGP demonstration and beyond) • Episodic care (e.g., CABG, joint replacement, cataract surgery, EPO)

  7. Highly-Reliable Diabetes Care (“All or None” Composite Measure)

  8. ProvenCareSM - Diabetes(Comprehensive Care; System-wide; >20K patients) 9/30/06 11/30/06 20% 10% % of all diabetic patients 6/30/06 3/31/06 0 1 2 3 4 5 6 7 8 All # Components Received/Achieved (by patient)

  9. Diabetes Outcomes(resulting from ProvenCareSM) % of all diabetic patients

  10. Coronary Artery Bypass: Reliability Go-Live Hired performance improvement clinician Documented current processes % of patients who received all components of care Engaged remaining stakeholders Confirmed the “ProvenCare CAB” processes & accountabilities Feb 06 Jul 05 Nov 05 May 06 Oct 06

  11. Coronary Artery Bypass: Outcomes Before With Improvement ProvenCareSM ProvenCare (% reduction) (n=143) (n=81) Patients with any complication 38% 30% 21% Patients with major complication 9.8% 6.2% 37% Atrial fibrillation 22% 19% 15% Any pulmonary comp 6.3% 2.5% 60% Re-admit ICU 2.8% 0.0% 100% Blood use 25% 19% 27% Re-operation for bleeding 4.2% 3.7% 12% In-hospital mortality (death) 1.4% 0.0% 100% Deep sternal wound infection 0.7% 0.0% 100% Discharged not to home 19% 7% 63% Charges per patient $61,176 $58,117 5%

  12. First Principles Pay for best practice • Don’t pay for less than best practice

  13. Focus on systems of care* as best model for testing new delivery incentives * Hehrotra A, Epstein A, Rosenthal B. Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?, Ann Intern Med, 2006, 145 (11): 826-833 * Casalino L. Which Types of Medical Group Provides Higher-Quality, Ann Intern Med, 2006, 145 (11): 860-861

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