Maximizing IT Investment for High-Performance Healthcare

1. P4P and Group IT Investment Douglas Allen, MD., MMM. November 18, 2004

2. IT Requirements for High Performance • Get Data • Lab Values, Rx, Prof Claims, ?Facility Claims • Therapeutic Class Summary Database • Extraction of Non-Claims Data • Chart Abstraction, ?EMR • Make Data Good • Dash Board Reports • Internal Investigative Team to Troubleshoot

3. IT Requirements for High Performance • Use Good Data • Disease Registries • Feed Physicians: Patient Negative Lists • Contact Patients: Education, Reminders • High Risk Case Manager Work List • Physician Specific Performance Measurement • +/- Incentives • Fed Back Blinded/Unblinded • Point of Care Support • Physician Reminders Upon Eligibility Checking • Lab Values

4. The Cost Ladder $ Dz Registry Through Vendor

5. The Cost Ladder $ Patient Negative lists Dz Registry Through Vendor

6. The Cost Ladder $$ $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

7. The Cost Ladder $$ Internal Data Warehouse $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

8. The Cost Ladder $$ Dr Financial Incentives Internal Data Warehouse $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

9. The Cost Ladder $$$ Real Time Decision Support $$ Dr Financial Incentives Internal Data Warehouse $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

10. The Cost Ladder Dz Specific Case Management $$$ Real Time Decision Support $$ Dr Financial Incentives Internal Data Warehouse $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

11. Investment Cost Ladder $$$$ Electronic Medical Record (Practitioner) Dz Specific Case Management $$$ Real Time Decision Support $$ Dr Financial Incentives Internal Data Warehouse $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

12. Investment Cost Ladder Electronic Medical Record (Group) $$$$ Electronic Medical Record (Practitioner) Dz Specific Case Management $$$ Real Time Decision Support $$ Dr Financial Incentives Internal Data Warehouse $ Patient Reminders Patient Negative lists Dz Registry Through Vendor

13. GNP Performance • VZV 90th %tile • MMR 85th %tile • Rest of Childhood Imm 60th %tile • Asthma 70th %tile • Breast Cancer 90th %tile • Cervical Screening 90th %tile • Diabetes 90th %tile • LDL 60th %tile

14. GNP Performance (cont) • IT Max • Patient Satisfaction (ave) 64th %tile State wide, but higher for our region

15. P4P $ (PMPM) to GNP • HMO P4P Payout PMPM • Plan 1 $0.25 • Plan 2 $0.78 • Plan 3 $0.94 • Plan 4 $1.30 • Plan 5 $1.38 • Plan 6 $1.89

16. What is GNP Investing In? • Internal CDR Already Developed • Expanding the Number of Analysts • Converting: SAS to Prof Data Warehouse • Internet Connectivity for Physicians • Alone, This Exceeded Full P4P $ • Real Time Decision Support

17. Too Few $ For … • Full Time Dz Case Management • EMR for IPA Physicians • Intensive Patient Satisfaction Intervention

18. No “New” Money Health Plans Bake Into Pricing Model Base Increases in Premium ? at Risk Including Those Needed to Meet Expenses Health Plan Payout Methodology Top X Percentile Continued Funding Guarantees, to Offset Premium Increases Concerns About Future $

19. Possible Solutions • CAPG Strategy for Transparency Publicize Health Plan $ and Methodology • CAPG Strategy for Payout Methodology Absolute Performance Payout + Percentile Payout. $2+ PMPM for P4P Metrics. Separate from Base Contract • ? Isolate the Funds • Separate Pool • Paid Directly by Employers