1 / 25

Outcome Based Benefit Management

Outcome Based Benefit Management. Getting the Right Care at the Right Time Presenters: Dr. David Kendrick, MD, MPH, OU and CEO MyHealth Access Kim Owen, QuikTrip Corporation. General Themes - Healthcare Today. Costs must stabilize or go down More OK patients need access to care

larissa-mcintosh
Télécharger la présentation

Outcome Based Benefit Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Outcome Based Benefit Management • Getting the Right Care at the Right Time • Presenters: • Dr. David Kendrick, MD, MPH, OU and CEO MyHealth Access • Kim Owen, QuikTrip Corporation

  2. General Themes - Healthcare Today • Costs must stabilize or go down • More OK patients need access to care • As Purchasers demanding more quality, and proof thereof; • Will make purchasing decisions and policy accordingly • Readmissions • Medical errors • Duplication of services • Bottom line: Must deliver a higher quality product to more people for less $$$ per person

  3. Better Care-Better Cost • Better care • Better results • At a lower cost • Reduce unnecessary repeated tests • Lower number of referrals to specialists • Reduce the delays in getting specialized care • Don’t pay for 30 day “readmits” • Identify trends in your population • Right Care, Right Time, Right Amount= Better Outcomes

  4. How To Accomplish in a Broken System • Need More Information • Need Health Information Shared with ALL Treating Providers • Need Data to Know Who Is At Risk

  5. What is MyHealth Access Network? • A non-profit organization - grass roots, community-driven effort • Focused on a common objective • To improve the health of our community by improving the Oklahoma healthcare system • For the benefit of all patients, employers, and providers • A “healthcare public utility” to improve our work and improve our health

  6. Why Is MyHealth Interested • MyHealth is infrastructure only = wires • Does not provide patient care • Exists as a public utility to • Support • Enhance • Extend The care and services its member organizations can provide • Charged with improving Oklahoma health

  7. Oklahoma only state where death rate has gotten worse….. Some Factors • Economic downturn healthy people and jobs left Oklahoma • Poverty remained • Heart Disease – (Diabetes) • Cancer • Access to Care • Obesity Age-adjusted Death Rates Past 25 Years

  8. 2009 State of the State’s Health Summary • Oklahoma Grade Card – F • Cerebrovascular deaths, Chronic Lower Respiratory deaths, and Unintentional Injury deaths • Overall Mortality per 100,000 • OK – 918.7 • US – 799.4 • Proper Nutrition and Physical Activity • Current Smoker – 25.8% vs.19.8%

  9. …And its not because we are not spending enough money on healthcare

  10. What is the problem? • We have; • High quality doctors and hospitals. • Often nationally ranked and recognized • Extensive network of safety net clinics • active and engaged philanthropic community But . . . • We also have; • highly fragmented healthcare system • Patients see doctors in separate health systems • Clinics serving the poor often left out of communications • The left hand often doesn’t know what the right hand is doing

  11. Three tools • Electronic Medical Records (EMRs) are important, but . . . • Health Information Exchanges (HIEs) provide immediate benefit and greater cost savings through efficiency • Community-wide care coordination will provide better outcomes and cost savings

  12. MyHealth: Beacon Objectives Three required categories: • Cost Control • Quality Improvement • Population Health All supported by the implementation of specific Health IT interventions

  13. Cost Control • Reduce inappropriate utilization • Duplicated Labs (outpatient) • HbA1c: 16% of tests duplicated • Cholesterol tests: 22% • Microalbuminuria: 37% • Imaging (X-ray, CT, MRI) • New onset low-back pain: 32.3% of tests unnecessary • Hospitalizations • 30-day Medicare readmissions: 18% • Admissions for asthma, COPD, CHF: 2,000 per year • Use of ER’s instead of PCP visits

  14. Quality Improvement • Improve management of diabetes • Patients with annual eye exam: 38% • Patients with blood sugar in control: 37% • Patients with cholesterol in control: 29% • Improve care coordination • Referral loops closed: 22% • Communication of eye exam results: ? • Decrease patient wait time for specialty referrals: ? • Decrease time to get specialist opinions: ?

  15. Population Health • Increase cancer screening rates in OK • Breast: 43% • Colon: 25.5% • Cervical: 66.5% • Increase immunization rates • Children: 64.6% • Elderly- influenza: 0.69% • Elderly- pneumovax: 9%

  16. MyHealth: Beacon Technologies • Community Decision Support System • Archimedes’ IndiGO • Calculates patient risk and quality-of-life scores • Returns health improvement recommendations • Supports ‘what-if’ experimentation • DocSynergy • Electronic Specialist Consult

  17. Optimize blood pressure management Individualized Guidelines: >Twice the benefit, Save $500,000 Current measures have Plans climbing up this line Individualized Guidelines: Same benefit, Save $750,000 National BP Guideline CONFIDENTIAL 23

  18. DocSynergy™ online consult efficiency

  19. Unexpected Dividends • Results we hadn’t anticipated: • Variety of Specialties participating with good results • Success of consult system-more dependent on the comfort-level of the individual than the specialty • Better relationship between PCPs and specialists • PCPs learn from each interaction, fewer unnecessary consult requests over time • Improved access: those who needed care got it sooner

  20. Out of the Hands of Insurance • Employer Involvement • This is what I am “promoting” today • Employers are the Payers • Not your insurance company • You can’t just let things happen • Transparency is needed • Employers pay for those who don’t/can’t • Need to understand health of your population • Insurance Companies Will Get It • The Company That Solved Healthcare

  21. Real Story About Cost Control • Why Pay For That 2nd MRI • Dr.s need access to all of a patients info • 3rd Generation Machines • Negotiated discounts • Know Hospitals Costs in Your Area • Are you paying Medicare plus 30%, 50%, 100% • Networks as the silver bullet – is it past it’s prime • Cut them out of plan-if out of control

  22. The Real Story About Discounts • Outpatient Surgery • $54,000+ • Good Insurance • Will Give 27% Discount • JUST SAY NO • Changed doctor and hospital - $6500 • Dropped hospital from Plan

  23. The Real Story About Outcomes • Using The Best by Diagnosis • Centers of Excellence • Specialty • Who has the best outcomes – how do you find them • Know Their Readmission Rates • Medicare won’t pay-why should you? • Consider Physician Reimbursement • Year end bonus based on outcomes • Pay more for following best practices

  24. What Can You Do? • Easy for Self-Insureds • Plan Design • Drop Providers if Billing Is Out of Hand • Ask Your Insurance Company • Limit repeated tests-don’t pay • 30 day readmits-don’t pay • Give me info on my population • Are they supporting HIT’s? How? • What Can You Do Today (Even If Not Self-Insured) • Employer interest coalition • Start up

More Related