32BJ Health Fund and the Primary Care Information Project: Partnering for High Quality Care

1. 32BJ Health Fund and the Primary Care Information Project: Partnering for High Quality Care

2. On ABCS, USA Gets an “F” • People at increased risk of CVD who are taking Aspirin – 33% • People with hypertension who have adequately controlled Blood pressure – 44% • People with high Cholesterol who have adequately controlled hyperlipidemia – 29% • Smokers who try to quit get help – 20% Despite spending nearly 1 out of every 6 dollars on health care

3. ELECTRONIC HEALTH RECORDS Customized for prevention Health Care that Lengthens Lives PAYMENT that rewards prevention & chronic disease management CARE MANAGEMENT & practice workflows to support prevention *Frieden TR, Mostashari F. JAMA. 2008 Feb 27;299(8):950-2. 3

4. Focusing EHRs on Population Health Point of Care Alerts on Patient’s status with measure compliance 4

5. Prevention and Quality Scorecards

6. Changing Primary Care to Focus on Prevention “Hi, My name is Insert Name and I am calling from Dr. Insert Name’s office because we want to schedule you for a follow-up appointment. At your last visit on Insert Date, your Blood Pressure was high. It was over 150/90.” A PCIP Prevention Outreach Specialist at Work

8. 32BJ - Who we are? • Cleaners, janitors, doormen, school custodians, porters, security officers, window washers • More than half have been on the job more than 5 years – 15% more than 20 years • Median household income ~$35,000 • 90,000 members and 77,000 dependents in 6 states and DC • ~50% immigrants

9. Good benefits, poor health • Low primary care utilization • High ER utilization • High concentration of costs • Generally, our members receive poor care • Non-English speaking • Immigrant • Working multiple jobs

10. Long term problem • Our contributions do not keep up with health trends. • Limited arsenal: • Cannot increase cost sharing • Low wage workers are cost sensitive and will become increasingly low utilizers • Cannot continue to negotiate 10% increases with employers or shift funds from wages • Cannot reduce payments to providers

11. What we have in our favor… • Influence with our membership • 240,000 calls and 30,000 walk-ins annually to our member service center • Active union staff and engaged membership • Access to all claims data and the ability to analyze • We receive all raw medical, hospital, Rx and mental health claims data and have built the capability to look at these claims internally in powerful ways

12. How to identify quality? • We do not have the expertise or the data to measure quality • BTE and NCQA provide very limited networks • We needed a large base network in NYC: • PCIP • Doctors motivated to invest in electronic health record • Doctors willing to be transparent may be better doctors. • Doctors who use electronic health records may improve their care.

13. Building a Quality Care Network • Joint Evaluation: A preliminary analysis attributed $127 per member in savings to PCIP participation. • Outreach to Providers: Providers with high volumes of 32BJ members receive outreach from 32BJ to encourage them to join PCIP. Six practices have joined. • Informed Care Seeking: In April, 32BJ began recognizing PCIP membership within quality rankings used to recommend practices to their members. Planned • Workforce Funding: 32BJ funding for Prevention Outreach Specialists shared across doctor’s offices • P4P/Quality-Contingent Capitation: Payment for practices demonstrated high quality through Bridges to Excellence Recognition Program based on EHR-derived data.

14. Creating Change in a Fragmented Health Care System Payor Mix at PCIP Practices Distribution of 32BJ Members in NYC Practices

15. Meeting The Challenges of Measuring Quality With EMRs Antithrombotic Therapy Smoking Cessation Intervention Control of BP: Hypertension Only Preliminary data, McCollough