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Lee Burdick Executive Director

CPEEHCC – CHCC Annual Training Conference. Health Care Coalitions ’ Role in Lowering Health Care Costs January 17, 2011. Lee Burdick Executive Director. About CHCC.

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Lee Burdick Executive Director

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  1. CPEEHCC – CHCC Annual Training Conference Health Care Coalitions’ Role in Lowering Health Care Costs January 17, 2011 Lee BurdickExecutive Director

  2. About CHCC • MissionThe California Health Care Coalition (CHCC) is a membership organization of public- and private-sector employers, unions and trust funds determined to improve healthcare quality, save lives and control costs without losing benefits. • VisionCHCC believes that healthcare should be safe, effective, patient-centered, efficient, fairly priced and available to all without regard to race, gender, socioeconomic status or geography. • Strategic Approach CHCC presently represents 3+ million lives and is focused on working with all stakeholders to improve the quality and appropriateness of healthcare to improve medical outcomes, save lives and lower healthcare costs to employers and employees.

  3. One Thing We All Know:Healthcare Is Broken The U.S. healthcare system currently represents about 17% of our entire economy and is expected to increase to 20% by 2016.

  4. Rising Healthcare Costs Are Unsustainable

  5. Rising Healthcare Costs Are Unsustainable

  6. Economics v. Outcomes The Patient Protection and Affordable Care Act of 2010 focused almost entirely on the economics of healthcare and has done little to address the outcomes or quality of care. As examples, the ACA provided: • Small businesses get tax credits for health insurance benefits • Half of all individuals will be eligible for premium subsidies • No more exclusion for preexisting conditions, lifetime limits, or rescission for sick people • Health insurance exchanges will make coverage more affordable for individuals and small businesses • Dependents up to 26-years-old can stay on their parents’ plans • The dreaded individual mandate Many of these mandates have cost our benefit plans even more!

  7. Quality of Care is Integral to the Economics In October 2009, the Institute of Medicine estimated that a third of all healthcare spending in the United States – about $800 billion – goes to medical care that doesn’t make us better.

  8. California Suffers Poor Quality Care In California, the cost of poor quality care is estimated at $5 billion annually, the equivalent of approximately 7700 firefighters or 12,500 teachers.

  9. California Suffers Poor Quality Care California ranks 42nd among the states in healthcare quality, according to a 2009 Commonwealth Fund report. Aiming Higher: Results from a State Scorecard on Health System Performance, Douglas McCarthy, M.B.A., Sabrina K. H. How, M.P.A. and Cathy Schoen, M.S., The Commonwealth Fund, Joel C. Cantor, Sc.D., and Dina Belloff, M.A., Rutgers University Center for State Health Policy, at page 79 (2009).

  10. What Can We Do About It? First and foremost, We must work together . . . to aggregate and leverage the voice of the purchasers and consumers to be heard above the din created by the health plans and the service providers.

  11. What Can We Do About It? To be effective, we have to change behaviors at every level of the healthcare system.

  12. What Can We Do About It? LOCALLY We must continue to work with the Doctors and Hospitals through our Local Initiatives to • Implement payment structures that incentivize quality care • Leverage our successful local initiatives, like in San Diego and Fresno, to bring significant savings on our healthcare spend to our Member organizations in other areas

  13. What Can We Do About It? LOCALLY San Diego Purchasers Co-op • Mine vast amount of members’ claims data to determine who are “high value” providers • Establish tiered networks that encourage consumers/insureds to seek care from” high value” providers • Direct negotiation with Doctors Groups and Hospitals to become “high value” providers

  14. What Can We Do About It? LOCALLY Fresno Area Quality Care Initiative • Direct negotiation with Doctors Groups and Hospitals to: • incentivize payment structures that improve quality of care • Provide direct discounts immediately for large, leveraged purchasing group • Leverage community leadership and resources to establish a culture of personal responsibility

  15. What Can We Do About It? STATEWIDE We must continue to work with the Health Plans to . . . • Implement payment structures that incentivize quality care • Disclose their massive claims data for data mining by plan administrators • Adopt state-of-the-art fraud, waste and abuse screening tools for our Members like the PMI Program

  16. What Can We Do About It? We must continue to work with Our Members’ Plans To implement cost containment tools that can save them money right now including . . . • Data mining to determine who the quality service providers are • Incentivizing your insureds to choose the highest value providers to save lives, get better results & save money! • Accessing discounted benefit plans through leveraged associations • Avoiding fraud, waste and abuse using state-of-the-art tools

  17. What Can We Do About It? We must continue to educate our Members’ Insureds To understand their personal responsibility in making informed choices through . . . • Providing tools like CHCC’s Hospital Value Scorecard to help our Members’ insureds make quality provider choices • Distributing informative materials on how personal healthcare choices impact our individual pocketbooks • Educational conferences, like the one in Fresno on Obesity & Diabetes, about managing one’s chronic disease(s)

  18. What Can We Do About It? We must continue to leverage our purchasing power to get the best possible economics In addition to education and informed dialogue through coalitions like CHCC, health care coalitions like CPEEHCC can negotiate huge benefit discounts on behalf of their members and can be even more successful the larger its membership base.

  19. Final Thought To have a real impact on the unsustainable rise in healthcare costs, we must change behaviors through education at every level. This is why CHCC’s work is more important now than ever.

  20. Thank you! I am happy to answer any questions.

  21. Bay Area: 600 Grand Ave, Suite 410 Oakland, CA 94610 Los Angeles 11601 Wilshire Blvd., 5th Floor Los Angeles, CA 90025-1741 San Diego: 2801 B Street, No.190 San Diego, CA 92102-2208 619-955-8499 800-761-0947 www.CHCCnet.org

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