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Let’s Talk the Business of Health Care… May 2012

Let’s Talk the Business of Health Care… May 2012. Your Goals… How can we help you achieve them?. Source: SCBCH website. The Cost of Health Care. What is largest US Health Care cost today?. Heart Disease/Stroke Causes 1 of every 3 deaths Over 2 M Heart Attacks and Strokes each year

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Let’s Talk the Business of Health Care… May 2012

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  1. Let’s Talk the Business of Health Care… May 2012
  2. Your Goals… How can we help you achieve them? Source: SCBCH website
  3. The Cost of Health Care What is largest US Health Care cost today? Heart Disease/Stroke Causes 1 of every 3 deaths Over 2 M Heart Attacks and Strokes each year Leading cause of preventable death in people <65 $444 Billion per year in health care costs and lost productivity Treatment accounts for $1 in every $6 spent Source: CDC Million Hearts: Strategies to Reduced the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
  4. Solutions We know what to do…. Prevention(take all of this you can get) Improve Nutrition Increase Fitness and Exercise Reduce Tobacco usage Effective Clinical Prevention (demand this) Focus on ABCS (Aspirin, Blood Pressure, Cholesterol, Smoking) Align Incentives with outcomes Innovate Care Delivery Source: CDC Million Hearts: Strategies to Reduced the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
  5. Status of ABCS Source: CDC Million Hearts: Strategies to Reduced the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60 Source: OQUIN CY 2011 network total. These are patients in treatment, not total population. Data capture issue with Aspirin.
  6. What is OQUIN? Outpatient Quality Improvement Network (OQUIN) is a collaborative of healthcare providers, most of whom are primary care physicians. It is built on a shared passion for serving patients in the best way possible. OQUIN physicians and providers are interested in using data to improve quality and are focused on outcomes. uses EMR, billing, claims, labs, & scheduling data for full view of processes and outcomes OQUIN maintains a central, searchable, database: Data since 1999 Demographic data ~2 million patient records ~9000 physicians & other providers ~5 million prescription records ~500,000 hypertensive patients ~150,000 diabetic patients
  7. What is OQUIN? Mission Promote Health and Prevent Disease Across the Lifespan. Strategies Healthy Lifestyles Physical Activity Good Nutrition Effective Healthcare Access to Care Access to Medications Benefits for Physicians and Providers: Recurring Quality Improvement Reports (paper, online) provided at no cost 24/7 Online Reports with decision support tools Quarterly Newsletter with Evidence-Based Information Meaningful Use & Bridges to Excellence Recognition Support for NCQA Recognition & bonuses from BCBSSC Over 30 CME credits/yr inclProcess Improvement Extensive Benchmarking Practice Based ResearchOpportunities
  8. Southeast > > > International Cardiovascular > > > All Conditions PBRN > > > Platform for CER Leadership Mission Mission To facilitate the transition of South Carolina and the Southeast from a leader in CV disease to a model of heart and vascular health. Promoting Health and Preventing Disease Across the Lifespan Began in 1999 20 physicians and other providers 3000 patients Goals to improve health and cut Heart Attack and Stroke in half Today Active Records 3000 physicians and other providers 1.2 million patients Reduced Heart Attack and Stroke to national average by 2017 Strategy remains the same: Healthy lifestyles—physical activity and good nutrition Effective health care access and medications
  9. Progress CV MORTALITY Worst to First 1995 SC is one of 5 WORST States 2007 SC is one of 2 BEST in Improvement From 5 worst states in 1995 to 2 most improved in by 2007 Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1995-2007. CDC WONDER On-line Database, compiled from Compressed Mortality File Series 20 No. 2M, 2010. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Aug 15, 2011 4:55:34 PM and using 2007 population as a constant for all comparisons.
  10. Improvement in CV Mortality and State Rank 1999-2007 Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1995-2007. CDC WONDER On-line Database, compiled from Compressed Mortality File Series 20 No. 2M, 2010. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Aug 15, 2011 4:55:34 PM and using 2007 population as a constant for all comparisons.
  11. Improvement in CV Mortality 1999-2007 South Carolina has improved over 12 Points in national ranking during the last reported twelve years. Double any other state in the Southeast. Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1995-2007. CDC WONDER On-line Database, compiled from Compressed Mortality File Series 20 No. 2M, 2010. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Aug 15, 2011 4:55:34 PM and using 2007 population as a constant for all comparisons.
  12. WORST TEN Improvement in CV Mortality 1995-2007 Of the WORST TEN in 1995, only South Carolina has improved more than 10 Points in national ranking. Double any other state in the WORST TEN. Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1995-2007. CDC WONDER On-line Database, compiled from Compressed Mortality File Series 20 No. 2M, 2010. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Aug 15, 2011 4:55:34 PM and using 2007 population as a constant for all comparisons.
  13. Coverage Coverage Patients in four states Entire VA VISN SE Practice Sites Now 220 Growing to 301 Patient Records Now ~2M Growing to ~3M
  14. Coverage: ~20% of SC adults on a path to ~47% of adults OQUIN Database contains 125 practice sites in South Carolina OQUIN Database contains patients in all but 3 SC Zip Codes
  15. Data Driven Quality reports that compare to national standards and OQUIN norms. Basic reports include: Heart and Stroke Diabetes Coronary Artery Disease Congestive Heart Failure Pediatrics Lean Six Sigma for Health Care education, certification and recognition. Rapid improvement cycles. Transforms data into information for action Focuses on outcomes
  16. An Example of one of the OQUIN Quality Reports
  17. Quality Reports and Certifications NCQA Report Providers can see at a glance how they are performing compared to NCQA Standards Confidential Report for each physician and provider Results by patient to identify potential actions and see results of actions taken Averages by category to identify areas for improvement and role model behavior Linked to Recognition programs and bonus payments
  18. Example Summary Reports For Certifications
  19. What can you do to partner with Primary Care? Prevention take all the prevention you can get workplace wellness (worksite wellness reduces absenteeism, health care, disability/workers’ comp by 25% preventive care included in insurance coverage Patient engagement in managing their health Team care everyone preforms at the top of their license (CNA, RN, MD, NP, Social Worker, Case Manager) Optimize Technology facilitated relay, Electronic Health Records, Portals Reward for outcomes not activities recognize and reward physicians/providers who have outstanding outcomes award bonuses to the outstanding physicians/providers
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