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Leading Edge Opportunities in Health Care and Medicine: Using Data to Increase Value

Leading Edge Opportunities in Health Care and Medicine: Using Data to Increase Value. Bob Gluckman, MD, FACP CMO- Providence Health Plan January 25, 2013. Exhibit 1. International Comparison of Spending on Health, 1980–2010. Average spending on health per capita ($US PPP).

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Leading Edge Opportunities in Health Care and Medicine: Using Data to Increase Value

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  1. Leading Edge Opportunities in Health Care and Medicine:Using Data to Increase Value Bob Gluckman, MD, FACP CMO- Providence Health Plan January 25, 2013

  2. Exhibit 1. International Comparison of Spending on Health, 1980–2010 Average spending on healthper capita ($US PPP) Total health expenditures aspercent of GDP Notes: PPP = purchasing power parity; GDP = gross domestic product. Source: Commonwealth Fund, based on OECD Health Data 2012.

  3. Exhibit 3. Premiums Rising Faster Than Inflation and Wages Cumulative changes in insurance premiums and workers’ earnings, 1999–2012 Projected average family premium as a percentage of median family income, 2013–2021 Percent Percent 180% 172% 47% 38% Projected Sources: (left) Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits Annual Surveys, 1999–2012; (right) authors’ estimates based on CPS ASEC 2001–12, Kaiser/HRET 2001–12, CMS OACT 2012–21.

  4. Case and Disease ManagementHealth Care Cost Continuum - Why We Focus on Specific members 1% of People 30% Total Cost 10% Total Cost 0% Total Cost % of People  20% of People 70% of People Source: Milliman USA Health Cost Guidelines—2001 Claim Probability Distributions.

  5. JAMA 2012;307:1513-1516

  6. Exhibit 7. Synergistic Strategy: Cumulative Savings, 2013–2023 Notes: SGR = sustainable growth rate formula; GDP = gross domestic product. * Malpractice policy savings included with provider payment policies. ** Target policy was not scored.

  7. Seven Megatrends That Will Influence the Healthcare Industry • Demanding demographics • Aging, obesity, income inequality • Strategic globalization • Competitive global economy, medical tourism • Unconstrained connectivity • Personal health records, smartphone apps • Accelerated consolidation • ? Impact on cost www.medcitynews.com/?s=keckley

  8. Seven Megatrends That Will Influence the Healthcare Industry • Constrained resources • Limited public budget, inability to shift costs • Consumer discontent • Cost sharing, mistrust of government, payers, providers • Big data • Ability to aggregate data to demonstrate quality and cost variation

  9. Integrating Claims and Clinical Data to Improve Quality and Lower Cost Cardiology

  10. Appropriateness of Diagnostic Angiography Retrospective analysis of 565,504 patients without previous MI or revascularization from 2005-2008 undergoing elective coronary angiography JACC 2011;58:801-809

  11. Cardiology- Practice Variation

  12. Cardiac Procedure Rates by Top 6 Regions (Jan 2010-Sep 2011)Data from Large Employer

  13. CAD Presentation in Patients Receiving Diagnostic Coronary Angiography

  14. CAD Presentation in Patients Receiving PCI

  15. Two or More Anti-Anginal Meds in PCI Patients without ACS

  16. Cardiology I = Inappropriate U = Uncertain A = Appropriate Note: 100% Agreement on Class I and Class III Guidelines

  17. Large Statewide Employer Caths/1,000 in a High Use Community

  18. Large Statewide Employer Stents/10,000 in a High Use Community

  19. Large Statewide Employer CABGs/10,000 in a High Use Community

  20. PEBB Cardiac Procedure Rates by Top 6 Regions (Jan 2010 - Dec 2011)

  21. Large Statewide Employer Cardiac Procedure Rates by Top 6 Regions (Jan 2012 – Sep 2012)

  22. CAD Presentation in Patients Receiving PCI

  23. Test performed by cardiologist within 30 days of cardiologist office visit

  24. Integrating Patient Outcome Data to Improve Care Orthopedics and Neurosurgery

  25. Total Joint Replacement and Spine Surgery • Add pre-operative and 6 month post-op standardized assessment of pain and functional status • WOMAC- TJR • OSWESTRY- LS Surgery • NDI- cervical spine surgery

  26. Using Data to Target Care to the Right Patients GI-Colonoscopy

  27. Cumulative Mortality from Colorectal Cancer in the General Population, as Compared with the Adenoma and Nonadenoma Cohorts. Zauber AG et al. N Engl J Med 2012;366:687-696

  28. Colonoscopy vs. Fecal Immunochemical Testing in Colorectal Cancer Screening

  29. Rate of high grade dysplasia or cancer with 5 year surveillance colonoscopy Complication rate requiring surgery approximately 1 per thousand procedures Gastroenterology 2007; 133; 1077-85

  30. PHP Diagnosis Associated with Colonoscopy: 2011-12

  31. Is this a shared decision making opportunity? • A collaborative process between patients and physicians • Uses best scientific evidence • Considers patient values and preferences

  32. Final Thoughts • Data can inform physicians on current practice and opportunities to improve value • Transparency needed to better inform patients and physicians on how practice variation impacts the value of care • Payment reform required to create better value • Improving value essential to pay for new treatment

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