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Health System Improvement Opportunities In Louisiana: Analysis Through the Lens of Unwarranted Variation

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Health System Improvement Opportunities In Louisiana: Analysis Through the Lens of Unwarranted Variation. June 9, 2008. Unwarranted Variation. Geographic variation that cannot be explained by illness or need, the dictates of evidence based medicine, or patient preferences*.

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Health System Improvement Opportunities In Louisiana: Analysis Through the Lens of Unwarranted Variation

June 9, 2008

unwarranted variation
Unwarranted Variation

Geographic variation that cannot be explained by illness or need, the dictates of evidence based medicine, or patient preferences*

Effective Care – includes services of proven clinical effectiveness derived from randomized controlled trials (traditionally defined measures of quality)

Preference-Sensitive Care – conditions for which treatment options exist that carry significant tradeoffs in terms of risks and benefits for the patient

Supply-Sensitive Care – care where the amount given is strongly correlated with health system resource capacity (efficiency)

*Dartmouth Atlas of Health Care: http://www.dartmouthatlas.org/agenda.shtm

project impetus and purpose
Project Impetus and Purpose
  • Louisiana Health Care Redesign Collaborative - strategy for New Orleans and State
  • The Blue Cross Blue Shield of Louisiana (BCBSLA) Foundation & Tulane – utilize data to inform decisions
  • Health Dialog – build a multi-payer data warehouse using pre-storm data for benchmarking and analysis
distribution of flooding orleans neighborhoods post storm
Distribution of FloodingOrleans Neighborhoods (post-storm)
  • Population decrease of almost 50%
  • Primary Care Physician decrease of 50%
  • Hospital inpatient capacity decrease of 80%

Health care issues in Louisiana did not start with Hurricanes Katrina or Rita

data warehouse 2 3 million state residents 2005 pre storm
Data Warehouse:2.3 Million State Residents, 2005 (pre-storm)
  • 2005 total State population: 4.5 million*
  • Data represents complete Medicare & Medicaid eligibility files
    • 977,000 Medicaid beneficiaries
    • 584,000 Medicare beneficiaries
    • 100,000 Dual-eligibles
  • Private/BCBSLA data fully-insured book of business
    • 591,000 members

Data Warehouse Payer Mix

*U.S. Census Bureau (www.census.gov/popest/states/tables/NST-EST2005-01.xls)

geographic units of analysis
8 –

Northeast

7 –

Northwest

6 –

Central

9 –

Northshore

2-

Baton

Rouge

5–

Southwest

4-

Acadiana

1-

New Orleans

3-

Houma

Geographic Units of Analysis

LA Department of Health and Hospital’s health care regions

HospitalService Areas*

*Dartmouth Atlas defined empirically derived local health care markets (67 in LA)

utilization variation by region population with chronic disease admits 1 000
Utilization Variation by Region: Population with Chronic Disease – Admits/1,000
  • Average: 750 Admits/1,000

*Age & sex adjusted

does chronic disease influence utilization variation
Does chronic disease influence utilization variation?

Variation in Healthcare Utilization for Chronic Disease* & Non-chronic Populations - Children

  • Diamonds represent Louisiana Hospital Services Areas (HSAs) with ≥ 10,000 people

Natchitoches

Bogalusa

*Chronics: CHF, COPD, Diabetes, Asthma, CAD

does insurance type influence utilization variation
Does insurance type influence utilization variation?

Variation in Healthcare Utilization by Payer: Admission Rates for Children – Medicaid vs. Private

  • Diamonds represent Louisiana Hospital Services Areas (HSAs) with ≥ 45,000 people

Alexandria

New Orleans

does race influence cost variation
1.72x

2.11x

Does race influence cost variation?

Medicare Variation: Impact of Race on Cost

  • Diamonds represent Louisiana Hospital Services Areas (HSAs) with ≥ 45,000 people
  • Only Medicare claims data identifies race
is there a correlation between cost and quality
R² =0.24Is there a correlation between cost and quality?

Quality & Cost – Beta Blocker Adherence & Annual Expenditures for CAD Patients

  • Average Beta blocker use 56%
  • Average cost $27,000
variation in preference sensitive care
Variation in Preference Sensitive Care

Preference Sensitive Care: Back Surgery Rates/1,000

  • The Statewide average is approximately 3/1,000
  • A 6-fold difference exists between the highest and lowest HSAs
  • Diamonds represent Louisiana Hospital Services Areas (HSAs) with ≥ 10,000 people
summary of findings
Summary of Findings
  • Prior to Hurricane Katrina, significant geographic variation in utilization, cost, and quality existed within Louisiana
    • Not due to conditions, payer, race, or gender
  • Higher costs are not correlated with higher quality
  • Significant variation in Preference Sensitive Care exists throughout the State
  • Local health care system factors play a significant role in Unwarranted Variation
    • Supply
    • Idiosyncratic decisions by providers
  • Louisiana Health Care Quality Forum adopting project as part of mission to help improve quality in the State
    • Report available at LHCQF.ORG
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