Transcript Employer Update - North Carolina Medical Society

North Carolina BTE
Collaborative
August 7, 2009
George Chedraoui
BTE Consultant
NC Status
Region
Eligible #
Physicians
Potential #
Patients Affected
Potential Rewards
Amounts
Charlotte
2,051
59,529
$2.9 million
 POL -190
396 physicians have 63%
of the reward/savings
potential
 DCL – 298
RTP
2,001
27,130
$1.4 million
136 physicians have 41%
of the reward/savings
potential
Date Paid
Total Reward Amt
1Q08
$20,480
2Q08
$23,130
3Q08
$38,185
4Q08
$95,815
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Physician
Recognitions
 CCL - 199
 POL - 76
 DCL – 139
 CCL - 42
 RTP increased from 19 to 258 recognized
physicians since 2006. 13% of the eligible
physicians are recognized.
 396 physicians have 63% of the reward/savings
potential
Charlotte increased from 91 to 687 recognized
physicians since 2006. 34% of the eligible
physicians are recognized.
 136 physicians have 41% of the reward/savings
potential
Page 2
Health Plan Partnerships
 BCBSNC – Completed state-wide pilot of 3 BTE programs.
Supporting BTE implementation for ASO customers. Working
on integrating BTE and NCQA programs into overall physician
performance assessment.
 Aetna – BTE baked in to Aexcel as a means to identify high
performing specialists. Rewards paid on full book of business
in select states. Supporting ASO customers in regional
implementations
 CIGNA – Supporting BTE implementations in various regions
for ASO customers. Working on network-wide incentive
program using BTE programs as a part of how physician
performance is assessed
 UHC – Supporting ASO customers in various regional
implementations. Working on baking in BTE recognitions as
part of overall physician performance assessment in Premium
Network designation.
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Page 3
Physicians increasingly have more options for BTE
assessment through existing reporting initiatives
Cincinnati
ABIM
Cleveland
NYC
DOH
Meridios
Athena
EPIC
BTE
MNCM
CINA
IPRO
eCW
DocSite
MAeHC
BioSignia
Allscripts
NextGen
GE
NCQA
Physician
A
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Physician
B
Physician
C
Page 4
The additional technologies and BTE Care Links
will increase the number of physicians assessed
I.
NCQA Provider Recognition
Programs ($400)
II.

III.

IV.

BTE Automated Performance
Assessment through MNCM &
IPRO ($ Free)
Data aggregator (e.g. EMR,
registry, decision support tool
vendor) data submission
BTE-IPRO Direct Data Submission
Portal
Physician upload of standardized
file format ($95)
American Board of Internal
Medicine ($95))
Elect to supplement sample for
Performance Improvement
Module (PIM) data for submission
through IPRO portal
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Program/
Pathway
NCQA
EMR
Portal
ABIM PIM
Diabetes




Cardiac



Hypertension


CAD


CHF


Asthma


COPD




Spine

POL/Systems
Use


Page 5
We Used To Think These Forces Were The Main
Drivers of Costs. They Are, But……
Waste due to
Medical Technology
emerging at an accelerated
rate
information
deficiencies and
defensive medicine
drive overall
medical costs
Crisis in
Primary care
Consumer
Behavior
Access limitations,
failing office
economics, flight to
sub-specialty fields
Lifestyle choices and
cost sharing
Labor Shortage
Medical Errors
affect the quality of
care and increase
costs; malpractice
Costs of
Uninsured
Provider & health plan
consolidation
Prescription
drug costs
continue to grow
significantly
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Page 6
Potentially Avoidable Complications (PAC) consume
close to 50¢ out of every chronic care dollar
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Prometheus Payment, April 2009
CHF
Diabetes CAD
COPD Asthma
HTN
Overall
The results of an analysis for a large employer in one state showed that
$150MM, or roughly $1,700 per chronic care patient could be saved if PACs
were reduced to zero
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Page 7
Diabetes costs for a large employer
$55,000,000
Typical
$110,000,000
$55,000,000
• Average total
cost is ~ $6,000
• 89% of patients
have some
avoidable costs
Care
Defects
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Page 8
North Carolina PACs
35,000
30,000
25,000
20,000
Potentially Avoidablce
Costs
15,000
10,000
Typical Costs
5,000
0
F
s
a
D
D
n
a
CH OP ete s io CA thm hm
C iab en
s Ast
t
A
r
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Page 9
North Carolina PACs
Condition
Typical NC
Costs
Potentially
Avoidable
NC Cost
Total NC
Episode
Cost
Rate of NC
PAC to
Total
CHF
7,259
25,931
33,189
78%
COPD
4,924
7,077
12,001
59%
Diabetes
5,970
5,540
11,509
48%
Hypertension
2,334
565
2,899
19%
CAD
8,654
3,349
12,003
28%
Adult Asthma
1,194
949
2,144
44%
Child Asthma
4,334
3,556
7,890
45%
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Page 10
North Carolina Opportunity for Savings
Best in
Country
PAC rate
Yearly per patient savings
Reducing PACs by
Potential
savings per
NC patient
6.00%
10.00%
15.00%
$1,556
$2,593
$3,890
CHF
35%
$11,616
$425
$708
$1,062
COPD
33%
$3,960
$332
$554
$831
DIA
21%
$2,417
$34
$56
$85
HTN
12%
$348
$201
$335
$502
CAD
11%
$1,320
$57
$95
$142
ADLT
20%
$429
$213
$356
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$533
CHLD
25%
$1,972
Page 11
Bridges to Excellence Achieves Value
Recognized physicians deliver better quality care:
 Their submission and scoring of medical record data
confirms this fact
 Less variations in practice pattern
Recognized physicians deliver lower cost of care:
 Patients seen by Diabetes Care Link physicians are 20%
less likely to have an acute flare up (less defects).
 The average savings for physicians recognized under the
Physician Office Link is $363 per patient per year
 The real transformation occurs when the programs are
used together to drive systems use towards patient
improvement.
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Page 12
The key to positive ROI is to payout less
than what you save
 These defects can be calculated for any condition
by practice/group with more than 500 patients
having that condition.
 For smaller practices, budgets per patient can be
estimated prospectively as well as total bonus
opportunities.
 Incentives get tied tightly to reductions in costs
caused by care defects. The greater the
decrease in these costs, the higher the bonus,
and the greater the savings
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Page 13
Employer Savings
To be successful in changing behaviors
we have to continuously up the ante
Defect
reductionbased
incentives
Case
rates/Episode
of care
payment
Fixed bonus
Provider Risk & Reward
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Page 14
Closing thoughts
 You can’t go up the glide path if you’re not on it –
NC Collaborative and BTE have gotten us on and
will keep us moving!
 The forces of the status quo have been greater
than the forces of change….however that’s
changing.
 If you don’t know how much money is currently
being spent on avoidable complications (care
defects), then how can you increase value in any
significant way?
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Page 15