Post on 01-Jan-2022
transcript
California Regional Health Care Cost & Quality Atlas Jeff Rideout MD, MA, FACPPresident and CEO
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The Integrated Healthcare Association (IHA)- a 501(c)6, NFP founded in 1994- advancing integrated care
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IHA’s Align. Measure. Perform. (AMP) & Atlas
AMP• Measures: 50 highly aligned
measures of clinical quality, utilization, total cost of care
• Who’s Included: Commercial HMO, commercial ACO, Medicare Advantage, and Managed Medi-Cal
• What’s Viewable: physician organization level performance
Atlas• Measures: Over two dozen
standardized measures of clinical quality, utilization, total cost of care
• Who’s Included: 29 million Californians inclusive of commercial HMO, PPO, Medicare FFS, Medicare Advantage and Medi-Cal
• What’s Viewable: geographic and product line performance information
Built on a single data platform with standardization throughout
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Key Takeaways from Atlas and AMP Analysis
• There is wide variation in quality and cost in California that is persistent over time
regardless of health plan product or provider delivery model
• Northern California and urban areas generally perform better on quality
• Southern California generally performs better on cost
• Less variation in Medi-Cal; comparability to commercial and MA is limited
• Health plan products that use integrated networks show superior cost and quality
overall and much lower patient cost sharing
• Financial risk sharing (capitation) between plans and providers tracks to higher
quality and lower costs—the more capitation, the better the performance
• Accountable Care Organizations (“ACOs”) have variable cost and quality performance but are
superior to non-integrated care networks
• Lack of Medi-Cal data limits Atlas’ ability to do comparable analysis
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Chronic Care Management - Wide Variation*-same pattern for preventive health screenings
* Lower is Better
0102030405060708090
100
Diabetes Care:Blood Sugar
Control <8.0%
Diabetes Care:Poorly
ControlledBlood Sugar*
Appropriate Useof Imaging
Studies for LowBack Pain
AsthmaMedication
Ratio
Diabetes Care:Kidney Disease
Monitoring
Diabetes Care:Blood SugarScreening
Perfo
rman
ce R
ate
(%)
State Average
0102030405060708090
100
Diabetes Care:Blood Sugar
Control <8.0%
Diabetes Care:Poorly
ControlledBlood Sugar*
Appropriate Useof Imaging
Studies for LowBack Pain
AsthmaMedication
Ratio
Diabetes Care:Kidney Disease
Monitoring
Diabetes Care:Blood SugarScreening
Perfo
rman
ce R
ate
(%)
State Average
0102030405060708090
100
Diabetes Care:Blood Sugar
Control <8.0%
Diabetes Care:Poorly
ControlledBlood Sugar*
Appropriate Useof Imaging
Studies for LowBack Pain
AsthmaMedication
Ratio
Diabetes Care:Kidney Disease
Monitoring
Diabetes Care:Blood SugarScreening
Perfo
rman
ce R
ate
(%)
State Average
0102030405060708090
100
Diabetes Care:Blood Sugar
Control <8.0%
Diabetes Care:Poorly
ControlledBlood Sugar*
Appropriate Useof Imaging
Studies for LowBack Pain
AsthmaMedication
Ratio
Diabetes Care:Kidney Disease
Monitoring
Diabetes Care:Blood SugarScreening
Perfo
rman
ce R
ate
(%)
State Average
Los Angeles County
Santa Clara
CountyNorth Bay Counties
Alameda County
Contra Costa County
Alameda County
*commercial enrollees
3000
4000
5000
6000
Northern Central SouthernRis
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average
3000
4000
5000
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Northern Central SouthernRis
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average
3000
4000
5000
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Northern Central SouthernRis
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average
Wide Variation in Cost within and between CA Regions*-available at the county or Covered CA regional level
*commercial enrollees
The Delivery Model Matters - Integrated Care Outperforms (typically HMO)*
0
10
20
30
40
50
60
70
80
90
100D
iabe
tes
Car
e: H
bA1c
Con
trol
Rat
e
18% difference
Integrated Care
Average55.65%
Best Integrated Care Average65.17%
Statewide Average47.11%
Highest Regional Average55.71%
78,500 More Diabetics with Blood Sugar Controlled
*commercial enrollees
Commercial Cost Breakdowns
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Another View - Degree of Financial Risk Sharing Impact on Quality & Cost*
BE
TT
ER
ßR
isk A
dju
ste
d T
CC
($
PM
PY
) à
WO
RS
E
OR
SE
ßA
ve
rag
e C
lin
ica
l Q
ua
lity
Ra
te (
%) à
BE
TT
ER
No Risk (FFS) Professional Risk Only Full Risk
4,300
4,400
4,500
4,600
4,700
4,800
4,900
5,000
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63
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4,300
4,400
4,500
4,600
4,700
4,800
4,900
5,000
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63
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commercial enrollees
W
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Medi-Cal Measurement - an Atlas Outlier Now
What Would High Value Care in California Deliver?
If care for all commercially insured Californians were provided at the same quality as the top-performing region:
205,000 more people would have been screened for colorectal cancer
30,500 more women would have been screened for breast cancer
If care were provided at the same cost as a relatively high-quality, low-cost region:
overall cost of care would decrease by an estimated $6.2 billion annually, a >10% decrease
Atlas 3 will be released in early April, t
hen annually going forward
Possible Actions*
• Focus investments on geographies and conditions in most need of improvement• Help define a uniform and practical definition of “value”• Support higher value care through plan designs and provider networks• Preferentially support integrated care models and financial risk sharing between
plans and providers• Drive full inclusion of Medi-Cal data into the Atlas program
*more complete list provided as a handout
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Questions?