View
191
Download
0
Category
Preview:
DESCRIPTION
Citation preview
1
The Myra Kraft Open Classroom Series Fall 2013: Policy for a Healthy America
Every Wednesday, 6pm – 8pmSeptember 4, 2013 through December 4, 2013
West Village F, Room 20
Northeastern UniversitySchool of Public Policy and Urban Affairs
This Week (October 16, 2013)
School of Public Policy & Urban Affairs | Northeastern University
“Why Paying Physicians and Hospitals for their Performance Scares Everyone”
Gary Young, JD, PhDDirector of The Center for Health Policy
and Healthcare Research and Professor of Strategic Management and Healthcare
Systems, Northeastern University
Sarah Iselin, MSSenior Vice President of Strategy, Policy and Community Partnerships and Chief Strategy Officer, Blue Cross Blue Shield
of Massachusetts
School of Public Policy & Urban Affairs | Northeastern University
4
US Health Care Reform: Paying for Value Not Volume
Gary Young, J.D., Ph.D.
Center for Health Policy and Healthcare Research,
School of Business and College of Health Sciences,
Northeastern University
Health Policy Open ClassroomOctober 16, 2013
5
Paying for Health Care Services in the US
• Fee-for-Service
• Diagnostic Related Groups
• Capitation
• Pay-for-Performance (P4P)
• Value-based purchasing through global payment
6
6
Why P4P in Health Care?
Quality problems
Escalating costs – business case for quality
7
8
9
10
What is P4P? Financial incentive
Assigned performance targets – (quality, efficiency)– e.g., annual blood sugar test for patients with
diabetes
Target recipient/Unit of accountability – individuals, teams, organizations
11
P4P: Centerpiece of US Health Policy
Over 200 P4P programs in private sector
Over half of state Medicaid programs have adopted P4P
ACA – Medicare value-based purchasing– Provider-specific P4P programs
– Accountable care organization (ACO) shared savings program
12
ACA – Provider-Specific Programs
• Law requires implementation of VBP:
-- for most hospitals in 2012,
-- physicians in 2015, and
-- the planning of P4P for nursing homes, home health agencies, and other types of organizations
13
ACA – Outline of Medicare P4P for Hospitals
• Funding: Budget neutral as funded from reduction in DRG payments -- initially 1% reduction in DRG payments transitioning to a 2% reduction in 2017. • Performance measures: clinical process measures; patient experience, patient outcome measures (2014); efficiency (2014).
• Performance standards for both achievement and improvement.
• Incentive payments: A hospital’s performance score determines the percentage of the DRG payments it earns as an incentive payment.
14
Medicare Hospital P4P: Examples of Measures
Clinical process– Prophylactic antibiotics for surgical patients within one
hour of surgery– Discharge instructions for patients w/ heart failure
Clinical outcome– Mortality for heart attack, heart failure
Patient experience– Pain management– Communication about medicines
15
ACA -- ACO Shared Savings
ACO bears financial risk for spending in excess of a budget.
ACO gains for reducing spending below budget.
ACO receives bonuses for meeting designated performance targets on quality measures including measures to promote population health (e.g., influenza immunization, colorectal cancer screening.
16Global Payment/ACO
Private-Sector Initiatives
Blue Cross Blue Shield of Massachusetts Alternative Quality Contract
17
17
18
Are Providers Scared?
19
Physicians should be rewarded financially when they provide higher quality care.
4.9%
5.1%
5.7%
10.4%
13.5%
6.7%
54.2%
40.5%
43.3%
26.0%
35.6%
42.1%
5.3%
4.5%
2.2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Rochester
Mass
California
Percent of Respondents
Strongly Disagree Disagree Neutral Agree Strongly Agree
General Attitudes Toward VBP
20
Financial incentives are an effective way to improve the quality of health care.
7.0%
8.4%
19.5%
21.2%
18.8%
45.6%
39.8%
44.6%
11.2%
13.6%
23.0%4.8% 8.8%
16.7%
17.1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Rochester
Mass
California
Percent of Respondents
Strongly Disagree Disagree Neutral Agree Strongly Agree
General Attitudes Toward VBP
21
Should You be Scared? P4P may not work
Unintended consequences
– Patient selection
– Teach to the test
22
Limited Evidence that P4P WorksSelected Findings:
– Rosenthal et al. (2006) Relative increase of 3.6 percentage points for cervical cancer screening.
– Young et al. (2007) Absolute increase of 7 percentage points for diabetes measure (e.g., eye exam).
_ Lindenauer et al. (2007) Relative increase of 2.6 percentage points for AMI measures; 3.4 points for pneumonia measures; 4.1 points for heart failure measures.
-- Petersen et al. (2013) Relative increase of 8.3 percentage points.
--Jha et al. (2012) No improvement in hospital mortality rates for cardiac care or pneumonia.
23Pre-Post Study of Diabetes Quality
IndicatorsDiabetes Measures (Annual) n = 334 1999 2004
Change in %
Points
HbA1c measurement – 2 tests annually
56% 63% +7%
Microalbumin or urinalysis 61% 70% +9%
LDL cholesterol level 58% 79% +21%
Retinal exam – 1 test annually 40% 54% +14%
24
Overview: Six-Year Trends in RIPA Diabetes Care(n=334)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1999 2000 2001 2002 2003 2004
Mea
n A
dh
eren
ce R
ate
(pat
ien
ts p
er p
hys
icia
n)
HbA1c Check Urinalysis LDL Check Retinal Exam
Pre-Incentive Post-Incentive
25
What are the Barriers ? Money may not be an effective motivator in the long
run. -- Some providers may perceive significant tradeoffs between money and autonomy. -- Monetizing quality may not be sustainable and even counter productive.
Infrastructure and training may be inadequate.
Our knowledge for designing programs may be insufficient.– Who should be incentivized and by how much?– How should we structure incentives and performance
measures?
26
Overview: Six-Year Trends in RIPA Diabetes Care(n=334)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1999 2000 2001 2002 2003 2004
Mea
n A
dh
eren
ce R
ate
(pat
ien
ts p
er p
hys
icia
n)
HbA1c Check Urinalysis LDL Check Retinal Exam
Pre-Incentive Post-Incentive
27
28
29
Table 2. Overall change in performance measures from initial to final measurement among VA
facilities.
Measure
Adoption of Performance-based
Incentives
Removal of Performance-based
Incentives
First
Quarter
Last
Quarter
Absolute
Difference P Value
First
Quarter
Last
Quarter
Absolute
Difference P Value
Cardiology Involvement 74 94 20 <.001 90 91 1 0.93
Troponin Returned 74 96 22 <.001 94 92 -2 0.35
Diagnostic
Catheterization84 95 11 <.001
9493
-10.26
ACEI or ARB 89 92 3 0.26 90 89 -1 0.50
Weight Monitoring 80 92 12 <.001 91 93 -2 0.11
Timely Antibiotic 53 82 29 <.001 81 84 3 0.06
Pneumococcal
Immunization85 92 7 <.001
8992
30.05
Are Any Improvements Sustainable in the Long Run?
30
2004 2005 2006 2007 2008 2009 20100.4
0.5
0.6
0.7
0.8
0.9
1 Figure 1C. Pneumonia
Pneumococcal Immunization
Fiscal Year (Oct-Sep)
Per
form
ance
(%)
2004 2005 2006 2007 2008 2009 2010 20110.600000000000001
0.650000000000001
0.700000000000001
0.750000000000001
0.800000000000001
0.850000000000001
0.900000000000001
0.950000000000001
1 Figure 1B. Heart Failure
Weight Monitor-ing
Fiscal Year (Oct-Sept)
Per
form
ance
(%)
2004 2005 2006 2007 2008 2009 2010 20110.4
0.5
0.6
0.7
0.8
0.9
1 Figure 1A. Acute Coronary Syndrome
Diagnostic CatheterizationLinear (Diagnostic Catheter-ization)
Fiscal Year (Oct-Sep)
Per
form
ance
(%)
31What About Unintended
Consequences?
Unintended Consequences
--Patient selection
--Teaching to the test
32
What Does the Future Hold?
No turning back (why be scared of stepping into the dark when you are already wearing a blindfold)
More experimentation -- payment incentives to keep people healthy!
Strong cooperation needed between purchasers and providers
– Dollars per quality adjusted life years
School of Public Policy & Urban Affairs | Northeastern University
Sarah IselinOctober 16, 2013Northeastern University Open Classroom Series
HEALTH REFORM IN MASSACHUSETTS: THE ROAD TO PAYMENT REFORM
35Blue Cross Blue Shield of Massachusetts
Massachusetts Now Has the Lowest Rate of Uninsurance in the Country
Series1
5.9%6.7%
7.4%6.4%
5.7%
2.6% 2.7%2.0%
3.1%
13.1%13.9% 14.3%
15.2% 14.7% 14.9%16.1% 16.3% 15.7%
2011
PERCENT UNINSURED, ALL AGES
2000 2002 2004 2006 2007 2008 2009 2010
U.S.AVERAGE
NOTE: The Massachusetts specific results are from a state-funded survey — the Massachusetts Health Insurance Survey (MHIS). Using a different methodology, researchers at the Urban Institute estimated that 507,000 Massachusetts residents were uninsured in 2005, or approximately 8.1 percent of the total population. Starting in 2008, the MHIS sampling methodology and survey questionnaire were enhanced. These changes may affect comparability of the 2008 and later results to prior years. The national comparison presented here utilizes a different survey methodology, the Current Population Survey, which is known to undercount Medicaid enrollment in some states.
SOURCES: Urban Institute, Health Insurance Coverage and the Uninsured in Massachusetts: An Update Based on 2005 Current Population Survey Data In Massachusetts , 2007; Massachusetts Center for Health Information and Analysis (formerly the Division of Health Care Finance and Policy), Massachusetts Health Insurance Survey 2000, 2002, 2004, 2006, 2007, 2008, 2009, 2010, 2011; U.S. Census Bureau, Current Population Survey, Health Insurance Historical Tables (HIB Series).
MASS.
36Blue Cross Blue Shield of Massachusetts
But the Highest Per PersonHealth Care Spending…PER CAPITA PERSONAL HEALTH CARE EXPENDITURES, 2009
NOTE: District of Columbia is not included.SOURCE: Centers for Medicare & Medicaid Services, Health Expenditures by State of Residence, CMS, 2011.
UT AZ GA ID NV TX CO AR CA AL VA SC TN NC OK MS OR KY MI MT NM IN IL KS WA LA HI IA MO WY NE SD OH FL WI MN MD NJ VT WV PA ND NH RI NY DE ME CT AK MA$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
State
NATIONAL AVERAGE
37Blue Cross Blue Shield of Massachusetts
…In the World
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
Massachusetts
United States
Germany
Canada
France
Australia
United Kingdom
NOTE: U.S. dollars are current-year values. Other currencies are converted based on purchasing power parity.SOURCE: OECD Health Data; National Health Expenditures by State of Residence, CMS Office of the Actuary, 2011.
38Blue Cross Blue Shield of Massachusetts
Though Health Reform Helped, Costs Are Still a Problem for Many Massachusetts Residents
SOURCES: Massachusetts Health Reform Survey, 2010
Had Out-of-Pocket Spending at or Above 10% Family Income
Had Problems Paying Medical Bills Had Medical Debt
10%
19% 19%
6%
18%
20%
2006 2010
39Blue Cross Blue Shield of Massachusetts
With Wages Stagnant, Increasing Health Care CostsConsume a Greater Portion of Household Budgets
MASSACHUSETTS PER CAPITA PERSONAL HEALTH EXPENDITURES AND MEDIAN INCOME, 1999-2009
NOTE: Health care expenditures and household income reported in current year (unadjusted) dollars.SOURCES: Data for health care expenditures from CMS, Health Expenditures by State of Residence, 1991-2009. Data for median income from U.S. Census Bureau, State Median Income.
Year1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$4,865$5,149
$5,590$6,094
$6,556$6,988
$7,436
$8,002
$8,568$8,926
$9,277
$44,005 $46,753
$52,253 $49,855 $50,955 $52,019
$56,017 $55,330 $58,463 $60,320 $59,375
MA PER CAPITA PERSONAL HEALTH CARE EXPENDITURES MA MEDIAN HOUSEHOLD INCOME
40Blue Cross Blue Shield of Massachusetts
The Increasing Costs of Health Care Squeeze Out Other Public Spending Priorities, Too
STATE BUDGET, FY2001 VS. FY2011 (BILLIONS OF DOLLARS)
NOTE: Dollar figures are inflation adjusted using a measure specific to government spending as developed by the U.S. Bureau of Labor and Statistics.SOURCE: Massachusetts Budget and Policy Center Budget Browser.
Series1$0
$2
$4
$6
$8
$10
$12
$14
$16FY2011FY2001
+$5.1 B(+59%)
-38% -33%
-15%
-23%
-13%
-50%
-11%
-$4.0 B(-20%)
Health Coverage(State Employees/GIC;
Medicaid/Health Reform)
PublicHealth
MentalHealth
Education Infrastructure/Housing
HumanServices
LocalAid
PublicSafety
41Blue Cross Blue Shield of Massachusetts
Costs Are the Most Important Health Care Issue for Massachusetts Residents
PLEASE TELL ME IF YOU CONSIDER IT TO BE A CRISIS, A MAJOR PROBLEM, A MINOR PROBLEM, OR NOT A PROBLEM IN THE STATE OF MASSACHUSETTS.
5%
11%
14%
25%
26%
22%
32%
53%
High cost of health care
Limited ability to get needed health care
Low quality of health care services
Long wait time for medical appointments
Crisis Major problem
78%
46%
33%
31%
QA
SOURCE: Blendon, R.J et al., “Public Perceptions of Health Care Costs in Massachusetts,” October 2011
42Blue Cross Blue Shield of Massachusetts
Key Affordability/Cost-Related Developments in Massachusetts
Health reform passes (Ch. 58)– Begins path
to near universal coverage
Much of Chapter 58 enacted, e.g.:– MassHealth
expansion– Commonwealth
Care– Consumer
affordability schedule
– New health plan options for young adults
– Employer Fair Share
Cost Containment Part 1 (Ch. 305) passes– Increased
transparency about cost drivers
– Reports on health insurer and hospital “reserves”
Special Commission on Payment Reform– Recommends
move to global payment
Government reports and hearings on cost drivers
Governor rejects small group premiums
Cost Containment Part 2 (Ch. 288) passes– Aims to control
premiums for small businesses, individuals
Governor Patrick files payment reform legislation
Special Commission on Provider Price Reform
Cost Containment Part 3 (Ch. 224) passes– Statewide cost
growth targets and payment reforms
– Continued focus on data transparency
2006 2007 2008 2009 2010 2011 2012
43Blue Cross Blue Shield of Massachusetts
“How Effective Do You Think Each of the Following Policy Strategies Would Be In Improving U.S. Health System Performance (Improving Quality and/or Reducing Costs)?”
Fundamental provider payment reform with broader incentives to provide high-quality and efficient care over time
Increased competition among health care providers
Public reporting of information on provider quality and efficiency
Bonus payments for high-quality providers and/or efficient providers
Incentives for patients to choose high-quality, efficient providers
Increased government regulation of providers
More consumer cost-sharing 5%
9%
10%
15%
18%
14%
45%
14%
16%
18%
27%
35%
41%
40%
VERY EFFECTIVE EFFECTIVE
55%
85%
53%
42%
28%
25%
19%
SOURCE: Commonwealth Fund Health Care Opinion Leaders Survey, September/October 2008.
44Blue Cross Blue Shield of Massachusetts
Special Commission on the Health Care Payment System’s Recommendation
PATIENT-CENTERED GLOBALPAYMENT SYSTEM
THE SOLUTIONGlobal payments made to a group of providers for all care. Providers are not rewarded for delivering more care, but for delivering the right care to meet patient’s needs.
PRIMARY CARE
HOSPITAL
SPECIALIST
HOME HEALTH
$
CURRENT FEE-FOR-SERVICE PAYMENT SYSTEM
THE PROBLEMCare is fragmented instead of coordinated. Each provider is paid for doing work in isolation, and no one is responsible for coordinating care. Quality can suffer, costs rise and there is little accountability for either.
SPECIALIST PRIMARYCARE
HOMEHEALTH
HOSPITAL
GOVERNMENT, PAYERS AND PROVIDERS WILL SHARE RESPONSIBILITY FOR PROVIDINGINFRASTRUCTURE, LEGAL AND TECHNICAL SUPPORT TO PROVIDERS IN MAKING THIS TRANSITION.
$ $ $ $$
45Blue Cross Blue Shield of Massachusetts
2006
AQC TIMELINE
2007 2008 2009 2010 2011 2012 2013
LEGISLATIVE/GOV’T TIMELINE
Model developed
Jan 2009 First full contracts begin
Sept 2011 Year 1 results published
July 2012 Year 2 results published
~85% of network physicians participating in AQC
Health reform passes (Ch. 58)– Begins path to
near universal coverage
Cost Containment Part 1 (Ch. 305) passes– Increased
transparency about cost drivers
Special Commission on Payment Reform– Recommends
move to global payment
Government reports and hearings on cost drivers
Governor rejects small group premiums
Cost Containment Part 2 (Ch. 288) passes– Aims to control
premiums for small business, individuals
Governor Patrick files payment reform legislation
Payment Reform (Ch. 224) passes– Sets health
care cost growth target at state GDP
Ahead of the Curve – The Alternative Quality Contract
46Blue Cross Blue Shield of Massachusetts
The AQC Model
1. Global Budget• Based on historical total medical expenses• Annual inflation for each year of the five-year
contract period is defined up front and designed to continually moderate spending growth
2. Efficiency Opportunity• Budget constraint creates incentive to
carefully steward resource use• Provider organizations share in budget
savings and share risk for budget deficits
3. Quality Performance Incentive• Based on a broad set of nationally accepted,
validated measures of ambulatory and hospital care• Range of performance targets on each measure
reward “good to great” performanceYear 1 Year 2 Year 3 Year 4 Year 5
Provider Organization's Total Spending
Quality Performance Incentive (Illustrative)
Efficiency Opportunity (Illustrative)
Initial GlobalBudget Level
47Blue Cross Blue Shield of Massachusetts
The 60+ measures include:
Ambulatory Hospital
Process •Preventive screenings•Acute care management•Chronic care management
– Depression– Diabetes– Cardiovascular disease
Evidence-based care elements for: • Heart attack (AMI)• Heart failure (CHF)• Pneumonia• Surgical infection prevention
Outcome • Control of chronic conditions– Diabetes – Cardiovascular disease – Hypertension
***Triple weighted***
•Post-operative complications•Hospital-acquired infections•Obstetrical injury•Mortality (condition –specific)
Patient Experience
•Access, Integration•Communication, Whole-person care
•Discharge quality, Staff responsiveness•Communication (MDs, RNs)
Emerging Up to 3 measures on priority topics for which measures are lacking
AQC Measure Set for Performance Incentives
48Blue Cross Blue Shield of Massachusetts
Insurance Risk Versus Incentive Risk
• AQC aims to hold providers responsible for incentive risk—but not insurance risk
• BCBSMA employs several strategies to insulate providers from insurance risk in the AQC:– Health status adjustment– Use of network-wide trend as
benchmark for budget-setting– Prescription drug benefit
adjustment– Reinsurance requirements/
contract terms– Caps on provider liability for
budget deficits– Upside risk-only in payment for
quality performance
Insurance Risk• Variation in costs and outcomes due to
factors beyond providers’ control• Example: Flu pandemic
Incentive Risk• Variation in costs and outcomes due
to factors within providers’ control—care processes, unnecessary utilization, etc.
• Examples: HbA1c control among diabetics, ED use for ambulatory-care sensitive visits
49Blue Cross Blue Shield of Massachusetts
AQC Physician Participation
1,373 1,420
2,303
4,592
82%
2009 2010 2011 2012
2,577 2,618
5,065
11,731
86%
2009 2010 2011 2012
Primary Care Physicians
5,136
2013 2013
12,986
Specialty Care Physicians
50Blue Cross Blue Shield of Massachusetts
AQC Groups
51Blue Cross Blue Shield of Massachusetts
AQC Results: Lower Costs and Higher Quality
•AQC groups showed dramatic increases in quality, especially around measures of preventive care and chronic care management•Evaluations by researchers at Harvard Medical School found that spending in AQC groups was 1.9% lower in year one and 3.3% lower in year two when compared to non-AQC providers •There is evidence that these benefits largely extend to all practice members cared for by AQC physicians, regardless of whether they are BCBSMA members
52Blue Cross Blue Shield of Massachusetts
The AQC is Driving Changes in How Careis Delivered
Staffing ModelsApproaches to
Patient Engagement
Data Systems
Referral Relationships &
Integration Across Settings
There are four domains in which we see AQC Groups innovating to improve quality and outcomes while reducing overall spending
53Blue Cross Blue Shield of Massachusetts
AQC Provider Innovations
Select AQC Group Improvement Initiatives
Reducing Readmissions
•Enhanced care transitions program ensuring f/u visit w/i 14 days for members with chronic conditions. Embedding case managers in practices.
•Formal multifaceted aftercare program implemented; includes case manager outreach calls. Reduced readmit rate from 11.2% to 9.6% (2010 to 2011).
•Staff on call for members at home hospital’s ED: MD/NP responds to ED and manages patient’s care (most appropriate setting)
•Case managers making outreach calls to members who’ve had an ED visit
•Creating ED registry to notify PCP daily of patients using the ED providing opportunity to educate patient about proper use of ED and available alternatives
•Opening an urgent care center near hospital to reduce ED visits
•Creating physician ED profiles, focusing on improving same-day appointment access
•Practices increasingly offering w/e and evening hours.
Reducing ED Use
54Blue Cross Blue Shield of Massachusetts
Provider Experience
“This has allowed me to be a better doctor. And it's better for my patients."
Damian Folch, MDPrimary Care Physician
Lowell General PHO
“The contract is a way to support us as a physician group to help provide better care for our patients and care at a lower medical expense.”
Richard Lopez, MDChief Medical Officer, Atrius Health
Hear for yourself! Go to www.bluecrossma.com, select Visitor, and then click on: About Us>Making Quality Health Care Affordable.
55Blue Cross Blue Shield of Massachusetts
Member Experience
“We’re doing a lot of outreach to our members about the things they need to do for preventative care. We’re developing a rapport with these patients and they seem to like receiving that sort of ‘concierge service’ where they are actually the focus of the conversation when you call.”
-Stacey Neudeck, Lowell General Hospital
“The majority of the Blue Cross members know that something’s a little different, a little better – more of a personal touch. A few members with chronic diseases seem to be themost appreciative. They notice the extra time that the physician spends with them, and the extra phone calls, and they see the biggest difference in their health care experience.”
-Philip Gaziano, M.D., Accountable Care Associates
56Blue Cross Blue Shield of Massachusetts
Success Through Support: Components of the AQC support model
Data and Actionable
Reports
Consultative Support
Best Practice Sharing/
Collaboration Opportunities
Communication & Training
Our four-pronged support model is designed to help provider groups succeed in the AQC.
57Blue Cross Blue Shield of Massachusetts
How Much We Pay – Prices – Is Just as Important as the Way We Pay for Care
NOTES: 1) Reflects fully-insured commercial trend.2) “Utilization” reflects the number of services provided. “Provider Mix and Service Mix” reflect changes in providers and location of care (shift to more or less expensive providers) and the intensity of services provided. “Price” reflects increases in provider rates. SOURCE: Office of Attorney General Martha Coakley, March 2010, “Investigation of Health Care Cost Trends and Drivers.”
COST DRIVERS 2004-2008 FOR BCBSMAPERCENT INCREASE IN SPENDING DUE TO CHANGES IN UTILIZATION, PROVIDER/SERVICE MIX, AND PRICE
2004 2005 2006 2007 20080%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PRICE(amount providers get paid)
PROVIDER MIX AND SERVICE MIX
UTILIZATION(number of visits)
33.1%
53.3%58.0%
54.8% 53.8%
58Blue Cross Blue Shield of Massachusetts
Current Wave of Hospital Mergers and Consolidation May Increase Prices More
Lahey, Northeast Health finalize mergerBoston Business JournalDate: Monday, May 7, 2012, 6:51am EDT
Cooley Dickinson Trustees Choose Massachusetts General Hospital02/28/2012 10:07 AM
Steward Continues Buying Spree; Globe Reports Deal for Lowell HospitalApril 4, 2011 | 12:37 PM | By Carey Goldberg
Partners Looks to add hospitals in Medford, MelroseBY ROBERT WEISMANOCTOBER 9, 2013
Mass Health Watchdog Says Partners Merger Raises Red FlagsMay 22, 2013 | 3:41 PM | By Carey Goldberg
Beth Israel Deaconess acquires JordanBY TARYN LUNAAUGUST 01, 2013
59Blue Cross Blue Shield of Massachusetts
Striking the Right Balance?
School of Public Policy & Urban Affairs | Northeastern University
Any Questions?
Gary Young, JD, PhDDirector of The Center for Health Policy
and Healthcare Research and Professor of Strategic Management and Healthcare
Systems, Northeastern University
Sarah Iselin, MSSenior Vice President of Strategy, Policy and Community Partnerships and Chief Strategy Officer, Blue Cross Blue Shield
of Massachusetts
The Myra Kraft Open Classroom Series, Fall 2013: Policy for a Healthy AmericaOctober 16 – “Why Paying Physicians and Hospitals for their Performance Scares Everyone”
Next Week (October 23, 2013)
School of Public Policy & Urban Affairs | Northeastern University
Harry Chen, MDCommissioner, Vermont State
Department of Health; former practicing emergency physician and Medical
Director, Rutland Regional Medical Center (Rutland, VT)
Jim Hester, PhDDirector of Health Care Reform
Commission, Vermont State Legislature; former Director of Population Health Models Group, Centers for Medicare
and Medicaid Services
A Single Payer System: Closer Than You Think?
62
The Myra Kraft Open Classroom Series Fall 2013: Policy for a Healthy America
Every Wednesday, 6pm – 8pmSeptember 4, 2013 through December 4, 2013
West Village F, Room 20
Northeastern UniversitySchool of Public Policy and Urban Affairs
Recommended