Bipartisan Congressional Health Policy ConferenceBipartisan Congressional Health Policy ConferenceJanuary 11 - 13, 2007January 11 - 13, 2007

Miami, FLMiami, FLAiming for the Best: Scorecard of U.S. Health Care Aiming for the Best: Scorecard of U.S. Health Care

System PerformanceSystem Performance

What Is Doable Now?What Is Doable Now? Glenn D. Steele Jr., MD, PhDGlenn D. Steele Jr., MD, PhD

President and CEOPresident and CEOGeisinger Health SystemGeisinger Health System

Strategic Targets – Can We Prioritize?

Who?

How?

Suggested Criteria

What works now, somewhere?

What is translatable?

What can produce recognizable improvement?

Learn From Best Practice

Go for Perfection

Model Reimbursement to Achieve:

▫ Optimum chronic care

▫ Optimum acute care

▫ Population health goal

Pay-for-Performance (P4P) Initiatives

• Chronic care (PGP demonstration and beyond)• Episodic care (e.g., CABG, joint replacement,

cataract surgery, EPO)

Component Measures FY07

HgbA1C measurement XHgbA1C control XLDL measurement XLDL control XBlood pressure control XRetinal examUrine (protein) exam XFoot examInfluenza immunization XPneumococcal immunization XSmoking status XUse of ACE/ARB for microalbuminuria/DM nephropathyUse of ACE/ARB for hypertension

Patients who receive/achieve ALL of the above X

YearlyYearlyOnce

Non-smoker

Within prior 12 months

YearlyYearly

YesYes

< 100< 130/80

Quality Standard

Every 6 months

Yearly< 7

Highly-Reliable Diabetes Care (“All or None” Composite Measure)

ProvenCareSM - Diabetes(Comprehensive Care; System-wide; >20K patients)

% of all diabetic patients

# Components Received/Achieved (by patient)

20%

10%

0 1 2 3 4 5 6 7 8 All

3/31/06

9/30/06

6/30/06

11/30/06

20

25

30

35

40

45

50

55

60

Jan-06 Sep-06

A1C < 7

LDL < 100

BP < 130/80

Diabetes Outcomes (resulting from ProvenCareSM)

% of all diabetic patients

Coronary Artery Bypass: Reliability

% of patients who received all components of care

0%

20%

40%

60%

80%

100%

Hired performance improvement clinician

Documented current processes

Engaged remaining stakeholders

Confirmed the “ProvenCare CAB” processes & accountabilities

Go-Live

Feb

06

Oct

06

May

06

Nov

05

Jul 0

5

Coronary Artery Bypass: OutcomesBefore With

Improvement

ProvenCareSM ProvenCare (% reduction)

(n=143) (n=81)

Patients with any complication 38% 30% 21%

Patients with major complication 9.8% 6.2% 37%

Atrial fibrillation 22% 19% 15%

Any pulmonary comp 6.3% 2.5% 60%

Re-admit ICU 2.8% 0.0% 100%

Blood use 25% 19% 27%

Re-operation for bleeding 4.2% 3.7% 12%

In-hospital mortality (death) 1.4% 0.0% 100%

Deep sternal wound infection 0.7% 0.0% 100%

Discharged not to home 19% 7% 63%

Charges per patient $61,176 $58,117 5%

Pay for best practice– Don’t pay for less than best practice

First Principles

Focus on systems of care* as best model for testing

new delivery incentives

* Hehrotra A, Epstein A, Rosenthal B. Do Integrated Medical

Groups Provide Higher-Quality Medical Care than

Individual Practice Associations?, Ann Intern Med, 2006,

145 (11): 826-833

* Casalino L. Which Types of Medical Group Provides

Higher-Quality, Ann Intern Med, 2006, 145 (11): 860-861