Transcript Gordon Moore, MD - Michigan Purchasers Health Alliance

The Ideal Medical Practices Project
The emerging role of the physician
Michigan Purchasers Health Alliance
September 20, 2007
L. Gordon Moore MD
Clinical Associate Professor University of Rochester Departments of Family
Medicine and Community and Preventive Medicine
Institute for Healthcare Improvement
IdealMedicalPractices.org
Funded by The Commonwealth
Fund and the Physician’s
Foundation for Health Systems
Excellence
Health Care Inflation
14.0%
13.0%
12.0%
Health Insurance Premiums
General Inflation
11.5%
12.0%
10.9%
10.0%
10.0%
9.2%
8.0%
8.0%
7.2%
6.0%
6.0%
4.0%
4.3%
4.4%
4.1%
2.0%
2.9%
2.3%
2.6%
2.5%
1.9%
0.7%
0.0%
1.9%
0.8%
2.8%
3.2%
3.2%
3.2%
1.0%
-0.1%
-2.0%
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Health Care continues to grow far in excess of CPI
Entrenched Patterns
Primary Care Score vs. Health Care Expenditures, 1996
Primary Care Score
2
1.5
UK
SP
1
US
0.5
0
1000
1500
2000
2500
3000
3500
Per Capita Health Care Expenditures
Primary Care Score: 2 = Stronger
From Barbara Starfield, MD
4000
Institute of Medicine:
Crossing the Quality Chasm
The problems come from poor systems …
not bad people
“In its current form, habits, and
environment, American health care is
incapable of providing the public with
the quality health care it expects and
deserves.”
National Academy Press 2001
The perfect storm
• Cost of practice is
rising
• Administrative burden
is growing
• Pipeline of primary
care supply is drying
up
• Aging and burned out
primary care work force
• Employer based primary care
– Docs have more time with patients
• Best practice guidelines/protocols
• Emphasis on health and wellness, prevention
• Disease management for any with chronic conditions
– Improved access with worksite facilities
– Refer to “high performance network of specialists”
– Integrated EAP/chemical dependency
•
Zastrow RJ, Quadracci L. Engaging Quad/Graphics Employees in the Improvement of Their
Health and Healthcare Journal of Ambulatory Care Management, 29(3), 227-231
Quad-med results
• Health care cost increases limited to 6.8%
during the last five years
• With Quad-Med, Quad/Graphics spends
17-20% less than Midwest average
• Superb HEDIS and employee satisfaction
scores
PAGE ONE February 11, 2005
Radical Surgery One Cure for High Health Costs: In-House Clinics at Companies
By VANESSA FUHRMANS Staff Reporter of THE WALL STREET JOURNAL
Good Collaborative Care is A
Good Thing
Study of 25,000 Americans 19-69
Good
Poor
collaborative collaborative
Past treatment has made:
care
care
pain much better
34.7%
9.6%
emotional problems much better
34.8%
12.5%
Pts with HTN, CAD, DM report their systolic
BP<140
74.8%
64.6%
Reports of problems from their medications
8.6%
20.1%
Spent at least one day at home because of
illness in past 3 months
26.9%
31.6%
Physical or emotional problems limiting
capactity to work in past 2 weeks
18.0%
33.4%
Hospitalized in past year with common chronic
diseases
12.3%
14.2%
Wasson, Johnson, et al. JACM Vol. 29, No. 3, pp. 199–206
Access and Efficiency
Overhead
•Baseline Surveys
•Listserve
•Time Management
•Practice Flow
Execution:
The
IMP
Method
Getting Focus
Catching Your Breath
•Baseline Surveys
•ListServe
•Time Management
Collaborative Care
Coaching
•Vital Signs
Confidence
•Electronics
Working with Others
•Patient Segmentation
•Self-Management Confidence
•Refinements of
•Problem-Solving
Previous Techniques
•Phone Coaching
•Referrals/Handoffs
A wealth
of
actionable
data
• A Family of (Free)
Patient/Employee/Person
Assessment and Feedback
Tools that:
–
–
–
–
–
Determine “What Matters”
Determine “What is the Matter”
Determine Preventive Needs
Determine Care Experience
Feedback Personalized Information
that Supports Additional Actions
• A Family of Reporting Tools for
Practices and Hospitals that:
– Automatically Summarize and
Compare Responses
– Offer Customization Options
Key lessons from IMP
• Significant improvement doesn’t have to
come at the cost of heavy lifting
• Simple HIT drives measurement and
improvement
• Data becomes a platform for adoption of
best practices
www.IdealMedicalHome.org
National collaborative
What we’re finding - positive
• Improved population health
• Improved experience of care
• Improvement is within reach of the
participants
What we are struggling with
• We’re paid for unit production so we
overproduce units (visits, procedures) to
maintain revenue streams
• A lot of the work to improve population
health is uncompensated
• It’s easy to be mislead by the promises of
IT
Moving ahead
• Prospective payment models
• Shared savings arrangements
• Overcoming inertia of status quo