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The Lasting Resonance of a Summit on Health Care Value

March 18, 2015
11:41 am

On March 2, the Healthcare Leadership Council, as part of its National Dialogue for Healthcare Innovation (NDHI) initiative, brought together over 70 leaders from organizations and institutions that design, implement and are affected by the U.S. healthcare system.  The purpose was to clearly define what constitutes value in healthcare and to begin crafting a pathway that will allow patients and consumers access to life-changing healthcare innovations within a structure that is affordable and financially sustainable.

The Summit on Value and Innovation was just the first step in what will be an ongoing dialogue designed to identify and address the existing barriers to health system improvement.  Summit participants have expressed their intention to continue working toward the goals and objectives they outlines on March 2.

Here are some highlights of the comments and coverage of the NDHI Summit:

“Last week I had the opportunity to sit at the table with some of the nation’s top thought leaders. We convened at the Newseum in Washington, DC, for the Healthcare Leadership Council’s National Dialogue for Healthcare Innovation; it was like a health policy nerd red carpet. Center for Medicare Director Sean Cavanaugh was there. Leapfrog Group CEO Leah Binder was there. America’s favorite bioethicist–oncologist–provocateur Zeke Emanuel was there. The chief executives of providers, payers, pharmaceutical companies, government agencies—all there. And what were they there to do? Define “value” in health care.”

–Neel Shah, M.D., Executive Director, Costs of Care in the AAMC Wing of Zock blog

***

“In order to improve value, we needed to identify some of the obstacles that could thwart progress. Regulatory and policy challenges; trust between stakeholders; insufficient time for measurement and lack of tools for patients to make healthcare decisions were among the barriers we cited.

“To surmount those obstacles, we honed in on several key initiatives: piloting a payment model that incentivizes value and shares risk among stakeholders; mapping the patient journey to better understand how we as stakeholders can work together, rather than focusing on our individual part of a patient’s healthcare experience; and developing medication adherence programs to educate patients on their disease, therapies and treatment goals.”

–Greg Irace, Senior Vice President of Global Services, Sanofi US

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Several participants said that the Medicare Advantage system does a good job of aligning incentives to produce high-quality care and good value. Barry Arbuckle, president and chief executive officer of MemorialCare Health System, which operates hospitals and provider groups as well as a health plan in the Los Angeles area, said, “If I could push every Medicare patient into Medicare Advantage, I’d do it tomorrow.”
Medicare Advantage is “a fundamentally better system. The financials are aligned. We have incentives to do disease-management programs. Frankly I don’t have that in Medicare, because I get paid when they get sick. And if they’re sicker, I get paid more,” Arbuckle said.

It’s more challenging to address these issues for the commercially insured population, Arbuckle said. Having a long-term relationship with members is crucial to the success of creating better health-care value, he said.

–Coverage in Bloomberg BNA, March 3, 2015

Aetna CEO: New Math for Medicare

October 22, 2014
5:02 pm

(We have made the point often in this space that, even with the private sector’s successes in containing healthcare costs and reducing Medicare per-capita spending to historic lows, the sheer magnitude of baby boomers reaching 65 and reaching Medicare eligibility necessitates significant changes to the program.  Moving away from a fee-for-service model that incentivizes volume rather than value is essential.  As Mark Bertolini, CEO of Aetna (a Healthcare Leadership Council member) points out in this Forbes op-ed column, innovative approaches to Medicare payment and healthcare delivery can achieve better patient health and improved system sustainability.)

By Mark T. Bertolini

The Medicare Part A trust fund will be exhausted by 2030. As 11,000 baby boomers become eligible for Medicare daily, Medicare spending is projected to exceed $1 trillion in 2020. We can’t change the numbers that define our population but, we can apply new math to them.

Focus first on helping the chronically ill

The sickest 5 percent of fee-for-service Medicare patients with chronic conditions drive more than 40 percent of the total cost of health care in the program. We should use the lessons learned in Medicare Advantage and other proven innovations. Encourage Medicare Part A and B enrollees with multiple chronic conditions to participate in new integrated care programs with top-notch physicians to ensure high-quality service. Pay managed care organizations rates that guarantee savings for taxpayers out of the gate.

Use the successes and learnings of this approach to phase out the Medicare fee-for-service payment model

The fee-for-service model has doctors getting paid by the number of procedures they do or tests they run, rather than on how well their patients do. We need to move to a system that pays for quality over quantity.

These two changes alone will mean lower cost coupled with better integrated, quality care for the members of our families that need that care the most.

While the Congressional Budget Office recently reported that estimated costs of Medicare and Medicaid have dropped, our country’s coffers are still being drained by a too-costly health care system. This was reconfirmed in July, when the Boards of Trustees of the Federal Hospital insurance and Federal Supplementary Medical Insurance Trust Funds projected that Medicare costs will grow from their current level of 3.5 percent of the gross domestic product (GDP) to at least 5.3 percent of the GDP in 2035.

Consider this: As baby boomers become Medicare eligible, the number of beneficiaries will grow from 50.7 million in 2012 to 81 million in 2030—a 60 percent increase in less than 20 years. Add to this that the tax base is shrinking: Baby boomers are retiring, leaving the country with a much smaller workforce paying a much higher Medicare tax burden. With average life expectancy projected to reach 81.5 years by 2030, on average those seniors will use Medicare benefits for three times as long as when Medicare was enacted in 1965. Chronic conditions among Medicare beneficiaries also are on the rise, making them a sicker and more expensive population than existed in 1965.

The current fee-for-service payment model unintentionally incentivizes the wrong kinds of behaviors—spending less time with patients, or having more tests and procedures. There is little reward for finding more efficient ways to make people better or for keeping them healthy in the first place.

Bringing innovative collaboration to traditional Medicare

Many programs that have been so effective for caring for Medicare Advantage’s sickest beneficiaries, including enhanced home-based care, care coordination and medication review, are not always covered under traditional Medicare. Our experience in Medicare Advantage shows the promise of these models. For several years, we have worked with health care providers to establish reimbursement models based on risk-sharing that encourages higher-quality performance. Aetna Aetna’s Medicare Advantage Provider Collaboration program, and its work to create accountable care organizations (ACOs), are examples of cooperative arrangements that are improving care quality and health outcomes while also reducing costs. In many instances, these programs have resulted in fewer inpatient hospital days, fewer hospital admissions and fewer readmissions for patients, which can reduce health care costs by as much as 30 percent.

Bringing innovative provider collaborations and managed care approaches to traditional Medicare is a winning proposition for everyone. Patients could get a full team of experts providing customized and focused attention, and be rewarded with incentives for adhering to treatment. Doctors could get greater support, information and resources to help their patients get and stay healthy. Managed care companies could serve a broader Medicare population, as long as they meet the required quality and outcomes results. Taxpayers could get a lower-cost, better-quality healthcare system.

In the past, we have shied away from making significant changes to Medicare, since the issues seemed to be so far down the road. That is no longer the case. Our Medicare spending has a tremendous impact on our economy now, and that will only increase over the next decade. Our population is aging too quickly and our nation’s Medicare costs are growing too rapidly for us to be timid. We need to take dramatic action now, and revolutionize how we approach the problem. The numbers can work if we are ready to adopt a new model. We can achieve a result that includes both healthier seniors and a lower tax burden.

Medicine, Exercise and the Importance of Patient Adherence

July 18, 2014
12:41 pm

(This month, the Healthcare Leadership Council sponsored a Capitol Hill briefing on the importance of patient adherence in improving the quality and cost-effectiveness of healthcare.  The briefing featured expert perspectives from inVentiv Health, Novartis, SCAN Health Plan and Walgreens.  We were pleased to see commentary about this briefing on the “Be Active Your Way” blog sponsored by the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health promotion.  The blog post is reprinted below.)

On Monday, July 14th, the Healthcare Leadership Council hosted an excellent briefing on non-adherence to medication, highlighting the fact that 1 out of 3 patients never fill their prescriptions, and nearly 3 out of 4 Americans don’t take their medications as directed.

The panelists discussed innovative strategies for improving adherence, such as targeted and timely communication. Each strategy was based on the reality that a one-size-fits-all approach to communication is both inefficient and ineffective. Clearly, the digital age is creating medical providers with new opportunities for engaging patients and tracking their adherence, but there are no simple solutions for getting folks to take their medicine.

The problem of non-adherence to medication raises an uncomfortable question for physical activity advocates.

If 1/3 of patients are signaling that a visit to the pharmacy is a barrier too high to overcome, and 75% are finding it too difficult to take medication properly, how many patients can we reasonably expect to fill an exercise prescription that typically requires 150 minutes/week of exertion?

Although evidence suggests that patients are more likely to exercise if their doctors prescribe exercise, we suspect very few patients will stick to an exercise program unless medical offices and physical activity providers (e.g. health clubs, personal trainers, community centers) adopt engagement strategies similar to those being implemented by the pharmaceutical industry for medication adherence.

At Novartis, for example, a comprehensive study of patients revealed 4 clusters of patients, each with a distinct set of compliance barriers: “Strugglers,” who seem overwhelmed by the medical condition and necessary medications; “Skeptics,” who view medication as a last resort; “A-Students,” who are fully engaged with their health care and likely to adhere to their prescription; and “Independents” who are likely to adhere but not be consumed with their health issues.

Understanding the four clusters helps Novartis create targeted adherence plans for each patient. The plans include customized messaging, 6 months of support, 3 or 4 email and text messages per week, an interactive website, real-time messaging support, and more.

Can this level of engagement be accomplished by a fitness center? Absolutely. And I know there are some pioneering clubs already on this path and achieving great results. But effective engagement does not happen overnight. It clearly requires an investment of time and resources, both of which are in short supply at most fitness centers.

So let’s make sure we support the great work of the Exercise Is Medicine initiative and champions of the “exercise prescription” movement like Dr. Eddie Phillips and Dr. Bob Sallis, by making sure that fitness facilities are prepared to help patients adhere to those prescriptions.

What do others think? How can we help patients adhere to exercise prescriptions? Do you work at a fitness center with a great member orientation program? Perhaps you work for a software company developing tracking systems for medical fitness providers? We’d love to hear from you.

The Intersection of Compassion and Quality in Healthcare’s Most Challenging Moments

May 29, 2014
3:37 pm

We’ve discussed advanced illness management previously in this space, focusing on the challenges faced by Medicare and healthcare plans and providers in examining both the cumulative costs of care provided to patients in the final months of life while wanting to do what is in the best interest of those patients and their loved ones.

Two Healthcare Leadership Council members provided insights on this issue in a Senate Special Committee on Aging hearing that took place last week.  Executives from Ascension Health, the nation’s largest non-profit hospital system, and Aetna, one of the country’s leading health insurers, shed important light on advances that are taking place to reduce the cost of advanced illness management while generating greater satisfaction among patients and families.

Dan O’Brien, Ascension Health’s Senior Vice President of Ethics, Discernment and Church Relations, discussed Ascension’s system-wide Palliative Care initiative, which has enabled the creation of standardized measures and outcomes as well as demonstrated financial feasibility and sustainability.  Within one year, he said, a 20 percent compliance rate within the Ascension system has grown to an 80 percent compliance rate with the palliative care program.  Palliative care teams have increased the quality of care while reducing costs, reducing length of stay, and increasing patient and family satisfaction.  He noted, however, that palliative care teams still struggle to receive necessary funding and he asked the committee to support appropriate funding for palliative care and advanced care planning.

Dr. Randall Krakauer, the National Medical Director of Medicare for Aetna, told the committee that, in the last month of life among seniors, 80 percent of care is received in an acute care setting, even when it’s not medically appropriate.  Palliative and hospice care, he said, reduces the use of medically unnecessary services and positively impacts beneficiary satisfaction and quality of care.  Aetna launched its Compassionate Care Program to assist plan members in managing their illnesses and has had strong results with the Medicare population, seeing a more than 80 percent reduction in acute days, intensive care days and emergency room use.  Dr. Krakauer testified it would be a positive step for Medicare Advantage beneficiaries to have access to hospice earlier and be able to receive curative treatment while in hospice.

With their testimony, these two organizations made significant contributions to the ongoing conversation and body of knowledge on how to address advanced illness care, making important points about the role of Medicare coverage regulations and funding for palliative care.

Our Veterans Deserve Better

January 31, 2014
1:45 pm

Last year, the book “Best Care Anywhere:  Why VA Health Care Would Work Better for Everyone” entered its third printing.  The book tells of a Veterans Administration healthcare system that, according to the author, is far superior to the private sector in both quality care delivery and cost containment.  The message delivered in this book, in fact, became something of a core liberal talking point during health reform debates – that the wonders of single-payer, government-run healthcare can be seen on full display at the VA.

This week, CNN is painting a different picture of the VA system, reporting that at least 19 veterans have died as a result of delays in receiving routine diagnostic exams such as colonoscopies and endoscopies.  This follows an earlier CNN report that as many as 7,000 veterans in just two states alone – South Carolina and Georgia — are on a backlog list to receive these fundamental diagnostic screenings.

And, as the cable network points out, not a single person has been dismissed or demoted as a result of this substandard care, and the VA is consistently ignoring congressional committee requests for explanations and accountability.  One has to agree with Rep. John Barrow (D-GA) who said, “We have a duty to make sure the veterans who serve get the best health care possible.  And it is very obvious that, for too long and for too many folks, that hasn’t happened.”

This is not to say that the VA doesn’t carry out some aspects of healthcare very well.  The institution has, for example, been among the early adopters in demonstrating the effective use and value of electronic medical records.

But in terms of the argument that all of American healthcare should emulate this type of bureaucratically-run system, it’s been made clear this week that several thousand service men and women have reason to disagree with that thesis.  For too many who have dedicated their lives to serving their country, the concept of getting the right care at the right time isn’t happening.  That’s simply unacceptable.