Professional Documents
Culture Documents
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Fundamental Issues
from a Provider¶s Perspective
Uninsured
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Ian Morrison*
Fundamental Issues
from a Provider¶s Perspective
Uninsured
Variable quality
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Deaths per 100,000 population
0 50 100 150
Why is coordinated,
integrated care needed?
Medicare patients with 4+ chronic
conditions are what % of total cost?
68%
Yearly per person average
13 physicians
50 prescriptions
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Is U.S. only place where health care
costs are rising?
U.S. 4.4%
Other
OCD 4.0%
countries
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A view that health spending does yield
benefits«
NY Times, August 22, 2006:
³Making Health Care the ngine
that Drives the conomy´
Says Robert . Hall
Charles I. Jones
³We have to spend our money on something.
So we get older and richer, which is more
valuable: a third car, yet another television, more
clothing²or an extra year
of your life?´
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Mayo Clinic Health Policy Center
Goal
Influence stakeholders to implement
substantive health care reform
before 2011 that will preserve quality
and availability of health care for all
patients
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Top Issues from Symposium
Health insurance for all Americans
Baker Center ± Univ. of Tennessee
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Individual Ownership
of Insurance for All
Provide health insurance and access to basic
health care for all Americans ± regardless
of their ability to pay
Require individual ownership of insurance
Provide sliding-scale subsidies for those in need
Create a simple mechanism (FHBP) to
coordinate insurance offerings
Appoint an independent health board to define
essential health care services
Allow people the option to buy more coverage
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Are there models of this approach?
FHBP
Netherlands
mu
ffectiveness and fficiency
Increase quality and patient satisfaction.
Decrease medical errors, costs and waste.
Develop a common definition of value
Measure and display outcomes, patient
satisfaction scores and costs as a whole
Create a trusted mechanism to synthesize
scientific, clinical and medical information
Reward consumers for choosing high-quality
health plans and providers
Hold all sectors accountable for reducing
waste and inefficiencies
Improving Integration
Patient care services must be coordinated across
people, functions, activities, sites and time
to increase value
Center care around the needs of the patient
Form coordinated systems to deliver effective
and appropriate care to patients
Develop incentives to encourage teamwork
Increase support for health care delivery science
Provide accurate information so patients can
make informed decisions
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Mayo/Dartmouth Forum
Principles for Payment Reform
Payment systems should be designed to
provide patients with no less than the care
they need and no more than fully
informed, cost-conscious patients would
want
Pay providers based on value ±
measurable outcomes, safety and service
compared to the cost over time
Mayo/Dartmouth Forum
Provider scores on the ³importance of continuing
development of the payment approach´
Score (10 = very important)
0 2 4 6 8 10
Mini-capitation 7.5
Dr. Len M. Nichols
(New America Foundation) testimony to U.S.
Committee of the Budget, June 26, 2007
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Hypothetical example of problem
with line item pricing emphasis
Coronary MD MD Cost of B
Angioplasty Team A Team B as % of A
Fee $7,200 $6,500 -10%
ICU days 0.5 1.2
Cost per episode $18,000 $21,000 +17%
No. per 1 million 2,500 4,400
population
Cost per 1 million $45.0 M $92.4 M +105%
population
Total Cost =
Price x Use Rate
Price Controls: Grayson¶s Maxim
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() &
!
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C. Jackson Grayson Jr.
Chair, U.S. Price Commission (1971-1973)
Source: * +
, 29 Mar 1993
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Annual Rates of Increase in Physician Fees
and xpenditures/Fee-for-Service Beneficiary
7.4 7.4
6 Fees
SGR-related
4 .4 expenditures/
Annual fee-for-service
percent beneficiary
change
-0.7
-
1997- 001 001- 005
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&
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* %-
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C. Jackson Grayson Jr.
Chair, U.S. Price Commission (1971-1973)
Source: * +
, 29 Mar 1993
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Patient/Public Input ± Focus Groups
Public Views Overall
Cornerstones accepted when explained
but are not self evident
When changing delivery system,
concerned about major shifts
Recommend a phased approach ± try
new things, see if work, then put in play
more broadly
People are dissatisfied with U.S. health
system, BUT are happy with their providers
Change could make things worse
for them
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YOUR VOIC, NW VISION Program
Mayo Clinic National Symposium
on Health Care Reform
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