18 September 2012
UM Docs Slash Dual-Eligible Costs
Project Yielded Thousands in Per-Patient Savings
and focused on providing close-in guidance to patients to ensure they avoided hospitalizations and adhered to their medication regimens, among other issues. “Their focus on transition calls, needs assessment for ongoing care management, development of comprehensive care plans, integration with primary care sites and medication reconciliation played a role in the resource reductions of this vulnerable population,” said U-M Executive Director David Spahlinger, M.D. “We know that quality improved in addition to our cost reductions, making this a double win for patients and the agencies that provide their coverage.” By contrast, the project’s savings for Medicare-only enrollees was $59 a year, suggesting many of the costs may have already been wrung out of caring for that specic population. However, the entire project was a success for the U-M Faculty Group, having saved the Medicare program $22 million over the life of the project. Partly as a result, the U-M Health System formed an accountable care organization last year that became a Pioneer ACO. The study, conducted by researchers from the Dartmouth Institute for Health Policy and Clinical Practice, was recently published in the Journal of the American Medical Association.
A physician group operated by the University of Michigan’s medical school faculty made the most strides of 10 groups across the nation in >5%":153:1!5:!=0'650?!=0'"!+,(+@!A9"! lowering costs for patients during a ve-year B:$"'?3:$5:":$08!C3$"8*!=8"4"80:6@! pilot project. !#3:13'"6!&.!$9"!=8"4"80:6!=85:5?*!$951! The U-M Faculty Group Practice enjoyed 1"%5:0'!51!05%"6!0$!:7'15:;!#'3D"1153:081@! ! E++FGEHF,@! the most success in cutting the costs of socalled “dual-eligibles” – those simultaneously =85?I!C"'"!D3'!J3'"!B:D3'%0$53: enrolled in Medicare and Medicaid who are often extraordinarily expensive to treat. Although dual-eligibles are a fraction of the Medicare and Medicaid populations, they October 3-5 often are chronically ill. They comprise 31% of all Medicare and 39% of all Medicaid expenditures but account for only about 15% B::3GO":$53:!+,(+*!P3.08!/0'I!C3$"8*! of all enrollees in both programs nationwide. P3?9"1$"'*!J5?95;0:@!K!J"65?08!J05:! The data focused on the 990,000 patients !$'""$!=3:D"'":?"*!D3?71"6!3:!$9"! treated by the 10 medical groups participating ?3%#8"$"!85D"!?.?8"!3D!%"65?08!6"45?"! in the pilot project, which operated between 6"4"83#%":$@!EQF@ 2005 and 2010. Those patients were =85?I!C"'"!D3'!J3'"!B:D3'%0$53: compared against a control group of the 7.5 million Medicare beneciaries who resided in the regions where the medical groups operated. December 4-5 The U-M Faculty Group dual-eligible patients had their annual costs reduced by $2,499 per year. For all 10 medical groups nationwide, costs were reduced an average of $532 per year for dual-eligibles. <5D"!?5":?"!K88".!0::708!?3:D"'":?"@! J5::"0#3851!=3:4":$53:!=":$"'@!K:! Ofcials attributed the U-M Faculty "L0%5:0$53:!3D!$9"!I"'.!6'54"'1!5:!85D"! Group’s success to its Complex Care 1?5":?"!0:6!9"08$9?0'"@!=31$!MNK@ Management Program. The initiative had been launched as part of the original pilot project, =85?I!C"'"!D3'!J3'"!B:D3'%0$53:
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Snyder Floats Mich. Blues Proposal
Conversion Would Cut Regulation But Bring Taxes
Michigan Gov. Rick Snyder has proposed converting the state’s largest health insurer to a mutual benet corporation that would be subject to state and local taxes but also able to operate more efciently. Under Snyder’s proposal, announced at a press conference last week, the Michigan Blues would convert from its present status as a “carrier of last resort” – which requires it insurer anyone regardless of their health status and be subject to intense rate regulation – to a mutual insurance company. Such insurers are essentially owned by its policyholders, but would allow the Michigan Blues far greater efciencies and potential for increasing its earnings. As part of the plan, the Michigan Blues would contribute $1.5 billion over the next 18 years into a new nonprot that would fund initiatives to promote healthier lifestyles and improve access to public health. And although it would retain its not-for-prot status, it would lose key tax exemptions and have to pay about $100 million a year in state and local taxes. Additionally, the Michigan Blues’ medigap premiums – what seniors pay to expand their Medicare coverage – would be frozen for four years. And fees imposed on the Blues’ small business and individual customers to subsidize other lines of business would also be eliminated. Those fees total about $200 million a year, according to Snyder. “This is an exciting opportunity to improve the health of Michiganders and create a modernized, efcient health care marketplace that spurs innovation and streamlines outdated regulations,” Snyder said. “It's especially important that we have a system that promotes wellness for our children and seniors. This proposal will ensure that quality healthcare remains affordable and accessible for everyone.” The proposal would require both approval by the Legislature and the board of directors for the Michigan Blues. Plan ofcials seemed at least amenable to discussing the proposal in greater depth, and perhaps negotiating some other changes. “This plan is not exactly what Blue Cross would have proposed, but it does create a fair and balanced set of rules for health insurance. Regulations should be fair to all. They should protect consumers, expand choice and competition and preserve an insurance safety net people can count on,” said Michigan Blues President Daniel J. Loepp. “Our competitors complain that our tax-exempt status gives us a competitive edge, and we say that our strict regulations give them an edge. The Governor's proposal smoothes out those edges. It makes everyone play by the same rules. Our board is open to considering this proposal because it preserves Blue Cross' nonprot mission and sets Michigan's insurance market up for success in the future.”
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MBGH Honors Healthy Employers
The Midwest Business Group on Health and the Building a Healthier Chicago coalition have honored 16 Chicago-area employers for their wellness programs. The employers, which include OfficeMax, Walgreens, Presence Health and Advocate Health Care, were cited for programs that not only obtained results for their employees but also could be easily replicable by other businesses. “We're proud that eight of the winners honored for their leading best practices in worksite wellness are members of MBGH," said MBGH Vice President Cheryl Laron. “As innovators, these companies are not only helping to improve the health of their employee and families, but leading by example to support employers throughout the Chicagoland area and the nation.” The Healthier Chicago coalition includes the Chicago Department of Public Health, the U.S. Department of Health and Human Services and the U.S. Office of the Regional Health Administrator.
Henry Ford West Bloomfield Grows Own Produce For Patients
An affiliate of the Henry Ford Health System has built a $1 million greenhouse and hired a resident farmer to grow organic produce for patients. Officials with Henry Ford West Bloomfield Hospital said the intent of the project is to promote healthier lifestyles that would
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Cardinal Launches Cancer Initiative
Will Team With Mich. Health Insurer, Medical Group
A division of Ohio-based Cardinal Health has entered into an initiative with a Detroit-area health plan and medical group in an attempt to reduce the costs of oncology care. Cardinal Health Specialty Solutions, Health Alliance Plan and Physician Resource Management call the initiative an “evidencebased clinical pathways program.” It focuses on treatments for breast, lung and colon cancers, using a panel of HAP-contracted oncologists to identify the best ways to treat them. Cardinal will provide proprietary education and training for the participating physicians, while HAP will provide incentive payments to providers who use the protocols. “I believe it's critical for oncologists, patients and payers to work together to develop a balanced set of quality and nancial outcome goals that improve cancer care," said Phillip Stella, M.D. president of Physician Resource Management, which represents more than 70 oncology practices in Michigan. “We're looking forward to participating in this new program because we believe it will enable us to effectively advance an innovative, new care delivery model into new markets and provide quality care to a broader group of patients.” Ofcials say the program has been launched to try and introduce efciencies into what is expected to be an ever-increasing demand for oncology services. The number of cancer cases diagnosed in the U.S. is expected to increase by as much as 45% by 2030.
eventually reduce the cost of providing care. Educational programs will be offered at the greenhouse with the intent of curbing the obesity epidemic. “Our goal is to be a national model for how wellness education can improve health and reduce healthcare costs by providing people with resources to help them achieve optimal health,” said Henry Ford West Bloomfield Chief Executive Officer Gerard van Grinsven. In addition to the promotion of healthier living, the hospital is expected to cut its food bill by about $20,000 a year by growing its own produce. The hospital is growing lettuce, peppers, herbs, Chinese cabbage and strawberries, among other items. The initiative has been funded by an anonymous donor.
UHC Awards Hospitals For Quality
Winners Did Best Following IOM Care Guidelines
Chicago-based UHC has recognized 10 hospitals that performed best on its annual quality and accountability study. Of the institutions who received the award, three were in the Midwest – the University of Kansas Hospital, William Beaumont Hospital in Royal Oak, Mich. and the Mayo Clinic in Minnesota. The UHC study compared the hospitals’ performance against the six “domains of care” established by the Institute of Medicine. The domains are mortality, effectiveness, safety, equity, patient-centeredness and efciency. UHC has been conducting the quality survey since 2005. “Improving patient care and operational effectiveness is of paramount importance to every healthcare provider, and these organizations are the best of the best,” said Irene M. Thompson, UHC president and chief executive ofcer. In addition to the quality awards, UHC also named the Cleveland Clinic, the Shands Jacksonville Medical Center in Florida, the Medical University of South Carolina and Duke University Medical Center as “rising stars” for achieving signicant improvements in patient safety, mortality rates and overall outcomes. UHC is an alliance of nearly 116 academic medical centers and 276 non-prot afliate hospitals. The awards were announced at UHC’s recent annual conference in Orlando, Fla.
UnitedHealth Joins Dow Jones Average
Minnetonka, Minn.-based United Health Group will join the Dow Jones Industrial Average on Sept. 21, and will experience its first trading day on Sept. 24. UnitedHealth will replace Kraft Foods on the Dow Jones. “The Index Committee believes the addition of UnitedHealth Group brings added healthcare diversification to the Dow Jones Industrial Average, and reflects the growing importance of health care spending in the U.S. economy,” the New York Stock Exchange said in a statement. The NYSE decided to remove Kraft after the foodstuffs giant’s decision to spin off its North American grocery business. The spinoff is expected to lead to a reduced market capitalization and a lower percentage of revenue generated in the U.S. That made it less representative of a Dow Jones company, officials said.
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The “Man On The Moon” Moment?
Hospitals Are Inching Toward Infection-Free Care
On a snowy night in February 2001, Josie doctors, nurses, and administrators, working as King, an adorable 18-month-old girl who part of CUSP team, believing this was their looked hauntingly like my daughter, was taken problem, knowing they were capable of solving off of life support and died in her mother’s it. It worked because it was informed by science. arms at Johns Hopkins. Josie died from a It worked because it aligned many groups cascade of errors that started with a central around a common measure, each doing their line-associated bloodstream infection, a type part to eliminate these infections. Like a fractal. of infection that kills nearly as many people as The program aligned efforts at the national, state breast cancer or prostate cancer. and local levels all around a Shortly after her death, her common goal: to eliminate these mother, Sorrel, asked if Josie infections. would be less likely to die now. No one group could have She wanted to know whether care done this, yet together we can was safer. We would not give her move a mountain. I want to thank an answer; she deserves one. At all of the staff at Hopkins, AHRQ, the time, our rates of infections, HRET, MHA, SHA and individual like most of the country’s, were hospitals who worked tirelessly to sky high. I was one of the doctors realize these results. People like putting in these catheters and harming Michael Tooke, the chief medical By patients. No clinician wants to harm ofcer at Memorial Hospital in Easton, Peter patients, but we were. Maryland, and Theresa Hickman, a So we set out to change this. We Pronovost, nurse educator at Peterson Regional developed a program that included a Medical Center in Kerrville, Texas, both M.D. checklist of best practices, an of whom you will hear from in a intervention called CUSP [the Comprehensive moment. Unit-based Safety Program] to help change This could be health care’s man on the culture and engage frontline clinicians, and moon moment. In 1961 JFK challenged the performance measures so we could be world to safely put a man on the moon. Eight accountable for results. It worked. We virtually years later Neil Armstrong took those giant steps eliminated these infections. forward for all of us. Then in 2003 through 2005, with With these results, health care takes a giant funding from AHRQ, we partnered with the step forward. So for the rst time we can Michigan Health & Hospital Association. condently look Sorrel King in the eye and say: Within six months in over 100 ICUs, these Josie is less likely to die, at Hopkins, in infections were reduced by 66 percent. Over Michigan, in Texas, in Maryland and across the 65 percent of ICUs went one year without an U.S. infection; 25 percent went two years. The This program offers hope of what is possible results were sustained, and the program saved when policymakers invest in the science of lives and money, all from a $500,000 health care delivery. investment by AHRQ for two years. The AHA, MHA and Johns Hopkins stood With continued AHRQ and with many others to eliminate these infections. philanthropic support and in partnership with Let us continue stand together on this journey to AHA and its research arm, HRET, SHA and address many other types of harms so we may many others, we have now spread this say to Sorrel King that Josie would be less likely program state by state across the U.S., and to die from any preventable harm. these infections have been reduced by over 40 percent. Indeed over 1200 hospitals—large Peter Pronovost, M.D., is Director of the Johns and small—have infection rates previously Hopkins Armstrong Institute for Patient Safety believed impossible. and Quality. This op-ed is adopted from the Preventable patient harm and waste is a Health Care Blog. persistent and pervasive problem. This is the rst national success story for broadly reducing Op-ed submissions of up to 600 words are a harm. So why did this work? welcomed. Please e-mail proposals to It worked because it was led by frontline email@example.com
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