North Texas Takes on Diabetes!

April 27, 2011

Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
The U.S. Spends More Per Person on Health
Care Than Any Other Nation in the World

Kaiser Family Foundation, 2007 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
What is the Impact?

• Trend continues to be higher than CPI

• Medicare & Medicaid are driving government deficits
• Current cost trends are unsustainable

Total HC Spend HC Spending as of % GDP % Total HC Spend by Gov’t

(Scale in trillions) domestic product government

19.3%
$5 $4.5 trillion 20% 60%
52%
4
15 25%
40
3
10
2 5.2%
20
$28 billion 5
1

0 0 0
‘60 ’70 ‘80 ‘90 ‘00 ’10 ‘14 ‘19 ‘60 ’70 ‘80 ‘90 ‘00 ’10 ‘14 ‘19 ‘60 ’70 ‘80 ‘90 ‘00 ’10 ‘14 ‘19

2010, 2014 and 2019 data are estimates

Source: Centers of Medicare and Medicaid Services
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Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
Why are Cost Trends High?
• Obesity Pandemic: “…the US spends about $160 Billion—2X what it did a
decade ago—…could double again by 2018. Obesity indirectly costs the US
$450 Billion annually—almost 3X the direct medical cost.”
• McKinsey analysis; Centers for Disease Control and Prevention

• 90% Increase in Imaging: “Imaging has risen dramatically in the past decade
with 97 million MRI and CT scans in the U.S. in 2007, up 90% since 2000.”
• Wall Street Journal

• Unnecessary Surgeries: “The number of fusions at U.S. Hospitals doubled

to 413,000 between 2002 and 2008, generating $34 billion in bills.
Unnecessary surgeries cost at least $150 billion a year.”
• Federal Healthcare Cost and Utilization Report

• Rising Employer Costs: “Premiums for businesses and their employees

increased 41% from 2003 to 2009. If costs continue to rise at this same pace,
annual premiums shared by employers and employees would increase 79%,
costing an average family $23,342 by 2020.”
• Commonwealth Fund Report

• Uninsured Population: “The State of Texas has an uninsured rate of 25%.

These rates are among the highest in the nation.”
• HealthLeaders InterStudy Estimate
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Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
 The Current Fragmented “System”
• 61 year old male • 3 admits via ER
The • Diabetic, CAD
• Admission early in year
Patient • Severe vascular disease
• 5 admissions this year for amputation
• Dialysis since 10/09

• Multiple health issues including wound infection Issues

• Care by different physicians with each different
hospital admission, and no one physician in
charge

The • Numerous outreaches by Case Managers, but he

Challenge declined Case Management’s support
• Claims currently at $233,016
• Evaluation phase for transplant

Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
 The Big Question:
So How Do You Fix it?

Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
The North Texas Accountable Partnership
 Consensus from the Summit with 50 Executives
 Focus on Health IT and Health Info Exchange
 Develop Care Coordination model at physician level
 Create alternative reimbursement model
 Facilitate physicians and hospitals working with
employers
 Determine community-wide health goal
 Steering Committee formed representing physicians,
hospitals, employers and insurance carriers
 Michael Darrouzet, DCMS
 Marianne Fazan, DFWBGH
 Steve Love, DFW Hospital Council
 David Toomey, CIGNA
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
The Partnership’s Direction
 Mission Statement: To promote and reward local
healthcare clinical performance for the citizens of North
Texas, that is coordinated, transparent, and value
based.
 Focus on Diabetes, Congestive Heart Failure, Asthma
 4 Workgroups: Metrics, Care Coordination,
Rewards, Plan Design
 Metrics and Care Coordination workgroups complete
 Rewards and Plan Design workgroups wrapping up
 Representatives from each stakeholder group involved
in driving change

Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
Diabetes Measures Results Frequency

A1C A1C < 7 in two consecutive 3 Every six months to one year
month tests
A1C A1C > 7 Every Three months

BP <130/80 mmHg in two Every six months to one year

consecutive 3 month tests
BP >140/90 mmHg Every three months

LDL <70 mg/dL in two consecutive 3 Every six months to one year
month tests
LDL >100 mg/dL Every Three months

Eye Exam Yearly

Nephropathy Yearly

Foot Exam Yearly

Smoking Status Each visit

Nutrition Each visit

Exercise Each visit

Mortality Yearly

Readmissions Yearly
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
Next Steps to Implement
 501c3 established
 Early Success: State approval of Partnership’s HIE grant request
­ $730,000 for Business Plan development
­ Additional funding for operational roll-out
­ Governing council formed and recruiting additional participants
 Determine Data Information Sharing approach
 Data collection from physicians and hospitals
 Promote transparency of quality and cost
 Expand awareness and involvement with the Partnership
 Finalize Partnership’s structure and solicit funding
 Work with physician groups, hospitals, and employers participating in
initial roll-out

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Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
The Pursuit of Value and Accountability!

• As the ultimate payers, employers are key for holding

individuals, healthcare professionals, and carriers
accountable for performance
• Clinical care “products” are needed from healthcare
professionals
• Shift from fee for service into an accountable payment
with reward for quality and cost efficiency
• Real healthcare reform comes from collaboration
amongst the willing stakeholders

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Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA