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- 1. Georgians for a Healthy Future Atlanta, Georgia January 10, 2019 Annual Legislative Breakfast: Health Care Unscrambled David Blumenthal, MD, MPP President, The Commonwealth Fund
- 2. 2 1. Introduction 2. Georgia by the numbers 3. Strategies for improvement Agenda
- 4. 4 National Map of State Ranking by Quartile Source: Health System Data Center, The Commonwealth Fund, 2018.
- 5. 27% 17% 21% 12% 0% 5% 10% 15% 20% 25% 30% Adults without a usual source of care (2016) Adults who went without care because of cost (2016) Access Alabama Tennessee Georgia Source: Health System Data Center, The Commonwealth Fund, 2018. Georgia Compared to the Best Comparable State in the Southeastern U.S. Georgia
- 6. 197 68 189 62 0 50 100 150 200 250 Potentially avoidable ED visits among Medicare patients (2015) Preventable hospital admissions for patients age 75 and older (2015) Cost Georgia South Carolina Source: Health System Data Center, The Commonwealth Fund, 2018. Data is per 1,000 Medicare beneficiaries. Georgia Compared to the Best Comparable State in Southeastern the U.S. Georgia South Carolina
- 7. 34% 66% 28% 58% 0% 10% 20% 30% 40% 50% 60% 70% Adults without age- and gender-appropriate cancer screenings (2016) Adults without age-appropriate vaccines (2016) Prevention North Carolina Source: Health System Data Center, The Commonwealth Fund, 2018. Georgia Compared to the Best Comparable State in Southeastern the U.S. Georgia Georgia North Carolina
- 8. 6.7% 5.7% 3.5% 5.3% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% Expansion States Nonexpansion States 2012 2015 Source: A. Dobson, J. E. DaVanzo, R. Haught et al., Comparing the Affordable Care Act’s Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not, The Commonwealth Fund, November 2017. Uncompensated Care Costs as a Share of Safety-Net Hospitals’ Operating Expenses Dropped Substantially Only in Medicaid Expansion States
- 9. 9 Market Concentration Levels Across the United States Brent D. Fulton, Daniel R. Arnold, and Richard M. Scheffler, “Market Concentration Variation of Health Care Providers and Health Insurers in the United States,” To the Point (blog), Commonwealth Fund, July 30, 2018. 3.6% 36.9% 54.5% 5.0% Health insurer market concentration 0.3% 9.6% 47.1% 43.0% Health care provider market concentration
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- 12. U.S. population Health expenditures Source: Agency for Healthcare Research and Quality analysis of 2013 Medical Expenditure Panel Survey; MEPS Statistical Brief 480. Health Care Costs Concentrated in Sick Few— Sickest 5% Account for 49% of Expenses 5% 49%
- 13. 13 1. Stratify patients by common needs 2. Invest in care coordination 3. Shift care from institutions to community 4. Integrate medical, behavioral, and social services 5. Give providers flexibility in allocating resources Strategies to Care for High- Need, High-Cost Patients G. F. Anderson, J. Ballreich, S. Bleich et al., “Attributes Common to Programs That Successfully Treat High-Need, High-Cost Individuals,” American Journal of Managed Care, November 2015.
- 14. 14 Program • Founded in 1993; acquired by Anthem in 2011 • HMO operating MA plans and delivery sites in 6 states • Care management system being piloted by health system, two Medicaid programs Key elements • “Extensivists” lead care team for high-risk patients • Adopt innovative technologies (e.g., partnership with Lyft) Results • Reduced hospital readmissions, ~50% fewer SNF days • Preliminary analysis shows lower costs CareMore Program
- 15. 15 Program • Health plan & network with 60+ sites in Massachusetts • Serves 17,000+ disabled adults & frail elderly Key elements • Interdisciplinary team with home visits • Individualized care plans • Blended Medicare and Medicaid funding Results • Reduces hospital and nursing home use; improves care experiences Commonwealth Care Alliance
- 17. 17 http://www.commonwealthfund.org/roi-calculator ROI Calculator for Partnerships to Address the Social Determinants of Health
- 18. 18 ROI Examples $4,334 in savings (per patient per month) Avoidable Utilization $5,177–7,857 in savings (per patient per month) Blood-Sugar Levels $3,423 in potential savings (per patient per month) Patient Adherence
Notas do Editor
- ROI Examples for Housing, Transportation, and Food Housing Health Plan of San Mateo (HPSM) Housing Supports Pilot Problem: Found that between 10-30% of their LTSS patients were primarily in residency due to a lack of housing or other social reasons Intervention: Subsidized patient housing costs. They referred patients to the appropriate community setting referral: assisted living, individual home support, or affordable housing, based off their need and they provided them with housing assistance from HPSM’s own resources as well as a range of funding sources. Results: Health Outcomes: Vast majority had improvements to quality of life There was a significant decrease in avoidable utilization of long-term care and skilled nursing facilities. Financial: Gross Savings: $7,083 Cost of investment: 2,750 per patient per month Using 6 month pre-post analysis HPSM found that they had an average decrease in cost per member of 43% from $10,055 to $5,721 per month. Over 6 months, they had total savings of $2.4 million from its 91 members, with a net saving of $1.4 million after accounting for 1 million dollars of start up costs start-up costs ROI: $1.57 savings for every $1 invested Source: https://institutes.kpmg.us/government/articles/2018/investing-social-services-core-strategy-for-healthcare.html Food Geisinger Health’s Fresh Food Farmacy Problem: Food insecurity can exacerbate diabetes. Intervention: Geisinger screened diabetic patients for food insecurity through a simple tool linked through EHR. They then, gave them a “prescription” for healthy food. This included food, menus, and recipes to make two healthy, fresh meals five days per week for the patient and their family. They also included 15 hours of group classes on diabetes self-management and on-going case management with a multidisciplinary team that in included: a program coordinator, nurse, primary care physician, registered dietitian, pharmacist, health coach, community health assistant, and, importantly, nonclinical administrative-support personnel. Results: Health Outcomes: After 12 months of the healthy food and lifestyle changes, participants saw drops of more than 2 points in their HbA1c levels. This was remarkable because patients that add a second or third diabetes medication to their treatment see HbA1C levels usually only drop between .5 and 1.2 points. Financial: Avg cost Geisinger Health Plan paid for these patients before the intervention was $8-12,000 per patient per month, Their costs dropped by 2/3 after being enrolled in their program. Gross savings : 5,360–8,040 Cost of program: $183 per patient per month which is $2,200 per year. (don’t pay rent, highest cost is labor, food is small) Source: https://hbr.org/2017/10/how-geisinger-treats-diabetes-by-giving-away-free-healthy-food Transportation ***Not a case study of a specific program, but it is study of the possible savings from non-emergency medical transport (NEMT) Problem: Missed dialysis appointments lead to deviations from clinical guidelines which, in turn, lead to complications and increased expensive medical services, such as hospitalizations. Study: To determine the present-state treatment volumes of NEMT users and expected future-state treatment volumes if NEMT were not provided, they surveyed diabetic Medicaid beneficiaries who use NEMT to attend their medical appointments. We surveyed Medicaid beneficiaries in New Jersey, Louisiana, and Michigan who use NEMT services provided by LogistiCare, the nation’s largest NEMT broker. Results: Health Outcomes: Diabetic patients with non-emergency medical transportation (NEMT) received dialysis treatment 12.0 times per month on average and without it they would expect to receive it 4.1 times per month. Financials: Medicaid cost analysis shows that dialysis patients who attend 3 to 6 dialysis treatments per month incur on average $4,140 gross savings more per month in total medical costs than dialysis patients who attend 11+ dialysis treatments per month. The cost of the average round trip of NEMT for dialysis patients (based on private broker data) is $60.24, so the average cost of NEMT per survey respondent per month for dialysis is 11.98 x $60.24 = $717.25. Therefore Medicaid would have net savings of $3,423 per patient per month (4,140-717.25). An ROI of 477% of $4.77 per 1 dollar invested Source: https://mtaccoalition.org/wp-content/uploads/2018/07/NEMT-ROI-Methodology-Paper.pdf