Introduction Why Do Health Insurance Rates Increase

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Introduction Why Do Health Insurance Rates Increase Powered By Docstoc
					Population Health Update                                                       January 2009
August 2008
                Built                                   Social
             Environment                             Determinants                            & Lifestyles

Two true stories are in this report. One compares the USA to seven countries re: chronic health care management (we
don’t fare well); and the other describes an American health care success because of their innovations in primary care and
chronic disease care. The broader point is that local innovations can and do, make a difference in sprite of negative
national trends.

In Chronic Condition: Experiences of Patients with
                                                                 • The U.S. stands out for patient costs, with 41 percent
Complex Health Care Needs, in Eight Countries,
                                                                 reporting they spent more than $1,000 on out of- pocket
                                                                 costs in the past year. U.K. and Dutch patients were
                                                                 most protected against such costs.
                                                                 • Only one-quarter (26%) of U.S. and Canadian patients
                                                                 reported same-day access to doctors when sick, and one-
                                                                 fourth or more reported long waits. About half or more
                                                                 of Dutch (60%), New Zealand, (54%), and U.K. (48%)
                                                                 patients were able to get same-day appointments.
                                                                 • A majority of respondents across the eight countries
                                                                 saw room for improvement. Chronically ill adults in the
                                                                 U.S. were the most negative; one-third said the health
                                                                 care system needs a complete overhaul.
                                                                 • In the past two years, 59 percent of U.S. patients
                                                                 visited an emergency room (ER); only Canada had a
                                                                 higher rate (64%). In both countries, one of five patients
The Issue                                                        said they went to the ER for a condition that could have
Across industrialized nations, patients with multiple            been treated by a regular doctor if one had been
chronic conditions account for a disproportionate share          available.
of national health spending. Such patients often see
multiple clinicians in a variety of care settings, putting       Study Implications
them at heightened risk for experiencing medical errors          While the U.S. did comparatively well on some
and having poorly coordinated care. Because of their             measures of hospital discharge instructions and patient-
extensive contact with the health care system, these             centered care, chronically ill Americans often cannot
patients offer unique perspective on many aspects of             afford to follow recommended care. Gaps in coverage
system performance.                                              and cost-sharing are undermining access and adherence.
                                                                 The survey finding that in all eight countries, patients
Key Findings                                                     most often reported that errors happened outside the
• More than half (54%) of U.S. patients did not get              hospital highlights the need to focus on ambulatory care
recommended care, fill prescriptions, or see a doctor            and medication safety. Initiatives under way across
when sick because of costs, versus 7 percent to 36               nations to improve performance through payment
percent in the other countries.                                  reform, information systems, and managing chronic
                                                                 conditions offer cross national opportunities to learn.
• About one-third of U.S. patients—the highest
proportion in the survey—experienced medical errors,             The Bottom Line
including delays in learning about abnormal lab test             Compared with their counterparts in seven other
results.                                                         countries, chronically ill adults in the U.S. are far more
• Similarly, one-third of U.S. patients encountered              likely to forgo care because of costs. They also
poorly coordinated care, including medical records not           experience the highest rates of medical errors, care
available during an appointment or duplicated tests.             coordination problems, and high out-of-pocket costs.

Continuous Innovation in Health Care: Implications                an after-visit summary to see how they are doing
of the Geisinger Experience                                       compared with their goal. In addition, practices receive
                                                                  performance reports that compare their results with
                                                                  historical trends and peer sites. Physicians may receive
                                                                  financial incentives linked to patient satisfaction, quality,
                                                                  and value goals. Initial results from more than 20,000
                                                                  diabetic patients have shown statistically significant
                                                                  improvements in measures like glucose control, blood
                                                                  pressure, and vaccination rates.

                                                                  Acute episode care. Although focusing on primary and
                                                                  chronic care is a priority for Geisinger, some patients
                                                                  will inevitably require acute intervention. To establish
                                                                  and implement best practices, develop a bundled
                                                                  package price for a single episode of care, and promote
                                                                  patient engagement, Geisinger created a new model for
Background                                                        coronary artery bypass graft surgery. Teams translated
Serving central and northeastern Pennsylvania,                    guidelines into 40 discrete steps, which were then
Geisinger Health System comprises nearly 700                      embedded into human and electronic workflows. If a
physicians across 55 clinical practice sites, three acute-        step is not completed, providers are automatically
care hospitals, a variety of specialty hospitals and              alerted. To highlight the need for patient–provider
ambulatory surgery campuses, a 215,000-member health              partnership, a team revamped patient education materials
plan, and other services and programs. Geisinger’s 2.5            and developed a ―patient compact,‖ which is signed by
million patients are, on average, poorer, older, and sicker       both the patient and Geisinger. The single episode price
than patients nationally.                                         includes preoperative evaluation and work-up, hospital
                                                                  and professional fees, routine discharge care, and
Innovative Practices                                              management of related complications occurring up to 90
Medical homes. At Geisinger, the implementation of                days post-surgery. Four months after the model was
patient-centered medical homes has meant round-the-               implemented, the proportion of patients receiving all 40
clock access to primary and specialty care services,              components increased from 59 percent to 100 percent.
which are enhanced through the use of nurse care                  Geisinger has now expanded the program to include hip
coordinators, care management support, and home-based             replacement and cataract surgery.
monitoring. Physicians and patients alike have access to
electronic health records (EHRs); for patients, this              Addressing the Problem
means they can view lab results, schedule appointments,           Based on Geisinger’s experience, the authors say that
receive reminders, and e-mail their providers. To                 policymakers nationally should:
encourage physician participation in the medical home              Recognize that EHRs are absolutely necessary but
innovation, Geisinger provides practice-based monthly                 not sufficient for creating sustainable change in care
payments of $1,800 per physician, and stipends of                     delivery.
$5,000 per 1,000 Medicare patients to help finance                 Align incentives so that providers are rewarded for
additional staff. Preliminary data show a 20 percent                  enhancing value in health care.
reduction in hospital admissions and 7 percent savings in          Create policies that encourage greater organization
total medical costs. Based on this success, Geisinger is              of care delivery and payer–provider collaboration.
expanding the initiative to additional practice sites.
                                                                  The Bottom Line
Chronic disease care optimization. Geisinger provides             Geisinger has committed to implementing best practices
coordinated, evidence-based care for patients with                and improving quality and outcomes. Its innovations
chronic diseases, including diabetes, congestive heart            show considerable promise for improving quality and
failure, and hypertension. Through its use of                     enhancing value. For their best practices and care models
EHRs, Geisinger is able to standardize clinical practices,        to spread more broadly, health policies to align payment
provide doctors with a ―snapshot report‖ of patients’             incentives, encourage greater organization of care
relevant clinical information, and generate automated             delivery, and adoption of modern information
reminders for patients as well as the clinical team.              technology are needed.
Patients can also self-schedule appointments and receive

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