# Presentation: 352582

## Purchasing Population Health:  Aligning Financial Incentives to Health Outcomes

- George Isham, M.D.
- Chief Health Officer
- HealthPartners

- NAHDO, January 17, 2000
- Pittsburgh, PA

## Why Do We Need A Population Health Focus?

- Health in the U.S. is not as good as it could be (or is in other civilized countries)
- Quality of care in the U.S. is poor and needs improving
- Health equity for all in the U.S. is a national disgrace
- Our health system continues to be in crisis

## Health Market Evolution

- Every market — including health care — is structured around the incentives created by the purchasers.

## Aligning the Market

- Stage 1:  Open Checkbook
- Stage 2:  Cost Containment
- Stage 3:  ?

## How Do We Get From Blue Sky to Grains of Sand and Back Again?

- Envision the Possibility of the Journey Through Credible Models of Health and Improvement in Health
- Establish a Policy Environment that Facilitates the Journey and Encourages Market Conditions and Demand For Health and Health Improvement
- Realize that We Must Move from Separateness to Togetherness (“Systemness”)

## How Do We Get From Blue Sky to Grains of Sand and Back Again?

- Establish a role and purpose for everyone going on the Journey (Organizational Mission, Clearly Articulated Team Purpose and Priorities)
- Establish Clearly Articulated and Linked Accountabilities At Each Level: Populations, systems,  care teams, and individuals Appropriate payment incentives
- Enroll Populations
- Keep Information with meaningful information on health and health care in State of the Art Data Systems

## How Do We Get From Blue Sky to Grains of Sand and Back Again?

- Determine What Works and What Doesn’t and Train Professionals to Know the Difference (Effectiveness information - Science)
- Develop the Capability to Use Effective Interventions to Change Performance
- Develop Metrics and Keep Score
- Use the Scores to Provide Feedback and to Hold Teams Accountable.
- Start the Cycle Again

## HealthPartners

- Consumer Governed, Minnesota Company
- Not For Profit
- 800,000 Member, Mixed Model, Health Plan
- 26 owned clinic sites
- 37 contracted medical groups
- 1 Owned Hospital, Many Contracted
- Research Foundation, Institute for Medical Education, Institute for clinical Systems Integration

## Our mission is to improve the health of our members and our community.

- HealthPartners’ Mission

## Health Condition Management Model

- No/Low Risk

- At Risk

- High Risk

- Early
- Symptoms

- Advanced
- Disease

- Diagnosis

- Treatment

- Salvage

- Prediction

- Risk Factor
- Modification

## Partners for Better Health Goals

- Heart Disease
- Diabetes
- Immunization
- Dental

- Breast Cancer
- Prenatal Outcomes
- Childhood Injury
- Violence

## The Population Health Cycle

- Set Goals

- Assess Members’
- Willingness to Participate

- Determine Health
- Status

- Evaluate Readiness
-  to Change

- Design Systematic
- Interventions

- Evaluate

- Modify Goals

## Choice Plus/Ultimate Choice Products

- Competition and the care system level
- A care system is a group of providers and facilities accountable for an enrolled population
- It includes:  primary care clinics, primary care physicians, specialists, hospitals, and other health professionals who work together to provide all the members health care needs
- Competition is on cost, quality, and service
- http://www.consumerchoice.com

## Measurement Activity for Health Plans

- Measurement for Accountability (External)
- Performance of the Health Plan
- Performance of the Delivery System Components (clinics, MDs, hospitals)
- Measurement for Improvement (Internal)
- Measurement for the Discovery of New Knowledge (Research)

## Clinical Indicator ResultsDiabetes Levels

## Improving Health

- Focus	*PBH*
- Agree on elements of care	*ICSI Guidelines*
- Determine a measurement approach	*CISC*
- Establish performance targets	*Stated Goals*
- Align incentives	*Outcomes Recognition Program*
- Support improvement	*‘At Risk’ lists, CQI, CHP...*
- Evaluate and repeat	*Clinical Indicator Report*

## Institute for Clinical Systems Improvement (ICSI) 

- Association of Medical Groups working together
- Self governed process
- Formal evidence of effectiveness grading
- CQI principles
- HealthPartners is the sponsor

## Institute for Clinical Systems Integration

- Over 40 guidelines
- Clinical practice
- Work site
- Focus has shifted over time
- Guideline development
- Guideline implementation
- Quality advocacy

## Performance Targets

## Outcomes Recognition Program

- Goals
- Promote health, recognize superior performance, reinforce HealthPartners priorities
- Principles
- Simple, valid, sufficient to motivate, will evolve
- Eligibility
- 2500 members
- 2 years of network participation
- Service Quality & Technical Quality

## Support Improvement

- Training
- CQI training available to network
- Quality and Utilization Forum
- Consultation/Facilitation
- Development and Deployment of Member materials
- Tobacco campaign
- Messages targeted to stage of change
- 10,000 Steps
- Partners for Better Health Phone Line

## Support Improvement

- Population identification
- ‘At Risk’ lists of enrollees
- Diabetes, CAD, Mammography, CHF, Pediatric  Immunizations, Adolescent Immunizations
- User friendly access to information
- Paper reporting
- On-line reporting
- Data analysis

## Performance Measurement Coordinating Council (PMCC)

- Created by AMAP, JACHO & NCQA
- Collaborative effort designed to coordinated performance measurement across the entire health care system
- Intended to ensure measurement driven assessment processes are efficient, consistent and useful
- Should result in measurement that is less burdensome and more meaningful
- Should result in more participation, more quality improvement, and better quality and service
- Will dovetail with President’s Quality Forum

## Evaluate and Repeat

- Clinical Indicator Report
- Assessment of effectiveness
- # of measures improvement @ 95% significance level
- # of medical groups improving @ 95% significance level
- # of additional people with the activity
- Annual Planning cycle

## Prevention Systems Developing

- Prevention is a system of care
- Visit planning works
- Changing high risk behaviors pays the greatest health dividend.

## Care for Heart Disease Getting Better

- Lowering LDL (bad) cholesterol in patients with heart disease prevents heart attacks.
- Advising smokers to quit works.
- Quitting smoking prevents heart attacks.
- Comprehensive CAD Care

## What it Will Take to Improve HEDIS Rates Further

- Systematic ‘Visit Planning’ approach
- Outreach to members by medical groups using ‘At Risk’ lists
- Practice guidelines that match measurement approach
- Measurement approach and billing practices that are consistent

## Other Population Health Interventions

- The restaurant challenge
- Anti-tobacco advertising
- Health risk assessments
- Telephone based case management and education
- Publications
- Internet
- Need “reach” and “depth” of intervention

## Slide 29

## Slide 30