BHCG Monitor: Focus on Health Care Benefits - April 2012
 
 

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BHCG Monitor: Focus on Health Care Benefits - April 2012

 

Strategic Partners – Partners in Progress

From its inception, the BHCG has clearly understood that neither a single employer nor one organization was large enough to have the positive impact on the cost and quality of health care that we desire. Just as the BHCG has brought together the interests of a significant number of employers, so too have we worked with other multi-stakeholder organizations in the state to effect change in our health care delivery system. The work of these organizations, recognized both regionally and nationally, is on the forefront of this change.

We view these organizations as strategic partners and lend our support for their work through participation on their boards and communicating their essential work to our members and interested stakeholders. The BHCG's executive director, Dianne Kiehl is a board member of each of these organizations.

Here is a report on some of the important initiatives that the Wisconsin Collaborative for Healthcare Quality (WCHQ), the Partnership for Healthcare Payment Reform (PHPR), the Wisconsin Health Information Organization (WHIO), the Wisconsin Health Information Exchange (WHIE) and the Wisconsin Statewide Health Information Network (WISHIN) are undertaking to positively impact health care delivery in our state.

Wisconsin Collaborative for
Healthcare Quality (WCHQ)

Who They Are

WCHQ is a voluntary, state-wide provider-driven organization working to improve the quality and cost of health care services delivered to our state's residents. Formed in 2003, the WCHQ is committed to the development of performance measures for assessing the quality and cost of health care services and to publicly report provider performance data. Click here to visit the WCHQ website to review publicly reported provider performance data. WCHQ also sponsors Wisconsin Health Reports, a website specifically designed for consumers to understand and review provider performance data.

Synergies with the BHCG

WCHQ's efforts to collect and publicly report standardized provider performance data supports BHCG's commitment to work with providers to improve health care value and to educate consumers and assist them in making choices using reliable information.

What's New

Presently the WCHQ publicly reports provider performance data at the medical group and health plan level – and will introduce "practice-site" level reporting this fall – but has not yet reported at the individual provider level. However, the drumbeat for the public reporting of individual provider performance grows louder every day. At a national level, the health care reform law requires the Center for Medicare and Medicaid Services (CMS) to develop a "Physician Compare" website to report information on the care provided to Medicare beneficiaries. In addition, a number of private sector initiatives in other states are working in this same direction.

Last month the WCHQ board of directors took up the issue of individual physician reporting measures. The Board adopted the following resolution:

By the end of 2012, each WCHQ member organization will have initiated transparent reporting of individual practitioner performance within their organization. WCHQ will assist its members in accomplishing this goal with technical assistance and support where necessary and appropriate. In addition, WCHQ will convene a "learning group" to capture key lessons to help inform the further development of methods and approaches that builds support by both members and physicians for this work. Finally, WCHQ will re-consider the question of establishing a timeline for publicly reporting individual performance at its March 2013 board meeting.

The BHCG applauds WCHQ's efforts to move toward public reporting of individual physician data. If consumers are to be held accountable for becoming informed purchasers of health care, they need to be armed with sufficient data and information to do so. This decision by the WCHQ board brings us another step closer to realizing the goal of developing informed health care purchasers.

Partnership for Healthcare
Payment Reform (PHPR)

Who They Are

The PHPR was launched in late 2009 under the sponsorship of Wisconsin Health Information Organization (WHIO). Recognizing that advancing the goal of better health care at lower cost requires the engagement of health care providers, payers, employers, state officials and consumers, a meeting was convened in early 2010 of representatives of these various constituencies. This meeting launched PHPR work groups involving more than 100 multi-stakeholder participants. Ultimately two payment reform pilot projects were developed and have been launched – bundled payments for total knee replacement and a shared savings methodology, transitioning to episode of care payments for adults with diabetes. Click here to visit the PHPR website and learn more about their current payment reform pilot projects.

Synergies with the BHCG

In order to improve the value – cost and quality – of health care, we believe we need to reform the way we pay providers. Instead of paying for units of care, it is preferable to move to a system that pays for outcomes. The pioneering work of the PHPR is a critical step in increasing the quality and affordability of health care in Wisconsin.

What's New

Total Knee Replacement is an increasingly common acute care procedure with costs that frequently vary from provider to provider. PHPR also selected this procedure as an acute care pilot program because there is strong evidence that a bundled episode payment methodology could improve both quality and efficiency of care. Several pilot project sites have gone live and will run for a three-year minimum time period. The project will utilize bundled payment for total knee replacement of one knee that includes services provided for 90 days post discharge due to complications as well as rehabilitation services.

Adults living with diabetes require a level of care from health care providers that enhances their quality of life. However, the level and availability of that health care can vary. PHPR has developed a chronic care pilot program to provide a continuum of quality care and address a number of flaws in current payment structures for the treatment of adult diabetes. Pilot projects are underway and will continue for a four-year minimum time period. In years one through three, providers will take the clinical risk and insurers, the insurance risk. Providers will be eligible for 75 percent of the shared savings, dependent upon quality measures. The transition will be made to total episode of care payment in year four and beyond.

PHPR has also been actively engaged with SMARTCare, an initiative sponsored by the American College of Cardiology, its Wisconsin chapter, and the Wisconsin Medical Society, to improve the quality and efficiency of diagnosis and treatment of stable ischemic heart disease. A grant proposal to launch this project in Wisconsin and Florida was submitted to the Center for Medicare and Medicaid Innovation. If funding is received, PHPR, in partnership with BHCG and others, will be involved in implementing this project in commercially insured populations. Humana has agreed to modify their reimbursement methodology to support this initiative.

As the health care system seeks to accelerate the transition toward value based purchasing, interest remains strong in Wisconsin and around the country in episode of care payments, including bundled payments, as a transitional step to more comprehensive payment and delivery system reforms.

Wisconsin Health Information
Organization (WHIO)

Who They Are

WHIO is a voluntary, not for profit public-private partnership with a multi-stakeholder board which includes payers, providers, business and the state government. WHIO has developed a statewide data mart of health care information which can be used to produce comparative analytics on provider performance and evaluate population health. Providers and others use this information to improve value in health care by focusing on quality and efficiency of delivery. Click here to visit the WHIO website to learn more.

Synergies with the BHCG

By aggregating data from a multiple payers representing a majority of claims in the state, the WHIO data mart creates a robust data set that providers and other interested parties can use to improve care. Providers having access to aggregate data from multiple sources obtain a more complete picture of their practice. Ultimately WHIO also plans to publicly report its data, thereby adding to health care cost and quality transparency.

What's New

Presently WHIO's data mart contains more than 230 million claims representing approximately 66 percent of the state's population and approximately $130 billion in billed charges. This includes the entire Medicaid population, a statistically significant portion of the commercial population and the portion of the state's Medicare population enrolled in Medicare Advantages plans.

As a result of recent rules issued by the Centers for Medicare and Medicaid (CMS), WHIO has the potential opportunity to add the rest of the State's Medicare population's claims to the data mart. WHIO is diligently working with CMS to overcome some obstacles and restrictions placed on the use of the data by CMS which conflict with WHIO's business model of pushing the data out to data subscribers enabling them to perform their own analysis.

In 2012 WHIO hopes to push its vast data repository out to data vendors, benefit consultants, TPAs, researchers and other interested entities, so they can begin to perform analyses which can ultimately benefit the state's health care consumers.

Wisconsin Health Information
Exchange (WHIE)

Who They Are

WHIE is a nonprofit organization whose mission is to improve the quality, safety, efficiency and accessibility of health care through the secure delivery of timely, accurate electronic health information to authorized users across institutional boundaries. WHIE, currently in its fourth year of clinical operation, is one of the nation's leading efforts to improve health care through regional electronic information exchange.

The BHCG is an active supporter of WHIE's provider community initiative that links emergency departments to the HIE network. Providing emergency department staff with access to a patient's emergency department visit and treatment history can save substantial money by reducing duplicate tests, procedures and unnecessary inpatient admissions. In addition, the patient experience, patient safety and quality of care are improved. Click here to visit the WHIE website to learn more about how WHIE is working to change how health information is used.

Synergies with the BHCG

The data sharing at the time of treatment among providers improves the patient experience, while positively impacting cost and quality. Emergency department physicians have access to patient's health history, thereby enhancing decision making for diagnosis and treatment and reducing costs by eliminating duplicative testing.

What's New

Four emergency departments became new users of WHIE in 2011, including: Wheaton Franciscan facilities, Elmbrook Memorial, The Wisconsin Heart Hospital and Wheaton Franciscan, Franklin; and Columbia St. Mary's Ozaukee. Wheaton Franciscan, All Saints (Racine) and Aurora Health Care, Grafton will come on board in April, 2012. With these additions, communities in four counties will realize the benefits of HIE in their emergency departments, including more informed decision making and improved coordination of care. Extending the care coordination model, WHIE is pleased to add Sixteenth Street Community Health Center as the most recent ambulatory site to begin using WHIE, joining Outreach Community Health Center which began in 2009.

WHIE, recognizing efficiencies from reuse of data, also supports work with City of Milwaukee and Wisconsin Department of Health Services on population health initiatives. Currently, WHIE receives admitting data from 51 hospitals statewide and makes it available to public health officials to identify potential public health threats. This "syndromic surveillance system" can quickly identify public health threats such as a flu outbreak or food borne illnesses. This real-time surveillance can in turn alert physicians to watch for patients presenting specific symptoms. This is a prime example of how WHIE is leveraging the collection of health information to positively impact patient safety and quality of care.

Over the next several months, WHIE will be engaging with large employers and community organizations to provide education around WHIE and our activities. If you are aware of a group you believe would find value in learning about the clinical and population health initiatives operating across Wisconsin with WHIE, please contact WHIE at 262-240-0198.

Wisconsin Statewide Health
Information Network (WISHIN)

Who They Are

WISHIN, an independent nonprofit organization incorporated in late 2010, is charged with bringing the benefits of widespread, secure and interoperable health information technology to patients and caregivers throughout Wisconsin. As Wisconsin's State-Designated Entity for Health Information Exchange (HIE) it is responsible for developing HIE capability throughout the state. WISHIN plans to build a statewide health information network to connect physicians, clinics, hospitals, pharmacies, clinical laboratories and others across Wisconsin, regardless of the electronic medical record system they use.

A statewide electronic health information exchange offers the promise of timely, relevant information that can lead to better clinical decisions and outcomes, less duplication, more effective transitions of care and reduced administrative costs. WISHIN's vision is to improve the health of individuals and communities in Wisconsin by allowing a secure electronic sharing of the right information, at the right place and time, with the right individuals. Click here to learn more about WISHIN.

Synergies with the BHCG

When patients move from one health care system to another, their health information does not always follow them, potentially leading to duplication of care and poorer clinical outcomes. As more providers join WISHIN and share information, higher quality care with lower costs is a likely outcome.

What's New

In January WISHIN issued a Request For Proposal in order to select a vendor who will develop and operate the statewide health information network this year. Three finalists will make a presentation to WISHIN's proposal evaluation team in early April, after which a recommendation will be forwarded to the WISHIN Board for approval.

Participating health care organizations will be able to access patient-specific information via a query system. The ability to query network participants and access complete and recent clinically relevant information can improve the quality of care as well as reduce administrative time and expense for both senders and receivers of clinical information.

WISHIN expects to implement its services in a small number of pilot communities in the fourth quarter of 2012, and expand statewide during 2013.

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BHCG Monitor: Focus on Health Care Benefits - April 2012