building quality and cost containment into health care reform betsy imholz special projects director...
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Building Quality and Cost Containment into
Health Care Reform
Betsy ImholzSpecial Projects Director
Consumers Union
Health Care Reform: The California PerspectiveITUP –Washington Workgroup
September 3, 2009
California Consumers Overview
1 in 7 uninsured Americans lives in CA 13% of nonelderly had medical debt 2/3 of those with medical debt were insured when the
debt was incurred Californians less likely to have insurance through job 2 million buy through individual market
Sources: UCLA Center for Health Policy ResearchUrban Institute and Kaiser Commission on Medicaid
California Reform Package 2007-2008Quality and Cost Containment Groundwork:
Health IT Disease Management Community Makeover Grants Enhanced Insurer Efficiencies Prevention Incentives Tobacco Cessation and Obesity Prevention Transparency—Quality and Cost
HR 3200 (Bending the Curve)
Prevention - $35 B Comparative Effectiveness Research Quality outcomes data Non-payment for hospital-acquired conditions Promoting competition Delivery system reforms Medicare & Medicaid incentive payments HIT enhancements
Quality and Cost Intersection: Two Consumers Union Priorities
1. Safety improvement incentivesA. Transparency
B. Non-payment for hospital-caused events
2. Closing the evidence gapA. Comparative effectiveness information
B. Getting the right care, avoiding unnecessary intervention
What gets reported publicly
gets improved!
Transformation
Positive Clinical Impact of Public Performance Reports
Hospitals whose performance data was publicly reported show statistically significant improvement in performance.
Improvement appears related to post-report quality improvement efforts.
Judith H. Hibbard, Jean Stockard, and Martin Tusler“Hospital Performance Reports: Impact on Quality, Market-Share, and Regulation”Health AffairsJuly/August 2005
8% Reduction in number of HAIs after 2 years of public reporting
Non pay Mistakes
Start with credible source of unbiased, rigorous analysis of clinical evidence about drug effectiveness (DERP)
Intense medical input through consultants, internal CU review, and medical peer review
Selections based on effectiveness, safety record, and price
Identifying CR Best Buy Drugs
Closing the Evidence Gap
Example: The “Perinatal Paradox – Doing More, Accomplishing Less”
Childbirth/pregnancy a leading reason for hospital admissions and costs
Caesarian rates rising dramatically (1/3 all births) Preterm births increasing 36% Low birthweight increasing 22%
In 1 California county: Vaginal delivery, at birthing center, by midwife $3,000 Vaginal delivery, in hospital, by physician $10,000 Caesarian delivery, in hospital $25,000+
Resource: “Evidence – Based Maternity Care,” Childbirth Connection, Milbank Memorial Fund, and Reforming States Group (Oct. 2008)
Building Quality and Cost Containment into
Health Care Reform
Betsy ImholzSpecial Projects Director
Consumers Union
Health Care Reform: The California PerspectiveITUP –Washington Workgroup
September 3, 2009