Market Driven Health Care Reform in Maine: How Market ...mdf.org/documents/MarketDrivenHCReform_Mitchell.pdf · Market Driven Health Care Reform in Maine: How Market Principles can

Market Driven Health Care Reform in Maine:

How Market Principles can Improve How Market Principles can Improve the Health Care System and

Wh M i i L di th C tWhy Maine is Leading the Country

Elizabeth MitchellCEO

www.mhmc.info & www.mehmc.org

Maine Health Management Coalition

Maine Health Management Coalitionwww.mhmc.info

PurchasersThe MHMC is an purchaser-led partnership among multiple stakeholders working

19 Private Employers5 Public Purchasers

g p gcollaboratively to maximize improvement in the value of healthcare services delivered to MHMC members’ employees and dependents.

The Maine Health Management Coalition Foundation is a public charity whose mission is21 Hospitals

Providers

Foundation is a public charity whose mission is to bring the purchaser, consumer and provider communities together in a partnership to measure and report to the people of Maine on the value of healthcare services and to educate

14 Physician Groups

H lth Pl the value of healthcare services and to educate the public to use information on cost and quality to make informed decisions.5 Health Plans

Health Plans

Collectively 35% of Comm Market

www.mhmc.info & www.mehmc.org2

Collectively 35% of Comm. Market

MHMC Value Equation

quality / outcomes + Value = change in health status +

employee satisfactionp ycost

Best quality health careBest quality health careBest outcomes and quality of lifeMost satisfactionMost satisfactionFor the most affordable costFor all Maine citizens


For all Maine citizens

Costs of Premiums Eroding Wages

www.mhmc.info & www.mehmc.org 44

If food prices had risen at medical inflation rates since the 1930’sinflation rates since the 1930 s.

*Source: American Institute for Preventive medicine

20091 dozen eggs $85.08 1 pound apples $12.971 pound apples $12.97 1 pound sugar $14.53 1 roll toilet paper $25.67 1 d $114 471 dozen oranges $114.47 1 pound butter $108.29 1 pound bananas $17.02 1 pound bacon $129.94 1 pound beef shoulder $46.22 1 pound coffee $68 08


1 pound coffee $68.08 10 Item Total $622.27

Good News and Bad NewsThe Good News:

Maine’s health care quality is good and improving.

2010: Biggest improvement in US

The Bad News:W ’t ff d itWe can’t afford it.

Maine’s health care cost 2nd highest in US.


4 Steps to Improving Health Care Value

1) Transparent Cost and Quality Information

1) Informed Consumer Choice)

1) Value Based Purchasing1) Value Based Purchasing

2) Effective Incentives


Maine HospitalsPTE Steering Committee Determines Pie and Blue Ribbon Cut Points.

www.mhmc.info & www.mehmc.org 88CMS Leapfrog &

MHMCCMSSource:

% Variance in Inpatient & Outpatient Hospital Allowed Payments, CY2005 Adjusted for Patient Mix by DRG & APGPayments, CY2005, Adjusted for Patient Mix by DRG & APG

Unadjusted variances in provider or insurer coding and processing of data may contribute to the variances shown in this report. Unadjusted variances in provider or insurer reimbursement arrangements, which may not be reflected in the administrative files, may contribute to the variances shown in this report. Although the Maine Health Information Center gmakes every effort to ensure the validity and accuracy of the report, the report is based on data provided by other organizations. Therefore, it is subject to the limitations of coding and financial information inherent in administrative files. This is provided to enhance the user’s understanding of relative payment for services.

*** Critical Access Hospital before 2005


* New Critical Access Hospital during 2005


Paying for Value: Better Coverage for Better Careg

State of Maine and The Jackson Laboratories: Tiered Networks• Hospitals based on PTE Metrics - 2006p

Waive $200 co-pay• PCPs based on PTE Metrics - July 2007y

Waive co-pay and deductible on office visits

Several other Maine employers planning tiered benefits in 2011

www.mhmc.info & www.mehmc.org 1111

You Get What You Pay For

Employers Pay For:Employers Want: Employers Pay For:TestsVisits

p yInformed EmployeesImproved Outcomes Visits

ProceduresPrescriptions

Improved OutcomesCare Coordination

Prevention pErrors & Complications

PreventionFunctional Status

Return to WorkReturn to Work


Current Payment Systems Reward Bad Outcomes, Not Better Health

ContinuedH lth

HealthyC

PreventableCondition

HealthConsumer

NoHospitalization

Acute Care Episode

Efficient Successful Outcome

Complications

High-CostSuccessfulOutcome$ Complications,Infections,Readmissions

$www.mhmc.info & www.mehmc.org 13


Documents

Market Driven Health Care Reform in Maine: How Market ...mdf.org/documents/MarketDrivenHCReform_Mitchell.pdf · Market Driven Health Care Reform in Maine: How Market Principles can