Wednesday, May 27, 2009

OPM Director's New Long Term Goal reports that OPM Director John Berry said today that "his longer-term goals include moving aggressively to control costs in the Federal Employees Health Benefits Program." That objective is easier said than achieved, particularly given the demographics of the FEHB Program. Because the federal government offers generous retiree benefits, half of the Program's four million enrollees are annuitants and the average age of a FEHBP enrollee is around sixty. Moreover, OPM and the carriers have been doing a good job with the Program, in my opinion.

Modern Healthcare reports that the United Healthcare Group released a paper concluding that "The federal government could save more than half a trillion dollars over the next decade simply by pushing initiatives to reduce medical errors, to promote better treatment of chronic and advanced illnesses, and to step up case management." Here are the 15 United Healthcare initiatives:
A. Incentivizing Member / Beneficiary Use of High Quality Providers 2010-2019 Savings
Option 1: Member Incentives to Use Highest Quality Providers Assessment of quality and efficiency of providers using “episodes of care” analytics measured against evidence-based standards and efficiency benchmarks. Provides members with incentives to use highest quality physicians. ~$37 billion
Option 2: Cancer Support Programs Voluntary guidance on cancer treatment best practices and patient options, including hospice care. Case management to prevent hospital readmissions between therapy sessions. ~$5 billion
Option 3: Transplant Solutions Program Voluntary guidance for patients on selecting the best transplant centers in the nation for their condition. ~$0.7 billion
B. Reducing Avoidable and Inappropriate Care
Option 4: Institutional Preadmission Program Provision of onsite nurse practitioners at skilled nursing facilities to manage illnesses and prevent avoidable hospitalizations. ~$166 billion
Option 5: Transitional Case Management Program Follow-up with patients after leaving the hospital to reduce readmissions by checking on recovery progress and supporting adherence to discharge plans and recommended medical care. ~$55 billion
Option 6: Advanced Illness Program Provides information and guidance to patients and their families about both their condition and the benefits of further treatment options including palliative care at the end of life. ~$18 billion
Option 7: Disease Management for Congestive Heart Failure Voluntary coaching for members with higher-acuity chronic illness to ensure treatment compliance. ~$25 billion
Option 8: Gaps In Care Program Voluntary intervention for members with chronic illness, but relatively good health to ensure ongoing treatment compliance. ~$1.4 billion
Option 9: Integrated Medical Management Application of clinical evidence-based care management tools with targeted preventative care and patient education tools to reduce admission rates. ~$102 billion
C. Incentivizing Physicians to Encourage High Quality Care
Option 10: Patient-Centered Medical Home Establish a primary care physician as the central ongoing coordinator of patient care. Reduces inappropriate or duplicative treatments while ensuring needed ‘anticipatory’ care is provided. ~$20 billion
Option 11: Physician Additional Compensation Program Rewarding physicians for providing comprehensive medical care and utilizing resources appropriately. ~$24 billion
Option 12: Specialist Data Sharing Sharing comparative quality and effectiveness data with physicians to induce behavioral change towards evidence-based clinical practice. ~$15 billion
D. Applying Evidence-Based Standards to Reimbursement Policies
Option 13: Radiology Benefit Management Application of clinical evidence to determine clinically appropriate diagnostic radiology studies. ~$13 billion
Option 14: Radiology Therapy Management Application of clinical evidence to determine clinically appropriate usage of radiology therapies. ~$5 billion
Option 15: Prospective Claims Review Analysis of claims before they are paid to detect upcoding, duplicate billing and billing for non-existent patients. ~$57 billion
I think that it's helpful to review the list and the paper because many if not all of these initiatives are being mulled over by the Senate Finance Committee and the new
Federal Coordinating Council for Comparative Effectiveness Research created by the 2009 recovery act. And speaking of cost effectiveness, Health Affairs has published a study based on Medicare's Hospital Compare initiative which finds no correlation between intensity of spending and quality of care. "The absence of positive correlations suggests that some institutions achieve exemplary performance on quality measures in settings that feature lower intensity of care." Medicine is as much an art as it is a science.

Under the no good deed etc. heading, the New York Times reported yesterday that legal experts are raising anti-trust concerns about cooperative efforts among health care providers and payers to control costs. The article points out historical precedents from the Clinton and Carter administration to support those opinions.

No comments: