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O =Transforming the Health Insurance Delivery Business Model  A Labor-Management Initiative to Manage Care and Targeting QualityYPresentation to the Citizens Health Care Working Group Salt Lake City, Utah July 22, 2005ZZ JBackground: Jointly Administered Health Plans in the Retail Food IndustryKKSponsor 70 Plans Governed by ERISA Cover 800,000 Full-Time and Part-Time Employees Pay an Estimated $4.8 Billion in Annual Plan Benefits Administered by Equal Number of Labor and Management Representatives Over 50 years of Experience Delivering Health Insurance Benefits1The Current Health Plan Business Model is Flawed22 Attempting to Manage Price of Care vs. Actually Managing Care At Competitive Disadvantage in Price Negotiations with National and Regional Managed Care Organizations and PBMs Plans are Dependent on Intermediaries, and Are One Step Removed from Health Care Providers Plans are Not Focused on Health Care Quality and Patient Safety Plan Participants are Expected to Navigate the Health Care System Without AssistanceZ6A Vision of a New Health Plan Delivery Business Model77 Directing Care to High Performance, High Quality Providers Empowering Members and Physicians through Access to Information Technology Perform Health Risk Profiling that Analyzes the Health of the Plan Population Identify High Risk or At-Risk Participants Organize Targeted Interventions (e.g. Wellness, Disease Management, and Case Management) for High Risk and At-Risk Participants Assist Participants with Personal Health Advocacy Programs Adopt Plan Designs that Compliment this Model iThe Economic Foundation for the New Business Model: Correcting Costly Myths About the Health Care SystemjjhThe Economic Foundation for the New Business Model: Correcting Costly Myths About the Health Care System"ihLIs the Information Technology to Support Quality Care Decisions Available?MM Private Sector Platforms Health Care Purchasers  Leapfrog Group Non-Profits: NCQA & JCAHO Medicare  www.hospitalcompare.hhs.gov X 0g ECost Analysis by Quality Ranking Salt Lake City, Utah Area HospitalsFF ECost Analysis by Quality Ranking Salt Lake City, Utah Area HospitalsFFBWill Plan Participants Accept Direction on Health Care Decisions?CC5Cost Savings Potential: Medical Delivery Efficiencies66$ ^How Federal and State Governments Can Support A Quality-Driven Health Insurance Business Model__States Require the Collective and Dissemination Health Provider Outcomes Data Congress Adopts the Recommendations of the HHS Health Information Technology Leadership Panel Report Issued 5/11/05. Congress Legislates the 21st Century Health Information Act (H.R. 2234) introduced by Patrick J. Kennedy and Tim Murphy Congress Should Legislate Price Transparency Requirements for Hospitals, Physicians, Drug Manufactures,and Pharmacy Benefit Mangers* /P !"#$%& ' ( &  0` >y5fw:q ̙` 3f3f` www` I$nIȰ̙>?" dd@,?nKd@ @F " d@ `h U n?" dd@   @@``PP   @ ` `p>> ""EER"(  ,T   "n  0 "0n  0 "`n  0 "n  0 " Pn  0 "n  0 "n   0 "@pn   0 "n   0 "0n   0 "`n   0 "n  0 " Pn  0 "n  0 "n  0 "@pn  0 "n  0 "0n  0 "`n  0 "n  0 " Pn  0 "n  0 "n  0 "@pn  0 "n  0 " 0 n  0 "`  n  0 "  n  0 " P n  0 "  n   0 "  n ! 0 "@ p n " 0 "  n # 0 " 0 n $ 0 "`  n % 0 "  n & 0 " P n ' 0 "  n ( 0 " n ) 0 "@pn * 0 "n + 0 "0n , 0 "`n - 0 "n . 0 " Pn / 0 "n 0 0 "n 1 0 "@pn 2 0 "n 3 0 "0n 4 0 "`n 5 0 "n 6 0 " Pn 7 0 "n 8 0 "n 9 0 "@pn : 0 "n ; 0 "0n < 0 "`n = 0 "n > 0 " P ? 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D 0E "   E W#Click to edit Master subtitle style$ $ E 6E "`` E \* F 6|E "`  E ^* G 6xE "`  E ^*B  s *޽h ? 3f3f  0 @(    0*J P   J T*    0/J    J V*  d  c $ ?  J  02J  @ J RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  67J `P  J T*    6Cost(2  p NZJ ?"O ?/ ?Quality 2 ~ p H?"@x p B?"P  p B Jf?" 7  <Fact(2 p HJ ?"  }  UData proves quality = cost:(2 xB p@ BD?" @` ~B p HD?"` 7 7 ~B p HD?"7 ~ p H?" e Ipx p B?" w[px p B?" e I x p B?" w[   p NZ|J ?" I  ?Quality 2  !p HpJ ?"7 } >Cost(2 & "p HDJ ?"   nSource: UFCW Working Group  Health Plan of the Future8 28 H p 0޽h ? 3f3f̙3f3f  0 y t(  t t  0JA{  J x t B?" x t B?"  t H\J ?"@L  QMyth #3 Cost Savings can be mined from plan administration and benefit reductions*R(2J t BJf?"  >Fact(2 t Hd ?"en0  : 2 l t 0A ??>  &  t HHd ?" m nSource: UFCW Working Group  Health Plan of the Future8 28 H t 0޽h ? 3f3f̙3f3f  0 xB(  x x  0dA~Q  d ~ x s *DdBp d H x 0޽h ? 3f3f̙3f3f`  0 x`p`tX`(  r  S xdA  d \   U #"B6    Z@d ??@, PCost  @`  Z)d ??,@ MLOS  @`  Z9d ??0, W Complications  @`  Z(Cd ?? ,0 S Mortality    @`  ZHLd ?? ,  U Patients/yr    @`  ZPUd ??@,  NName  @`  ZX^d ??,@ RQuartile    @` P Z`gd ??@   P12,084  @` O Zrd ?? @  b4th ,    @` N Z|d ??0   b4th ,    @` M Zd ?? 0  I-  @` L Zd ??  b3rd ,    @` K ZDd ??@  n&University of Utah Hospitals & Clinics''  @` J Zd ?? @  W4th"   @` I Zd ??@H   P11,847  @` H Zd ??H @  W3rd"   @` G Z,d ??0H   W3rd"   @` F Zd ?? H 0  I-  @` E Z Zz ?? H  W2nd"   @` = Zx!z ??@ H  ^Jordan Valley Hospital  @` < ZT+z ?? @H  W4th"   @` ; ZX5z ??@   O9,286  @` : Z>z ?? @  W4th"   @` 9 Z8z ??0   W2nd"   @` 8 ZlQz ?? 0  I-  @` 7 Z|[z ??  W1st"   @` 6 Z ez ??@  n&St. Mark s Hospital  @` 5 ZXnz ?? @  W2nd"   @` 4 ZDhz ??@@   O8,316  @` 3 Z@z ??@ @  W3rd"   @` 2 Zlz ??0@   W4th"   @` 1 ZHz ?? @ 0  I-  @` 0 Z|z ?? @  W1st"   @` / Z|z ??@@  bLatter-Day Saints Hospital  @` . Z(z ??@ @  W2nd"   @` - Zz ??@@  O6,757  @` , Zz ??@@  W4th"   @` + Z Z| ?? P   W1st"   @` = ZT| ??@P   n&St. Mark s Hospital  @` < Z<| ??P @  W3rd"   @` ; Z| ??^ P  P34,071  @` : Z| ?? ^P  W1st"   @` 9 Z| ??R P  W1st"   @` 8 Z| ?? RP  b3rd ,    @` 7 ZH| ?? P  b4th ,    @` 6 Zh| ??@ P  i!Salt Lake Regional Medical Center""  @` 5 Z$| ?? @P  W3rd"   @` 4 Z} ??^  P32,183  @` 3 ZLu| ??^  W2nd"   @` 2 Z|} ??R  W4th"   @` 1 Zh} ?? R  W1st"   @` 0 Z(*} ??   b2nd ,    @` / Z3} ??@  n&University of Utah Hospitals & Clinics''  @` . Z<=} ??@  W2nd"   @` - ZF} ??^4 P26,863  @` , Z P} ??4^ W3rd"   @` + Z J} ??R4 W2nd"   @` * Zd} ?? 4R b3rd ,    @` ) Z\o} ?? 4  b1st ,    @` ( Z^} ??@4  aMcKay-Dee Hospital Center  @` ' Z} ??4@ W2nd"   @` & Z|} ??^4 P24,886  @` % Z} ??^4 W2nd"   @` $ Zi} ??R4 W3rd"   @` # Z} ?? R4 b2nd ,    @` " Zl} ??  4 b1st ,    @` ! Z} ??@ 4 bLatter-Day Saints Hospital  @`   Z} ??@4 W1st"   @`  ZL} ??^ P17,096  @`  Zl} ??^ W1st"   @`  Z} ??R W2nd"   @`  Z} ?? R b1st ,    @`  Z} ??   b4th ,    @`  Z ??@  ^American Fork Hospital  @`  Z ??@ W1st"   @`  Z ??^0 Q$15,851  @`  Z! ??0^ W1st"   @`  Z+ ??R0 W1st"   @`  Z5 ?? 0R b2nd ,    @`  Zt@ ?? 0  b2nd ,    @`  ZI ??@0  j"Cottonwood Hospital Medical Center##  @`  ZPS ??0@ W1st"   @`  ZL\ ??^p0 PCost  @`  Ze ??p^0 MLOS  @`  ZDo ??Rp0 W Complications  @`  Zj ?? pR0 S Mortality    @`   Z ?? p 0 U Patients/yr    @`   Z$ ??@p 0 NName  @`   Zؒ ??p@0 RQuartile    @`  ZL ??p aReport of Colon Surgery  @`B C Zo??B L Zo?? @ B M Zo??pB T Zo??pB  Zo??p0B  Zo??p0B  Zo??0B  Zo??0B  Zo??B  Zo??B  Zo??4B  Zo??4B  Zo??4B ʔ Zo??4B ̔ Zo?? B ؔ Zo?? B ڔ Zo?? P B  Zo?? P B  Zo??P  B  Zo??P  B  Zo??@  B  Zo??   B  Zo??  R B  Zo??R  B  Zo?? ^ B  Zo??^  d  T ?? 0 Average of All Hospitals $25,156 Top Hospital Cost $15,851 Difference between Top and Average Hospital 37% Difference between Top and Most Expensive Hospital 53.5% 2   T ??= wSource: HealthShare Technology  2    H  0޽h ? 3f3f'  0 |g(  |~ | s *!A t    |0 HA  ?B^Y    | HAXsXs_Q' ESource: HSC Community Tracking Study Household Survey, 2001 and 2003F 2F,,,BBXXH | 0޽h ? 3f3f̙3f3f    0  }  (  ~  s *A@    0 HA ?BU  x2  B?"   H ?" n  P shallow end  2 xB  BD?" [[ xB  BD?" [ xB  BD?" w. xB  BD?" .. 2  Z >?" n   H, ?"eM < 2    b3fA?25%"@I  H0 ?" wE Low est. Medium est. High est.F 2F x  B3f?"I`  A0?Light downward diagonal"`I  Ht ?" d TSource: Mercer  Business Roundtable Study+(2+H  0޽h ? 3f3f̙3f3f   0 $(  r  S tEA%;  E r  S LEB ` E H  0޽h ? 3f3f 0 jb0(  X  C    Jb  S IJ @  J Presentation by David Blitzstein on Transforming the Health Insurance Delivery Business Model  A Labor-Management Initiative to Manage Care and Targeting Quality, to the Citizens Health Care Working Group, Salt Lake City, Utah, July 22, 2005.H  0޽h ? ̙3380___PPT10. j% 0 @5(  X  C      S L  @   7#The current health plan business model is flawed: trying to control price rather than managing care, resulting in competitive disadvantage; health care providers are not directly involved; quality issues have low priority; and participants are not given assistance to navigate in the system.H  0޽h ? ̙3380___PPT10.@*E 0 PU(  X  C      S   @   WCInfluenced by IOM Crossing the Quality Chasm, the organization seeks to direct care to high performance, high quality providers, empower members and physicians through information technology, perform health risk profiling, identify high risk employees, organize targeted interventions, and assign personal health advocates.H  0޽h ? ̙3380___PPT10.t7 0 `(  X  C      S 8  @   Plan members believe myths that providers are infallible, and that spending more money results in better quality of health care.H  0޽h ? ̙3380___PPT10.`Sfx 0 p(  X  C      S   @   Another myth is that cost savings can be mined from plan administration and benefit reductions. The bar graph indicates that the largest source of potential cost savings is by reducing provider  variance. H  0޽h ? ̙3380___PPT10. 0 (  X  C      S d)  @   Through the National Commission on Quality Assurance (NCQA), some activities under way. A number of private groups are developing ways to estimate quality.H  0޽h ? ̙3380___PPT10.{  0 (  X  C      S 48  @   yCounter to the prevailing belief, the cost of care for hospitals offering highest quality was 25% lower than the average.H  0޽h ? ̙3380___PPT10.`t  0 (  X  C      S d?  @   rPreferred provider organizations may not be a good idea; they tend to stress cost at the expense of quality. Further, it appears that a hospital can t be the top performer in all areas.H  0޽h ? ̙3380___PPT10.p| 0 (  X  C      S PG  @   zThere is a growing willingness on the part of employees to accept limitations on their choice in exchange for lower costs.H  0޽h ? ̙3380___PPT10.lO 0 _(  X  C      S N  @   aMAs one might expect, more efficient providers tend to obtain greater savings.H  0޽h ? ̙3380___PPT10.#z+Y  0 i(  X  C      S \T  @   k#Actions that the governments can take to support quality-driven health insurance: require collection and dissemination of health provider outcomes data; adopt the recommendations of the HIT leadership report; legislate price transparency requirements for all providers and benefit managers. ,& H  0޽h ? ̙3380___PPT10.[J  0 d\(  X  C    \  S ^  @   The presentation addressed the jointly administered health plans in the retail food industry, the sponsor of 70 plans covering 800,000 full and part time employees, and paying an estimated $4.8 billion in annual plan benefits.H  0޽h ? ̙3380___PPT10.{ع "xXklT>sm @xl5klRj mS!B7x nKVJ'U eSIdh?">\UU !E*TKAQls̽w.fIZԌ3̜9s̙3{7 Q|lULR,@SR"KoEC.~Ro 0o= y5u`RM# a|Gp(,Y%.`ߎ-[&A՜"KSz28xryMt)>Janއ>ïV;2D,J.u|[|W~ZHV,O+ yj8&Y_Z?؝ri,t^wjj.6Z# I]Wo3}m̬V !!+܎ڄCǕ h|'loElu|ּIqK/TYTmCmitJ's~p!y|%p#*(Z_UV5b1vيxf1s+٫᚛9[nh cZ7oJ~Ews_& ' )g4xq/#-~ Ү &I#yNj 5ھngS,B^u)༴gPlV 5bt# &mbk;yMMU :/j;p^ڳ$1Ma9H"Go0RLɖ-?JF0S^QciG͏[=A3y@ˋk^Y+oSdWyӇ4%D}yΨ0B"1eh1߄Gh3mFLr#zCVTg @i-}3u`8nk]ŞTF QIT~;iI^WFx/e \RQ)U3U<A(PviIͣ^tr#c㙞܉cl^-r#[/.^]jG޴|U4;r_?op :xZ}pT?$"߄G%T|RBJdC5me)mi?XZu NǎuR18VGt8T:?֖wνlL2w|sϽfqovi)בMz#T)R"˴/zK3U (5s3 9/"g>0VL.LLLLLL3<.OWB)| ԊgM)}cp쪫:_Q6]c)1$%K,]9y:=v]C?9M6HoXYnhYGb~@sD L \Xp%`! 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LYeӕ'ڟjY-(h^yBXc5^N/F MnRX.H `RvU܄/Nƾt/-=5ǝ9hSGӣGGS$&-6֯HDtf B@Dic ÍU#HkR:,XJ&Y1ބbB?i7HTy]%Y$tJaM:?/l(M}t\NyKdKFǭ.!l%?ouIO5k|nh3kem(ЧiDӎ iJw߽<s߀VLɑFZ=Oc JU"8DR_xdӗ&k䈶\W 6aX ڎ`1K 0F[JJU=Il; mn򶛼&o ɛk暼1&o4y؅ezuS|"hnϪpbs^?8qqutL#XG.1#:ҍqO1zhYjAxG}u2j u<|R+:QZ= SN55ZK#qEh$KvE&;^ V'*v8to2/ߒb@w'x Ql=w"];|h(]5v-z˭h& Ю zSFaOa 2UYL>2-3ew*.ǵYN=^&,t}ښo7GN:E~PsN{:@ۺ:,!TDАox t c|"ijT_Fc9=YrDdMLEӸj Q||WW22 DE0O`؞cb`E@w|<SGtJz}p%OxE; :zakxCcᶜgu0NB,2>9MI0xMMv7yM^L\71ycL^4yh] 8;`JSb5y<-H">a?;,'"A(T3n tJ'(,* 77 xZVř%xV8aGMb83!C E{V E/x4 YB1n:0 Ca=FBwS gNx~ŒB\ ;*{az}YR[t  yA^{-OC[TpB*@DIK(.))<%%-} U]j*DJ҂Xk Xᆴ84͐U?D7$d;[] e4x'~LGrSGrXbJ構eZZ IZZkY2,d1 k;KTŰ~,A=LG !g  }C  y--$xx--'--$xx--'--$xx--'--$xx--'--$x x --'--$ x x --'--$ xx --'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$ x!x! --'--$""x$x$"--'--$%%x&x&%--'--$((x)x)(--'--$**x,x,*--'--$--x.x.---'--$00x1x10--'--$22x4x42--'--$55x6x65--'--$88x9x98--'--$::x<x<:--'--$==x>x>=--'--$@@xAxA@--'--$BBxDxDB--'--$EExFxFE--'--$HHxIxIH--'--$JJxLxLJ--'--$MMxNxNM--'--$PPxQxQP--'--$RRxTxTR--'--$UUxVxVU--'--$XXxYxYX--'--$ZZx\x\Z--'--$]]x^x^]--'--$``xaxa`--'--$bbxdxdb--'--$eexfxfe--'--$hhxixih--'--$jjxlxlj--'--$mmxnxnm--'--$ppxqxqp--'--$rrxtxtr--'--$uuxvxvu--'--$xxxyxyx--'--$zzx|x|z--'--$}}x~x~}--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'--$xx--'- @ IZx  -B( UUUU-- @ y --  @ IZx -'3f- @ IZ  -B( UUUU-- @ --  @ IZ -'- @ IZV,< -B( UUUU-- @ V-=--  @ IZV,<-'@"Verdana-. 3f:2 "Transforming the Health Insurance ."System:-@"Verdana-. 3f+2 )Delivery Business Model .-@"Verdana-. 3f 2 sF.-@"Verdana-. 3f2 !A Labor.-@"Verdana-. 3f 2 !3-F.-@"Verdana-. 3f-2 !6Management Initiative to o.-@"Verdana-. 3f92 (!Manage Care and Targeting Quality .-@"Verdana-. =2 <$Presentation to the Citizens Health .-@"Verdana-. "2 B3Care Working Group.-@"Verdana-. %2 J4Salt Lake City, Utah.-@"Verdana-. 2 Q< July 22, 2005.-@Times New Roman-. <2 dg#Presented by: David S. Blitzstein .-@Times New Roman-. C2 h[(Director, Negotiated Benefits Department.-@Times New Roman-. -2 noUnited Food & Commercial o.-@Times New Roman-. 02 snWorkers International Union.-՜.+,D՜.+,@    $ tOn-screen ShowUFCW International Union   Times New RomanVerdana Wingdings Bold StripesMicrosoft Graph 2000 ChartTransforming the Health Insurance Delivery Business Model A Labor-Management Initiative to Manage Care and Targeting QualityKBackground: Jointly Administered Health Plans in the Retail Food Industry2The Current Health Plan Business Model is Flawed7A Vision of a New Health Plan Delivery Business ModeljThe Economic Foundation for the New Business Model: Correcting Costly Myths About the Health Care SystemiThe Economic Foundation for the New Business Model: Correcting Costly Myths About the Health Care SystemMIs the Information Technology to Support Quality Care Decisions Available?FCost Analysis by Quality Ranking Salt Lake City, Utah Area HospitalsFCost Analysis by Quality Ranking Salt Lake City, Utah Area HospitalsCWill Plan Participants Accept Direction on Health Care Decisions?6Cost Savings Potential: Medical Delivery Efficiencies_How Federal and State Governments Can Support A Quality-Driven Health Insurance Business Model  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles  8@ _PID_HLINKSA$http://www.hospitalcompare.hhs.gov/_r0WhydeWhyde  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)PicturesMCurrent UserSummaryInformation(#PowerPoint Document(DocumentSummaryInformation8