Perspectives on Costs & Financing of GME Lewis G. Sandy MD FACP

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Joanna Montgomery
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1 Perspectives on Costs & Financing of GME Lewis G. Sandy MD FACP IOM Study: Governance and Financing of GME December 20, 2012

2 Overview: GME, as a public good, needs to be aligned with national needs Costs of GME are opaque UnitedHealth Premium Designation program example Financing of GME should be accompanied by transparency and accountability

3 GME As a Public Good Current State: Output of GME is not well aligned to current and future needs e.g. National Quality Strategy: Better Care Affordable Care Healthy People and Communities Quantity and specialty distribution opportunities Quality opportunities Geographic distribution opportunities Desired Future State: Output of GME better aligned to current and future needs New graduates with competencies better aligned to practice in new care models, new team configurations and new payment approaches GME output better aligned for appropriate access, especially to underserved and vulnerable populations 3

4 Primary care pressure points Areas with below average primary care capacity and above average projected 2014 coverage increases Full Report:

5 Costs of GME are Opaque No one knows the costs of GME Case Study: UnitedHealth Premium Designation Program 240,000 physicians, 21 specialties Measures and reports case-mix and risk-adjusted quality and episode efficiency Supports transparency for consumers and plan sponsors, and quality improvement, continuous professional development for physicians When first deployed in 2004, issue arose: how to account for higher costs of academically affiliated physicians for mission related costs

6 UnitedHealth Premium Designation: Academic Cardiologist

UnitedHealth Premium Designation: Academic Adjustment Question: What is a reasonable adjustment factor for mission-related costs when profiling academic physicians?

7 UnitedHealth Premium Designation: Academic Adjustment Question: What is a reasonable adjustment factor for mission-related costs when profiling academic physicians? Research: AAMC, University HealthSystem Consortium, academics Findings: no answer Teaching Mission Academic Credit The Premium program recognizes the teaching mission of academic medical group practices through an academic credit. Academic credit will be awarded to all members of a group with full-time faculty who have primary teaching responsibilities, and are affiliated with and admit 100 percent of their patients to a medical center that is a sponsor or participating institution of a program accredited by the Accreditation Council for Graduate Medical Education(ACGME). A ten percent credit is applied to the cost efficiency score of the affiliated physicians. Source: US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Unitedhealth%20Premium/UnitedHealth_Premium_Detailed_Methodology_2012.pdf

8 Financing of GME Transparency, Accountability GME, as a public good, deserves adequate support Support should be accompanied by transparency re use of GME financing dollars, costs of GME, and output Support should be accompanied by clear accountabilities and performance expectations

The Health Plan Role in Health Care Transparency: From Here s Some Data to Empowering The Consumer

The Health Plan Role in Health Care Transparency: From Here s Some Data to Empowering The Consumer Lewis G. Sandy MD RWJ Transparency Summit December 3, 2013 1 Pervasive Variation: Episode Costs and Care