In Utilization and Trend In Quality

Transcription

1 AHA Taskforce on Variation in Health Care Spending O Hare Hilton, Chicago February 10, 2010 Allan M. Korn, M.D., FACP Senior Vice President, Clinical Affairs and Chief Medical Officer

2 Variation In Utilization and Trend In Quality In Safety 2

3 Key Findings Profile Men have a higher rate of arthroscopy overall, consistent with published literaturere Rate of Procedure, by Gender Rate of Procedure, by Gender and Age Source: Intelimedix Proprietary & Confidential; BCBSA Analysis 3

4 Key Findings Variability Markets show substantial differences in arthroscopy rates after adjusting for age, gender, industry and type of diagnosis. Source: Intelimedix Proprietary & Confidential; BCBSA Analysis 4

5 Key Findings Variability These arthroscopy rates can be further refined on a MSA basis 5.7 to 6.6% 5.0 to 5.6% 4.5 to 4.9% 4.0 to 4.4% 0 to 3.9% Source: Intelimedix Proprietary & Confidential; BCBSA Analysis 5

6 Program Overview A national designation awarded by Blue Cross and Blue Shield companies to hospitals and medical facilities that have demonstrated expertise in delivering quality healthcare in the areas of bariatric surgery, cardiac care, complex and rare cancers, transplants and our newest designations in spine surgery and knee/hip replacement. The designation is based on objective, evidence-based selection criteria established in collaboration with expert physicians and medical organizations. 6

7 Geographic Reach More than 270 medical facilities across 41 states have been designated as for Bariatric Surgery for Bariatric Surgery for Cardiac Care for Complex and Rare Cancers for Knee and Hip Replacement SM WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS MN OK IA WI MO AR LA MI IN IL KY TN MS AL GA OH WV SC NY PA MD VA NC ME VT NH MA CT RI NJ DE for Spine Surgery SM TX FL for Transplants AK HI PR 7

8 Geographic Reach More than 420 medical facilities across 40 states have been designated as for Cardiac Care for Bariatric Surgery for Cardiac Care for Complex and Rare Cancers for Knee and Hip Replacement SM WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS MN OK IA WI MO AR LA MI IN IL KY TN MS AL GA OH WV SC NY PA MD VA NC ME VT NH MA CT RI NJ DE for Spine Surgery SM TX FL for Transplants AK HI PR 8

9 Geographic Reach More than 90 medical facilities across 33 states have been designated as for Complex and Rare Cancers for Bariatric Surgery for Cardiac Care for Complex and Rare Cancers for Knee and Hip Replacement SM WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS MN OK IA WI MO AR LA MI IN IL KY TN MS AL GA OH WV SC NY PA MD VA NC ME VT NH MA CT RI NJ DE for Spine Surgery SM TX FL for Transplants AK HI PR 9

10 Geographic Reach More than 500* medical facilities across 37 states have been designated d as for Knee and Hip Replacement SM for Bariatric Surgery for Cardiac Care for Complex and Rare Cancers for Knee and Hip Replacement SM * for Spine Surgery SM OR CA WA NV ID UT AZ MT WY CO NM SD TX ND NE KS MN OK IA MO AR LA WI IL TN IN MI KY OH MS AL GA WV SC PA FL NY MD VA NC ME VT NH MA CT RI NJ DE for Transplants AK HI PR *Approximate number of designated facilities by the end of Q

11 Geographic Reach More than 300* medical facilities across 35 states have been designated as for Spine Surgery SM for Bariatric Surgery for Cardiac Care for Complex and Rare Cancers for Knee and Hip Replacement SM WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS MN OK IA WI MO AR LA MI IN IL KY TN MS AL GA OH WV SC NY PA MD VA NC ME VT NH MA CT RI NJ DE for Spine Surgery SM * TX FL for Transplants AK HI PR *Approximate number of designated facilities by the end of Q

12 Geographic Reach More than 80 medical facilities in 32 states have been designated as for Transplants for Bariatric Surgery for Cardiac Care for Complex and Rare Cancers for Knee and Hip Replacement SM WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS MN OK IA WI MO AR LA MI IN IL KY TN MS AL GA OH WV SC NY PA MD VA NC ME VT NH MA CT RI NJ DE for Spine Surgery SM TX FL for Transplants AK HI PR 12

13 Geographic Reach The Blues achieve a national presence, with more than 1,600* Blue Distinction designations across 46 states t for Bariatric Surgery for Cardiac Care for Complex and Rare Cancers for Knee and Hip Replacement SM WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS MN OK IA WI MO AR LA MI IN IL KY TN MS AL GA OH WV SC NY PA MD VA NC ME VT NH MA CT RI NJ DE for Spine Surgery SM TX FL for Transplants AK HI PR *Approximate number of designated facilities by the end of Q

14 Results from RFI Clinical Data Patient Outcomes deliver significantly better overall quality outcomes 42% 52% 19% 2% 3% 11% 5% 8% Bypass Surgery (30 days post) Adult Allogeneic Stem Cell Transplant (1 year post) Heart Transplant (1 year post) Bariatric Surgery (30 days post) Mortality Rates Complication Rates BDC Other Note: Results shown are mean values. Mortality rates for bypass surgery and heart transplant are risk-adjusted. Source: BCBSA Analysis of Hospital RFI Data. Bone marrow transplant data based on actuarial data. Heart transplant data include facility results abstracted from the Scientific Registry for Transplant Recipients. 14

15 Variation in Quality RFI Scores for Knee and Hip Replacement points (out of 100 Score Facilities (n=835) 15

16 Where does safety fit on this agenda? There has been little variation in the safety of health care since the IOM report 10 years ago This is unacceptable 16

17 Contact Information Allan M. Korn, M.D., FACP Senior Vice President Clinical Affairs and Chief Medical Officer b Christine Izui Executive e Manager, Quality christine.izui@bcbsa.com Blue Cross Blue Shield Association 225 North Michigan Avenue Chicago, Illinois