GBMC HealthCare is Building a Better System of Care for Our Community. John B. Chessare MD, MPH President and CEO GBMC HealthCare System

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1 GBMC HealthCare is Building a Better System of Care for Our Community John B. Chessare MD, MPH President and CEO GBMC HealthCare System

2 Agenda The Challenges in our National and Local Healthcare Systems GBMC HealthCare s Transformation to Deal with These Challenges How GBMC HealthCare Can Help Businesses Improve the Health and Care Experience of Their People While Lowering Cost

3 What is good about the U.S. system and Baltimore s healthcare? We have the best trained doctors and nurses in the world They are the hardest working in the world Many citizens have a good relationship with their physician(s) and get access when they need it We have an excellent system for trauma care We do well for a lot of acute problems

4 What are our challenges Nationally and in Baltimore? 1. We spend 40% more per capita on healthcare than any other country in the world

5 International Comparison of Spending on Health, Average spending on health per capita ($US PPP) Total health expenditures as percent of GDP $8,000 $7,000 US SWIZ $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 NETH CAN GER FR AUS UK JPN US NETH FR GER CAN SWIZ UK JPN AUS Notes: PPP = purchasing power parity; GDP = gross domestic product. Source: Commonwealth Fund, based on OECD Health Data 2012.

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8 What are our challenges Nationally and in Baltimore? 1. We spend 40% more per capita on healthcare than any other country in the world 2. Over 40 million (generally working) citizens don t have health insurance; In Texas, 23% of citizens have no health insurance 3. Our outcomes are frequently not as good as in other countries

9 Country Rankings Overall Ranking AUS CAN GER NETH NZ UK US OVERALL RANKING (2010) Quality Care Effective Care Safe Care Coordinated Care Patient-Centered Care Access Cost-Related Problem Timeliness of Care Efficiency Equity Long, Healthy, Productive Lives Health Expenditures/Capita, 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290 Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

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11 The US has the highest rate of obesity among adults in the world, presenting increased risks of chronic diseases

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13 Doctors Use Electronic Patient Medical Percent 100 Records* NET NZ NOR UK AUS ITA SWE GER FR US CAN * Not including billing systems. Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 13

14 What do Americans say about their healthcare system?

15 Coordination Problems with Medical Tests or Records in Past Two Years Base: Adults with any chronic condition Percent AUS CAN FR GER NETH NZ UK US Test results/records not available at time of appointment Duplicate tests: doctors ordered test that had already been done Either/both coordination problems Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

16 Perception of Inefficient or Wasteful Care Base: Adults with any chronic condition Percent AUS CAN FR GER NETH NZ UK US Doctor recommended treatment you thought had little or no benefit Often/sometimes felt time was wasted due to poorly organized care Either/both experiences Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

17 Overall Views of the Health Care System in Eight Countries Base: Adults with any chronic condition Percent AUS CAN FR GER NETH NZ UK US Only minor changes needed Fundamental changes needed Rebuild completely Data collection: Harris Interactive, Inc. Source: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults.

18 $500 Total Health Care Spending on Health Insurance Administration per Capita, 2006 $486 Adjusted for Differences in the Cost of Living $400 $300 $243 $200 $195 $190 $184 $139 $100 $96 $93 $74 $67 $32 $0 US FRA SWITZ* NETH GER CAN NZ AUS* OECD SWED DEN (7.2%) (7.0%) (4.8%) (5.6%) (5.4%) (3.8%) (3.9%) (3.1%) Median (2.1%) (0.9%) (3.4%) (Percent of total health expenditure) *2005 Note: Total health care spending on health insurance administration includes insurer costs only. Data: OECD Health Data 2008 (June 2008).

19 Fee-for-Service: Follow the Dollars. We get what we incentivize. A lot of hospital beds (Are more bed towers good?) A lot of operating rooms and MRI scanners No logic in purchasing: an elective gallbladder surgery may cost 55% more at one hospital than another with no better outcome but very few citizens realize this. Fragmented care with poor primary care capacity to coordinate for those with chronic disease A broken, inadequate mental health system

20 Business Owners No logic in purchasing: an elective gallbladder surgery may cost 55% more at one hospital than another with no better outcome but very few business owners realize this.

21 Cost of Admission for Pneumonia % Hospital Cost Higher Than GBMC GBMC $10,878 Hospital B 10,952 1% Hospital C 12,069 11% Hospital D 12,468 15% Hospital E 12,769 17% Hospital F 13,219 22% Hospital G 13,541 25% Hospital H 17,628 62% Hospital I 18,619 71%

22 So what is GBMC doing about any of this? In the fall of 2010, the GBMC HealthCare Board chose to become a part of the solution and GBMC has been in action since then!

23 Our Vision Statement In order for GBMC to maintain its status as a provider of the highest quality medical care to our community, in the context of an evolving national healthcare system, we must transform our philosophy and organizational structure, and develop a model system for delivering patient-centered care. We define patient-centered care as care that manages the patient s health effectively and efficiently while respecting the perspective and experience of the patient and the patient s family. Continuity of care with a focus on prevention and ease of navigation through a full array of services will be the rule. Our professional staff will be able to say with confidence that the guidance and medical care they are providing mirrors what they would want for their own family. We will create the organizational and economic infrastructure required to deliver evidence-based, patient-centered care and for holding ourselves accountable for that care. This new organization will be defined by collaboration and continuous improvement. Physicians will lead teams that will manage patient care. We are moving into the future with renewed energy and increasing insight. We look forward to building relationships with both community-based and employed physicians that will form the foundation of the Greater Baltimore Health Alliance. We welcome all those who share our vision of health care as it is transformed to meet the needs of our community and nation in the 21 st century. Vision Phrase: To every patient, every time, we will provide the care that we would want for our own loved ones.

24 Vision Phrase: To every patient, every time, we will provide the care that we would want for our own loved ones.

25 What do we want for our own loved ones? GBMC HealthCare Quadruple Aim The Best Health Outcomes The Best Care Experience Lowest Cost With the Most Joy for those providing the care

26 The GBMC HealthCare System Greater Baltimore Health Alliance (GBHA) Private practicing physicians Greater Baltimore Medical Associates (GBMA) GBMC Medical Center Gilchrist Hospice Care

27 We are building a system of care 1. Better care coordination through the eyes of the patient (patient-centered) leading to better health, better care, and lower cost. 2. The Patient Centered Medical Home is the fundamental building block Your physician and her team are accountable They are available -100 clinicians; extended hours They use electronic records and patient registries mygbmc patient portal

28 The Patient Centered Medical Home The Team includes: Your Personal Physician Nurse practitioners Physician assistants Nurses Medical Technicians Care managers

29 The Patient Centered Medical Home The Team is accountable for your health They don t act as if it s a surprise that you are sick at 4:30 PM they have hours until at least 7PM, Saturday morning, and coming in April Sunday hours!. If you just need a conversation they will do it on the phone or on-line They contact you because they are actively reflecting on your health They get a daily report from CRISP on patients who have been in other hospitals and Emergency Departments

30 GBHA Providers 3 6 GBHA Total Primary Care Providers Today = Chapel View 2. J. Pallan 3. R. Habersat 4. M. Ramos 5. D. Weglein 6. Jarrettsville Family Care 7. O Malley/Fischer 8. V. Wroblewski GBMA PCP 30

31 800 GBHA Medicare Shared Savings Plan ED Visits/ 1,000 Plan Years % Reduction CY 2011 Annual CY 2012 Q3 CY 2012 Q4 CY 2013 Q1 CY 2013 Q2 CY 2013 Q3

32 350 GBHA Medicare Shared Savings Plan ED Admits/ 1,000 Plan Years % Reduction CY 2011 Annual CY 2012 Q3 CY 2012 Q4 CY 2013 Q1 CY 2013 Q2 CY 2013 Q3

33 450 GBHA Medicare Shared Savings Plan Hospitalizations/ 1,000 Plan Years % Reduction CY 2011 Annual CY 2012 Q3 CY 2012 Q4 CY 2013 Q1 CY 2013 Q2 CY 2013 Q3

34 GBHA Medicare Shared Savings Plan 30-Day Readmissions/1,000 Discharges % Reduction CY 2011 Annual CY 2012 Q3 CY 2012 Q4 CY 2013 Q1 CY 2013 Q2 CY 2013 Q3

35 14,000 GBHA Medicare Shared Savings Plan Total Per Capita Cost 13,000 12,653 12,300 12,352 12,000 11,654 11,000 10,000 9,000 8,000 CY 2011Annual CY 2012 Q3 CY 2012 Q4 CY 2013 Q1

36 Score GBMA Doctor s Offices Overall Satisfaction Score 93 Press Ganey Overall Score Control Chart Focus on the Patient Begins

37 Score Patient Satisfaction Access Section 92 Press Ganey Access Saturday Hours Focus on access 85

38 And we are making our wonderful hospital and our award-winning hospice better too!

39 Go to to see our quality data updated monthly.

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42 Median Time from ED Arrival to Admission to an Inpatient Bed Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun FY13 Actual FY14 Actual Goal = 20% Reduction

43 Mean Trends Inpatient Greater Baltimore Medical Center Question - Wait time in ER before admitted Greater Baltimore Medical Center Displayed by Discharged Date

44 How has GBMC used these changes to improve the health and care experience of its own employees while reducing its healthcare costs?

45 We incentivized our people to use our own system by reducing their out of pocket costs (co-pays and deductibles). And it worked.

46 $25,000,000 GBMC Self-Insurance Medical Costs $20,000,000 $20,382,895 $18,844,993 $16,559,148 $15,000,000 $9,394,328* $10,000,000 $5,000,000 $- Jul Jun 2011 Jul Jun 2012 Jul Jun 2013 Jul Jan 2014

47 GBMC HEALTHCARE, INC. EMPLOYEE HEALTH PLAN COST PER MEMBER $5222 $5202 $ $4705*

48 We Can Do This For You Too! GBMC is working directly with self-insured employers to create a GBMC tier within their offering to save these companies money and to get better health and better care for their employees

49 Interested? Leave Your Business Card with us today and we will contact you. Or, call John Ellis, Senior Vice President for Strategy

50 More Information About our System?

51 We are building a system of care for a better future for healthcare in our region Do not doubt that a small group of thoughtful people could change the world. Indeed, it's the only thing that ever has. Margaret Mead

52 Thank You!