Baskets of Care
Recommendations on Topic Areas
Situation
• Health care reform legislation includes provisions for establishing uniform definitions
for “baskets of care” beginning with a minimum of seven, by July 1, 2009.
• Health care providers may establish pricing for these baskets by January 1, 2010
• George Isham, MD and Doug Wood, MD (Mayo) will co-chair the Minnesota Department
of Health (MDH) baskets of care Steering Committee. Subsequently, up to 7 subcommittees could be formed to define each individual basket.
Task at Hand:
In preparation for his assignment, George has requested input on which 7 topic areas to
select and why.
One topic area may be assigned to a subcommittee to vett the most efficient process
and tools for defining the basket. If that occurs, do we have a recommendation on an
initial basket to pursue?
•
•
Background
• The legislation asks that the following topics be contemplated:
o coronary artery disease & heart disease
o diabetes
o asthma
o depression
• In selecting health conditions, also consider the following:
o Prevalence of the health condition
o Cost of treating the health condition
o Potential for innovations to reduce cost and improve quality
• Other stakeholders may have wildly different points of view on potential topics. Ranging
from purely ambulatory services (ala Carol.com) or specialty specific topics.
Condition
1.
2.
Prevalence & Potential
for Innovation &
Improved Quality
CAD &
heart
disease
(CAD,
Ischemic
heart
disease,
CHF)
MNCM Eligible Population
27,787
Diabetes
MNCM Eligible Population
85,225
MNCM Optimal CAD Care
Statewide Ave 45.1%
Prometheus definition exists.
Additional Rationale
Recommend splitting CAD and CHF as they are two
distinct patient populations that would be difficult to blend
in a clinical workflow for a basket of care.
CAD is recommended for one of the 7 baskets based on
prevalence, cost & availability of standardized measures.
CHF is not recommended due to lack of standardized
measures currently available with MNCM. CHF is also not
prevalent in the commercial population relative to other
conditions.
MNCM Optimal Diabetes
Statewide Ave 13.5%
3.
AsthmaPediatric &
Adult
Prometheus definition exists.
MNCM Asthma Care Statewide
Ave
Ages 5-56: 91.3%
Recommend a focus on pediatric asthma. Adult asthma
often overlaps with COPD which will complicate the basket
definition and is better suited with a condition neutral
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Ages 5-17: 94.6%
Ages 18-56: 89.7%
Prometheus definition exists
(general asthma).
Depression
Joint
degeneration,
localized, with
surgery, neck &
back
Joint
degeneration,
localized,
without surgery,
neck & back
5. Benign
hypertensio
n, w/o
comorbidity
Type II
diabetes, with
comorbidity
Joint
degeneration,
localized, with
surgery – knee
& lower leg
Chronic renal
failure, with
ESRD
Coronary artery
disease, w/o
AMI, with
angioplasty
6. Preventative
Services
Up-to-Date
including an
option to
bundle
Health
Assessment
Completion
to Measure
& Influence
Healthy
Lifestyles
7.
Health Care
Home (aka
Medical
Home)
DIAMOND underway; MNCM to
begin reporting PHQ9 remission
rates; HP has optimal
depression measure 26.4% and
alcohol screening measure
51.3% (see attachment)
medical home model. Pediatric asthma includes an
impact to productivity and absenteeism as parents take
time off to care for children. Workgroup could consider
adding measures of Medical Possession Ratio (MPR) and
ED visit rates to evaluate effectiveness to compliment the
existing MNCM measure of prescriptions for appropriate
medications.
Depression is common comorbidity present with other
chronic conditions. Given this and the work of the
DIAMOND and medical home transformations currently
underway, it is not recommended that depression on its
own be considered for a basket of care.
4.
MNCM Eligible Population
101,902
Neck & Back Care, inclusive of care with our without
surgery, is a number one driver of Commercial and
Medicare costs. Prevalence is increasing yet little
evidence of efficacy of surgery exists.
Medication choice is a main driver of variation in BP
control. Care model innovation can be instrumental in
improving quality and outcome.
MNCM BP <140/90 Statewide
Ave 65.5%
Prometheus definition exists.
See above
Increased volume drives trend.
Opportunity to measure
improved functional status.
See above
MNCM Statewide Ave
Cancer Screening Combined
49.3%
Chlamydia 40.8%
Childhood Imm. 20,434
National Priority Partners
Recommendations include
measures of health lifestyle
All risk levels need to be addressed to improve health
outcomes and affordability. Of the high cost claimants in
year, more than 50% tend to be low cost in year one. To
effectively manage trend, a total population health
management approach is needed. Healthy behaviors
associated with diet, exercise, tobacco and alcohol use
eventually contribute to 55% of all mortality. Collection
of these data is a start and doesn’t necessarily need to
burden the face-to-face office visit. Innovative solutions
with broad reach are available to augment care delivery.
Source: HealthPartners Health Promotion analysis, 2006.
A basket of care aligned with Health Care Home would
provide a person-centered and acuity sensitive approach
that aligns with a condition-neutral care delivery design.
This design could accommodate all patients ranging from
those who are healthy to those with acute or chronic
needs. For those with chronic conditions, it recognizes
that most have more than one such as depression which
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is prevalent with many other chronic conditions as
mentioned above.
The health care home basket of care approach may need
a different organizational approach other than a mutually
exclusive sub-committee being designed to charter the
definition.
Final Recommendation for Baskets & Potential HP Work Group Participants:
Recommended topic areas 1-6 represent conditions that cross commercial and Medicare
populations in terms of prevalence and appear in the top 15 ranking based on cost. Health
outcomes for these areas all have some room for innovation and quality improvement based
on current performance displayed on MNCM.
A basket of care aligned with Health Care Home would provide a person-centered and acuity
sensitive approach that aligns with a condition-neutral care delivery design. This design
could accommodate all patients ranging from those who are healthy to those with acute or
chronic needs. For those with chronic conditions, it recognizes that most have more than
one such as depression which is prevalent with many other chronic conditions.
The health care home basket of care approach may need a different organizational approach
other than a mutually exclusive sub-committee being designed to charter the definition.
*Preferred choice if one basket topic area is chosen to move to subcommittee first.
Rationale for selection is:
• Diabetes will force the scope question of ambulatory only or across the entire
continuum of care early on in the discussion.
• Availability of robust measurement for optimal care directly submitted by
providers to MNCM. Results indicate opportunity for continued innovation and
improved quality.
• Prevalence and spend across commercial and Medicare populations is great.
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