Quality, Transparency &
Accountability
William C. Rupp, M.D.
[email protected]
JU Public Policy Institute
November 14, 2013
Challenging
External Environment
National debt
Fee-for-service
reimbursement model
Administrative burden
in healthcare
Medical technology
Patients with multiple
chronic conditions
Insurance plan designs
Provider consolidation
Fragmentation
Quality uneven
Consumer expectations
Aging demographics
Resulting in
Increased health care spending
Mortality Amenable to Health Care by State
Deaths* per 100,000 Population, 2004–05
Total
White Only
DC
Top quartile (63.9–76.8) Best:
MN
Second quartile (77.2–89.9)
Third quartile (90.7–
107.5)
Bottom quartile (108.0–158.3)
Worst: DC
DC
Top quartile (56.4–72.6) Best:
DC
Second quartile (73.4–82.0)
Third quartile (83.7–91.7)
Bottom quartile (91.8–110.6) Worst:
WV
* Age-standardized deaths before age 75 from select causes.
Data: Analysis of 2004–05 Centers for Disease Control and Prevention’s Multiple Cause-of-Death data files using
methodology from E. Nolte and M. McKee, “Measuring the Health of Nations: Analysis of Mortality Amenable to Health
Care,” BMJ, Nov. 15, 2003 327(7424):1129.
Source: Commonwealth Fund State Scorecard on Health System Performance, 2009.
Regional Variation in Medicare Spending
Dartmouth Atlas of Health Care
La Crosse, WI
$6,008
Bronx, NY
$12,714
Los Angeles, CA
$11,303
Jacksonville
$9,160
Miami
$17,274
Optum Labs
MAYO CLINIC
UNITED HEALTH
CARE
Patient Outcomes
Data
Payer Claims Data
OPTUM LABS
Clinical efficacy and value
Improved outcomes
Fragmentation
Mayo Clinic Care Network
13
20 1
10
3
15
5
21
9
16
7
6
11
2
12
4
18
22
19
8
17
Mayo Clinic
Mayo Clinic Health System
Mayo Clinic Care Network
Current – 21
14
Puerto Rico
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Altru Health System
Kingman Regional Medical Center
CentraCare Coborn Cancer Center
Arizona State University Health Services
Heartland Health
Sparrow Health System
Dartmouth- Hitchcock
NCH Healthcare
NorthShore University HealthSystem
St. Alexius Medical Center
St. Elizabeth Healthcare
Yuma Regional Medical Center
Billings Clinic
Salus
Shriners Hospitals for Children – Twin Cities
OSF HealthCare
Médica Sur
Pikeville Medical Center
Baptist Health Care – Pensacola, FL
Trinity Health
ThedaCare
St. Francis Hospital
As of November 2013
Transparency
2011 Quality, Value and Safety – Leapfrog Survey
100
90
80
Methodist
70
Resource
use
score
MCA Hospital
St. Marys
MCF Hospital
60
50
40
30
20
10
0
0
10
20
30
40
50
60
70
80
90
100
Quality score
©2010 MFMER | 3043325-9
Accountability
Individualized Medicine
“I
look through a half-opened door into
the future, full of interest, intriguing
beyond my power to describe…”
William J. Mayo, M.D. , 1931