FTC Workshop on Clinical Integration in Health Care Thomas H. Lee, M.D. Network President, Partners HealthCare System Washington, D.C. May 29, 2008
Intro to Partners Community HealthCare, Inc. � Partners Community HealthCare, Inc. � The physician organization of Partners HealthCare, founded by the Massachusetts General and Brigham and Women’s Hospitals � Founded in 1994. � Approximately 5,500 Physicians in 900 practices.
PCHI’s Vision Working together for better, safer, more cost- effective care We will achieve our vision by: � Taking a leadership role in creating new approaches to delivering, measuring and financing health care in the future � Fostering an efficient and satisfying practice environment that allows clinicians to focus their energy and attention on high quality patient care � Using technology to support clinical decisions and foster communication and collaboration among clinicians � Working with employers and payers to develop payment mechanisms that recognize and reward the quality, efficiency and personalized service delivered by PCHI clinicians
PCHI’s Nuclear Cardiology Use Declining Intervention mo_yr 10 12 14 16 18 20 22 24 HPHC Pgm 2005- 1 - 2005- 2 - 2005- 3 1 - 2005- 4 - 2005- 5 6 Nuc Img Ed 2005- 6 6 - 2005- 7 - 2005- 8 2 Back Img Ed 2005- 9 TAHP Pgm 2005-10 PCHI - Nuc. Card. Head Img Ed 2005-11 BCBS Pgm 2005-12 - 2006- 1 - 2006- 2 - 2006- 3 - 2006- 4 - 2006- 5 - 2006- 6 - 2006- 7 - 2006- 8 - 2006- 9 - 2006-10 - 2006-11 - 2006-12 - 2007- 1 - 2007- 2 - 2007- 3 - 2007- 4 - 2007- 5 - 2007- 6 - 2007- 7 - 2007- 8 - 2007- 9 5 -3SL=10.52 -2SL=12.34 -1SL=14.15 X=15.96 _ +1SL=17.78 +2SL=19.59 +3SL=21.40
Using Data to Track Performance Richard L. Curtis, M.D. YTD2004_Q1 Specialist: Gastroenterology Current Period: Specialist: Richard L. Curtis, M.D. Current Period: YTD2004_Q1 Gastroenterology Specialist DEA No.: AC2959926 AC2959926 Specialist DEA No.: Specialist Pharmacy Utilization Overview Specialist Pharmacy Utilization Overview (Year to Date thru Q1) (Year to Date thru Q1) Avg. Cost Per Script ($) Generic Utilization Rate (%) Avg. Cost Per Script ($) Generic Utilization Rate (%) Statistics For Current Period Statistics For Current Period 200 70 200 70 Specialis PCHI Specialty Group 175 Specialis PCHI Specialty Group 65 175 65 150 60 Patients With 104 3,096 150 Patients With 104 3,096 60 125 125 55 55 351 100 Number of 8,797 351 Number of 8,797 100 50 75 50 75 45 Total Cost $31,945 $704,970 50 45 Total Cost $31,945 $704,970 50 40 25 40 25 Generic Utilization Rate (%) 50.1 55.3 0 35 Generic Utilization Rate (%) 50.1 55.3 0 35 Specialist PCHI Specialty Group Specialist PCHI Specialty Group Specialist PCHI Specialty Group Specialist PCHI Specialty Group Avg. Cost Per Script ($) $91.01 $80.14 Avg. Cost Per Script ($) $91.01 $80.14 PPI Agent Utilization PPI Agent Utilization Drug Number of Share of Avg Cost Cost (Doc) Share of Avg Cost Drug Number of Share of Avg Cost Cost (Doc) Share of Avg Cost Scripts (S Scripts ( Per Script Scripts Per Script Avg. Cost for PPI Agents Prescribed by Gastroenterologists Scripts (S Scripts ( Per Script Scripts Per Script Avg. Cost for PPI Agents Prescribed by Gastroenterologists (Doc) (Spec. Grp.) (Spec Grp (Doc) (Spec. Grp.) (Spec Grp 240 Group 240 Group 200 200 OMEPRAZOLE 30 56% $113.21 $3,396 28% $146.26 OMEPRAZOLE 30 56% $113.21 $3,396 28% $146.26 160 160 ACIPHEX 11 20% $146.93 $1,616 9% $191.69 ACIPHEX 11 20% $146.93 $1,616 9% $191.69 120 120 NEXIUM 11 20% $135.59 $1,491 28% $178.53 NEXIUM 11 20% $135.59 $1,491 28% $178.53 80 80 PROTONIX 2 4% $201.92 $404 33% $148.95 PROTONIX 2 4% $201.92 $404 33% $148.95 40 40 PREVACID 0 0% $0 0% $125.39 PREVACID 0 0% $0 0% $125.39 0 PREVACID 0 0% $0 1% $235.67 0 (1) OTC OMEPRAZOLE (3) OMEPRAZOLE (5) PROTONIX (7) ACIPHEX PREVACID 0 0% $0 1% $235.67 (1) OTC OMEPRAZOLE (3) OMEPRAZOLE (5) PROTONIX (7) ACIPHEX (2) PREVACID (4) PRILOSEC (6) NEXIUM (8) PREVACID (2) PREVACID (4) PRILOSEC (6) NEXIUM (8) PREVACID PRILOSEC 0 0% $0 1% $147.22 PRILOSEC 0 0% $0 1% $147.22 Top 5 Drugs (by Total Cost) Top 5 Drugs (by Total Scripts) Top 5 Drugs (by Total Cost) Top 5 Drugs (by Total Scripts) Drug Class Cost Scripts Avg. Cost Drug Class Scripts Cost Avg. Cost Drug Class Cost Scripts Avg. Cost Drug Class Scripts Cost Avg. Cost Per Script Per Script Per Script Per Script ASACOL MISCELLANEOUS GI $5,501 23 $239.18 OMEPRAZOLE PPI 30 $3,396 $113.21 ASACOL MISCELLANEOUS GI $5,501 23 $239.18 OMEPRAZOLE PPI 30 $3,396 $113.21 OMEPRAZOLE PPI $3,396 30 $113.21 ASACOL MISCELLANEOUS GI 23 $5,501 $239.18 OMEPRAZOLE PPI $3,396 30 $113.21 ASACOL MISCELLANEOUS GI 23 $5,501 $239.18 LIPITOR ANTIHYPERLIPIDEMICS $2,472 18 $137.36 LIPITOR ANTIHYPERLIPIDEMICS 18 $2,472 $137.36 LIPITOR ANTIHYPERLIPIDEMICS $2,472 18 $137.36 LIPITOR ANTIHYPERLIPIDEMICS 18 $2,472 $137.36 ROWASA MISCELLANEOUS GI $1,967 8 $245.91 NORVASC CALCIUM CHANNEL 16 $819 $51.17 ROWASA MISCELLANEOUS GI $1,967 8 $245.91 NORVASC CALCIUM CHANNEL 16 $819 $51.17 ACIPHEX PPI $1,616 11 $146.93 ACIPHEX PPI 11 $1,616 $146.93 ACIPHEX PPI $1,616 11 $146.93 ACIPHEX PPI 11 $1,616 $146.93 OTHER ALL $16,991 261 $65.10 NEXIUM PPI 11 $1,491 $135.59 OTHER ALL $16,991 261 $65.10 NEXIUM PPI 11 $1,491 $135.59 OTHER ALL 242 $16,648 $68.79 OTHER ALL 242 $16,648 $68.79 MESSAGE: MESSAGE:
Improvement Making Performance Transparent to Drive Practice Variation Report John Doe1, MD John Doe2, MD John Doe3, MD John Doe4, MD John Doe5, MD John Doe6, MD (normalized for 1000 PT Panel) by Modality October 01 2006 thru September 30 2007 HMA High Cost Radiology PCP Ordering John Doe7, MD John Doe8, MD John Doe9, MD John Doe10, MD John Doe11, MD John Doe12, MD John Doe13, MD John Doe14, MD John Doe15, MD John Doe16, MD John Doe17, MD John Doe18, MD John Doe19, MD John Doe20, MD John Doe21, MD John Doe22, MD John Doe23, MD 1
“Carrots and Sticks” Drive EMR Adoption in the Community 1 0 0 % PCP Status as of 12/31/07 9 0 % 8 0 % 7 0 % 6 0 % 5 0 % 4 0 % 3 0 % 2 0 % 1 0 % 0 % 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 L i v e I m p l e m e n t a t i o n 1 0 0 % 9 0 % Specialist Status as of 12/31/07 8 0 % 7 0 % 6 0 % 5 0 % 4 0 % 3 0 % 2 0 % 1 0 % 0 % 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 L i v e I m p l e m e n t i n g
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