statement: There are no competing interests relevant to this - PowerPoint PPT Presentation

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services What drives health care costs ? What drives health care costs ? (not what you think) Noon, January 17, 2017 (not what you think) Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital VC#827633 Dr. Richard Lewanczuk REMOTE SITES: PLEASE MUTE YOUR AUDIO AT ALL TIME Senior Medical Director EXCEPT WHEN ASKING QUESTION/COMMENTING AT Q/A. Primary Health Care “This event is a self -approved group learning activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada.” Alberta Health Services “This event is eligible for 1 “MAINPRO - M1” credit from the Maintenance of Proficiency Program of College of Family Physicians of Canada.” Members of the Colleges planning on claiming the credit are requested to sign the appropriate attendance records at the entrance. Conflict of interest Per capita health spending statement: There are no competing interests relevant to this presentation 2008 http://www.health.alberta.ca/health-info/macro-health-data-dashboard.html http://bit.ly/2jlpuWR January 17, 20171

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services Alberta spent 25% faster on Higher hospital expenditure is associated with greater utilization – Hospitals over the period than Other Provinces more bed days Provincial Government Constant (2002) 1 Expenditure 2 on Hospitals Acute Bed Days, All Cases (Typical and Non-Typical) 1 per Adjusted 3 Capita, by Jurisidiction, 1996 to 2008 per Adjusted 2 Capita, by Jurisidiction, 2003 to 2007 1,500 Expenditure per Adjusted Capita 800 Alberta 1,250 Days per Adjusted Capita Alberta 600 Other 1,000 Other Provinces Provinces 750 400 500 200 250 Canada Canada 0 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2003 2004 2005 2006 2007 1 Source: Statistics Canada, CANSIM, table 326-0021 and Catalogue nos. 62-001-X and 62-010-X. 1 Source: Canadian Institute for Health Information Portal. Extracted 08/28/2009. Parts of this material are based on data and information provided by the Canadian Institute for Health Information 2 Source: Canadian Institute for Health Information, National Health Expenditure Trends, 1975 – 2008 (Ottawa, Ont.: CIHI, 2008). (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of the Canadian Institute for Health Information. 3 Adjusted Population is Weighted by All-Sector Expenditure by Age and Gender (2007/2008 Population-Based Funding Weights for Albe rta). Alberta’s weights were applied across all provinces. 2 Adjusted Population is Weighted by All-Sector Expenditure by Age and Gender (2007/2008 Population-Based Funding Weights for Albe rta). Alberta’s weights were applied across all provinces. Source: Canadian Institute for Health Information, National Health Expenditure Trends, 1975 – 2008 Source: Canadian Institute for Health Information, National Health Expenditure Trends, 1975 – 2008 There is strong correlation between beds per 1000 and Beds vs Admissions by AHS Sub- hospital inpatient visits per 1000. Zone Acute Inpatient Beds per 1000 Vs Acute Inpatient Hospital Visits per 1000 (Correlation=84%) 180 3.50 161 160 3.00 2.9 140 130 2.50 122 117 120 112 2.7 108 102 2.00 R² = 0.7915 100 93 92 91 89 89 Visits per Beds per Beds/1000 2.5 84 80 1000 1000 80 1.50 2.3 60 1.00 2.1 40 0.50 20 1.9 0 - 1.7 75 95 115 135 155 175 Admissions/1000 Hospital Visits per 1000 (Age/Sex Standardized) 2014/15 Acute + Psychiatric Beds Per 1,000 Courtesy DIMR July 2016 http://bit.ly/2jlpuWR January 17, 20172

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services Higher occupancy strongly correlated with higher case mix 2013 The Commonwealth Fund 10 Hypothesis Primary Care Score vs. Health Care Expenditures, 1996 UK 2 Primary Care Score If we spend more on primary and community 1.5 SP care will we have lower costs, better outcomes 1 and higher quality? 0.5 US 0 1000 1500 2000 2500 3000 3500 4000 Per Capital Health Care Expenditures Primary Care Score: 2 = Stronger From Barbara Starfield, MD http://bit.ly/2jlpuWR January 17, 20173

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services Utilization by attachment to a Continuity vs cost by CRG family doctor (in the top 5%) 9 – catastrophic 8 – dominant malignancy 7 – chronic disease 3 or more organ systems 6 – significant chronic disease multiple organ systems 80 5 – single dominant or moderate chronic disease <50 4 – minor chronic disease in multiple organ systems 3 – single minor chronic disease 70 2 – significant acute disease 1 - healthy 50-75 60 50 >75 40 % 30 20 10 0 hospitalizations LOS cost Work in progress, Interdisciplinary Chronic Disease Collaborative – courtesy of Dr. Paul Ronksley 14 Mortality by continuity of care End of part 1 Health Trends Alberta 2016 http://bit.ly/2jlpuWR January 17, 20174

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services Top diseases by cost in Leading diagnoses resulting in visits Alberta in rank order to physician offices in Canada 25 1. Hypertension 20 Routine medical Acute respiratory Million visits/year 2. Diabetes Depression tract infection Diabetes 15 Hypertension 3. Depression exams 4. Asthma 10 5. Dyslipidemia 5 6. Coronary artery disease 0 17 Source: IMS HEALTH Canada 2002. http://www.imshealthcanada.com/ Impact of common chronic diseases in Alberta Health care costs are driven by the common chronic diseases that are managed by primary care every day 19 http://bit.ly/2jlpuWR January 17, 20175

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services It therefore makes sense why health systems that invest in How are health care costs primary care have lower costs driven ? and better outcomes 21 Determinants of appearing in HC5 Alberta Population Proportions Versus Health Care Cost Proportions – 2009/10 40% 35% 30% 25% 20% 15% 10% 5% 0% 0-25th Cost 25-50th Cost 50-75th Cost 75-90th Cost 90-95th Cost 95-99th Cost 99-100th Cost Percentile ($10) Percentile ($131) Percentile ($369) Percentile ($911) Percentile ($2288) Percentile ($6367) Percentile ($34407) % Of Population 25% 25% 25% 15% 5% 4% 1% % Of Costs 0% 3% 9% 14% 12% 26% 35% sex, age group, days spent in inpatient, death, number of previous years in the HC5, Notes: 1)Costs only include direct costs for inpatient, emergency, and urgent care and total physician costs for these same sectors and community primary care (approx. $3.7 billion). Costs in parantheses are average costs per person for the group. 2)Total population includes anyone active as of April 2010 or anyone who died within 2009/10. average rank in previous years, and the 6 Group A CACP chronic diseases included in 3)Cost percentiles were: 90th=$1,511; 95th=$3,504; 99th=$13,977. In other words 5% of folks used $3,504 or more and consumed 61% of total reported costs. Source: Strategic Analytics - DIMR - Alberta Health Services model – on IP days had any significant bearing http://bit.ly/2jlpuWR January 17, 20176

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services Keeping people out of hospital, is the single most important way of Who are these people? reducing health care costs Complex High Needs Patients - Financial Impact 27 28 http://bit.ly/2jlpuWR January 17, 20177

Geriatric Grand Rounds: What drives health care costs ? Dr. Richard Lewanczuk Senior Medical Director (not what you think) Primary Health Care Alberta Health Services Composition of “top 5%” by age Frail Elderly Clinical Profile (Partial)  Hypertension 72.5%  Acute Musculoskeletal Diagnosis 39.3%  Acute Respiratory Diseases/COPD 33.7% / 22.6%  Osteoarthritis 31.8%  Diabetes 28.5%  Congestive Heart Failure 20.8%  Neuromuscular/Neurological Diagnoses 20.7%  Depressive and/or Other Psychoses 20.2%  Average IP days 20.6 29 Note: Data shows averages based on physician visit billing Why are they being admitted into hospital? http://bit.ly/2jlpuWR January 17, 20178