HPCI News is distributed to members and over 400 other Iowa leaders in business, industry, health care professionals, health plans, labor, consumer groups, public policy makers and government, news media, and others.

In This Issue: October, 2006

October 25th Cedar Rapids Seminar "Getting Quality Up and Costs Down"

You are invited to the first in a series of seminars around the state entitled "Getting Quality Up and Costs Down" which will be held October 25th at the Cedar Rapids Marriott Hotel.

This seminar promises to be rich in information on leading edge issues and solutions in health care. The agenda, registration and accommodation information are posted on the IHBA website:www.ihbaonline.org. Please forward this announcement to others who may be interested and don't forget to register today as space is limited.

Topics and speakers will include:

  • "Transparency of Health Care Quality & Cost Information" -Fred Schuster, Regional Director, Office of the Secretary, U.S. Department of Health & Human Services
  • "Purchasing for Quality" -J. "Sean" Kenney, Ph.D., President/CEO of Labor Management Health Care Coalition of the Upper Midwest
  • "Consumer Reports Best Buy Drugs" - Lynn Ohman, Outreach Team, Washington, DC;
  • "The Leapfrog Group" -Greg Belden, Director Regional Implementation, The Leapfrog Group, Washington, DC
  • "Creating Value in Pharmacy Benefits Programs" -Jordan Cohen, Ph.D., Dean, University of Iowa College of Pharmacy
  • "Getting Medical Care Quality & Value Up, A Physician's Perspective" -David Swieskowski, MD, MBA, Vice President of Quality Improvement, Mercy Clinics, Inc. and Joel Hasenwinkel, Director of Clinical Collaboration, Wellmark Blue Cross and Blue Shield
  • "Wellness and Lifestyle: A Win, Win, Win" -Kerry Juhl, Executive Director, Wellness Council of Iowa

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Guide #1: Consumers' Health Reference Guide, Version 1.0

The first in a series of Iowa Consumers' Health Guides was recently published and made available to IHBA members. It is entitled "Guide 1: Consumers' Health Reference Guide, Version 1.0."

Two additional Guides are under development for publication and distribution over the next eight months. They are: "Guide 2: Hospital Performance Report for Greater Iowa, Version 1.0" and "Guide 3: Heart Health Guide, Version 1.0."

HPCI is working with the Iowa Health Care Buyers Alliance on this Consumers' Guide series. Members are encouraged to widely use these Guides and make them available to their employees/members during open enrollment, during lunch and learn sessions and in other ways. The Guides are also available electronically for use on member's intranet sites. Members can customize the Guides by adding such information as their organization's name, logo and message. It is important, however, that the base document remain unchanged.

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"Ask Your Doctor" Series

Working collectively with the IHBA, the "Ask Your Doctor" series is being developed for publication. This involves a series of "cards" each with a brief set of questions around a given topic. Find out more at the October 25th Cedar Rapids seminar.

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Iowa Leapfrog Group Initiative

HPCI will spearhead the Iowa Leapfrog Group Initiative during 2007 - 2008. An information and education campaign will be conducted with the assistance of the Iowa Association of Business and Industry, the Iowa Health Buyers Alliance, the Iowa Healthcare Collaborative and The Leapfrog Group. An Iowa Leapfrog Group roll-out is planned.

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2006 Iowa Employer Benefit Study

David P. Lind and Associates recently released results of the 2006 Iowa Employer Benefit Study.

Highlights Included

Overall, 93.7% of Iowa employers offer health insurance benefits. The average health insurance rate increase reported in 2006 overall was 10.8%. This ranged from 8.4% for large employers up to 15.4% for small groups.

This 10.8% increase is down some from last year's 12.4% and from the 2004 increase of 15.7%. The percent of employers offering a Health Reimbursement Account (HRA) or Health Savings Account (HSA) increased to 19.3% from the prior year of 4.5%.

Employer responses to health insurance rate increases reported in 2006:

  • 57.7% increased employee contribution (through payroll deductions)
  • 34.8% raised deductibles
  • 23.9% increased prescription drug co-pays
  • 22.7% raised out-of-pocket maximums
  • 20.3% increased office co-pays
  • 14.0% changed insurance companies
  • 13.2% organization absorbed the entire cost increase
  • 5.2% passed all increased costs onto employees
  • 4.4% reduced pay raises or bonuses
  • 2.9% hired fewer new employees
  • 2.4% changed from a PPO to an HMO/POS product
  • 1.9% offered internet site with personalized health information
  • 1.7% postponed capital improvements
  • 1.3% began surcharge for employees who smoke
  • 1.1% began surcharge for covered spouses
  • 1.1% made available medical provider cost and quality information via internet
  • 0.9% released employee(s)
  • 0% stopped providing health insurance coverage
  • 21.4% other

Additional information can be obtained through the HPCI office.


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November 15th Conference on Quality, Patient Safety and Value

The Iowa Healthcare Collaborative will be holding its third annual Conference on Quality, Patient Safety and Value on November 15th at the Iowa Events Center - Hy-Vee Hall in Des Moines. The conference agenda is packed with valuable information and top speakers. John Toussaint, MD, President/CEO of ThedaCare, Appleton, Wisconsin will lead off on the topic of "Culture and Leadership in Health Care". Dr. Toussaint is a nationally recognized leader in applying Lean in health care and in public reporting of cost and quality. To view the agenda and registration information, go online to www.ihconline.org.

The Iowa Healthcare Collaborative is doing a super job of informing and educating the Iowa health care community on the advantages of Lean in health care. Their August conference, "Getting Lean in Health Care: Using Process Improvement to Eliminate the Fat" was a "sell-out" with a packed house of 250 people in attendance. A Lean in Healthcare toolkit has also been posted on the IHC website.

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"Redefining Health Care: Creating Value-Based Competition on Results"

Michael E. Porter and Elizabeth Olmsted Teisberg are the authors of a new book entitled, "Redefining Health Care: Creating Value-Based Competition on Results", Harvard Business School Press.

For more than a decade, Porter and Tiesberg wondered why competition didn't work in health care as it does in other industries. Why wasn't competition improving quality, driving innovation and lowering costs? Why was the U.S. health system, perhaps the most competitive in the world, performing so poorly? Others have asked the same question.

Michael E. Porter, though, is one of the world's leading experts on strategy and competition. He is someone who advises countries, not to mention the Boston Red Sox, and whose standard consulting fee is $100,000 a day.

He believes that competition can work in health care - provided it is the right kind of competition. "The fundamental problem with health care is we have a lot of competition, but the competition has been at the wrong level, "Porter stated. The only way to reform health care is to realign competition, focusing on what he calls "value-driven competition", or providing the best quality at the lowest cost.

Competition in health care should be based on results. For this to happen, accepted measures of quality must be developed and publicly disclosed. Prices, too, must be disclosed. Only when information on quality and prices are widely available will the market be able to reward the most efficient hospitals and doctors. This is the single most important step, Porter said, in reforming the health care system.

Note: From the July 16, 2006 edition of the Milwaukee Journal Sentinel.

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Health Care Transparency

HPCI Supports Federal Efforts to Advance Transparency

On August 22nd an Executive Order was issued which firmly cements the Federal government's commitment to advance transparency in America's health care system. It uses the purchasing power of the Medicare Program, the Department of Defense, Veteran's Affairs, Indian Health Affairs, and the Federal Employee Health Benefits Program to drive availability of quality and pricing information and may prove to be a water-shed event in efforts to advance a value-based health care system.

HPCI recently signed on in support of this initiative through a letter to Secretary Michael D. Leavitt, U.S. Department of Health and Human Services. HPCI indicated that we are pleased that the Federal health care information directives built upon the work that has and is being done at the local and national levels. These include two private-public collaboratives - the Hospital Quality Alliance (HQA) and the AQA (formerly the Ambulatory Quality Alliance) which have been spearheading efforts to implement performance measures pertaining to hospitals and physicians respectfully.

HPCI recognizes that transparency of performance information is essential. It has proven to be an important catalyst for improvement in health care. It is also essential for consumers and patients. Comparative quality and cost information will improve the consumer's ability to make informed decisions.

Recognizing the importance of leveraging and supporting national resources, HPCI is an active member of the Consumer Purchaser Alliance, The Leapfrog Group, and supports other efforts such as the National Quality Forum. These groups like HPCI, in turn, recognize the central role of the Federal government. It is a pivotal time for consumers and purchasers to be involved in shaping the agenda in partnership with the Federal government.

Florida Leads in Public Reporting

According to the Des Moines Register (10/8/06), Florida leads the nation in publicly reporting health care information to residents. The state Web site: www.FloridaCompareCare.gov provides information on cost, quality and errors in hospitals. In November 2005, Florida became the first state in the country to publicly report infection and mortality rates in each hospital. The goal is to improve care and reduce costs.

Ohio Will Put Hospital Rankings on Web

By the middle of next year, consumers will be able to go to the Ohio Department of Health's web site to compare Ohio hospitals' cost and quality of care. Governor Bob Taft recently signed the legislation that will force hospitals to provide more information about the quality of medical care they provide and how much it costs. According to the report from The Enquirer, about 15 states have approved similar legislation.

Taft signed the legislation at TSS Aviation because "it's an example of a kind of small business in Ohio that welcomes this new resource because it will help its employees make important health-care decisions" said a spokesman for the Governor's office. Hospitals will have to report on the cost of the top 60 inpatient and outpatient procedures they perform.

Hospitals Post Their Pricing Information

One by one, or in groups, hospitals across the country are beginning to pull back the curtains and let consumers take a look at how they run their businesses. The New Mexico Hospital and Health System Association began the disclosures earlier this year by posting on its web site how member hospitals perform against evidence-based treatment standards. Also, 34 hospitals in 26 communities began posting their pricing information. Next, the association will disclose how New Mexico hospitals do when it comes to controlling infections.

Association President Jeff Dye said hospital transparency lets consumers, employers and insurers make better health care decisions. "Members expect this will generate questions from the public," he said. "That's as important as the numbers and their comparative value".

Editor's Note: Reports are that pricing information will be made available beginning January, 2007, for Iowa hospitals through the Iowa Hospital Association.

Hospital Payment Information Released by CMS

To help consumers, providers, and payers make more informed health care decisions, the Department of Health and Human Services through its Centers for Medicare and Medicaid Services (CMS) recently posted information on what Medicare pays for the 30 common elective procedures and other hospital admissions. This is an important step towards transparency in health care costs and quality.

"Once people gain better information, they become better consumers of health care and that helps get health care costs down and quality of care up," HHS Secretary Mike Leavitt said. "The Federal government is the biggest single payer of health care in America, and by taking steps to post prices and quality data, we hope to encourage more insurance companies, hospitals, clinics, and doctors to do the same."

The new information shows the range of payments by county and the number of cases treated by each hospital for a variety of treatments provided to seniors and people with disabilities in fiscal year 2005. These include 30 common elective procedures including heart operations and implanting cardiac defibrillators, hip and knee replacements, kidney and urinary tract operations, gallbladder operations and back and neck operations, and for common non-surgical admissions.

This information is posted by CMS at: www.cms.hhs.gov

Doctors Decline Offer to Increase Medicare Reimbursement

According to the September 15, 2006 Kaiser Daily Health Policy Report, the American Medical Association (AMA) and other doctors' groups rejected an offer from the leadership of the House Ways and Means Committee to block a scheduled reduction in Medicare physician payment in exchange for a participation in a quality of care program. The offer would have blocked a 5.1% reimbursement cut currently scheduled to take effect in January 2007. It would have also increased reimbursements by between 2.5% and 2.8% in June 2007 to the doctors who agreed to report quality-of-care data to the government. Doctors' groups are seeking a 2.0% reimbursement increase for 2007 that is not tied to reporting requirements. Stay tuned.

"Better Care, Lower Costs: You Deserve to Know...Health Care Transparency"

The U. S. Department of Health and Human Services has a new publication entitled "Better Care, Lower Costs: You Deserve to Know....Health Care Transparency". In the vision statement, Michael O. Leavitt, Secretary of the Department of Health and Human Services states that "Every American should have access to a full range of information about the quality and cost of health care options".

"Americans are value- conscience consumers. We clip coupons, check for bargain flights on the web, and carefully research our next car purchase. It is the American way. Yet, when it comes to almost any aspect of health care, we lack the tools to compare either quality or cost. Consumers need to know - and they deserve to know - the value of their health care. I believe that bringing transparency to quality and cost information will reform health care in America."

The booklet highlights the health care in crises, four cornerstones of value-based health care, quality standards, price standards, the future, igniting change, and an agenda for change.

Contact the HPCI office for more information.

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We welcome and encourage you to become a HPCI member, contributor and /or project supporter. Please contact the HPCI office 515.282.7727), contact us at health@hpci.org, or check our web site www.hpci.org

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