MBGH Participating in TN's All Claims Database Development

 MBGH is a member of the Tennessee Health Information Committee which oversees the development of TN's all claims database in terms of information that is collected and information that is publicly reported.

Click here to read a report which summarizes why states are creating these all claims databases. Examples of how information from these databases can be used include:

• Employers can begin to understand the variation in cost and utilization by geographic area within a state;
• The value equation (cost & quality) of new health care services can be assessed;
• The design and implementation of health reforms can be informed by data and data can be tracked to determine impact;
• Compare prevalence of disease across populations;
• Determine payer competitiveness;
• Report on the cost and quality of individual providers. 

TN's all claims database is currently in the data collection process and the first public reports are expected in 2011. MBGH will keep your members informed as information becomes available.

PWC Report Forecasts 2011 Employer Health Benefit Trends

PricewaterhouseCoopers’ Health Research Institute surveyed 700 U.S.-based companies, small through jumbo sized, to gauge their perspectives on health care costs and benefits program priorities for 2011. Interviews were conducted in the first quarter of 2010. Click here for a copy of the report.

Major findings include:

• Medical costs are projected to increase 9% in 2011.
• More employers will move away from co-payments & toward co-insurance at the point of care.
• Hospitals, getting less from Medicare, will cost-shift to employers/commercial to make it up.
• Providers will merge and consolidate, creating greater leverage in negotiations with health plans.
• Employers plan to add more worksite wellness & health promotion programs.

What Do Physicians Think Employers Should Do?

What do physicians think employer's should do?

82% think employers should offer employees incentives to manage their chronic diseases and/or stay healthy
70% think employers should reduce or waive copays to increase adherence on medications

These strategies are consistent with the current emphasis on "value-based benefit design" which uses benefit design to motivate employees to use high value services which will keep them as healthy as possible for as long as possible.

What do physicians want from employers?

62% want to know about worksite and employer-based programs so they can counsel patients on participation
47% think benefit design should "be an extension of the physician's treatment program" leaving them in control of treatment decisions.

The study, conducted by the Midwest Business Group on Health, also concludes that communication between employers, employees and physicians is critical to improving/maintaining health.

Check out an article on the study by clicking here.

Addressing Over-Use by Reducing Diagnostic Imaging Services

The quality crisis is generally described as consisting of:

• Under-use
• Mis-use, and
• Over-use.

Addressing under-use has generally been greeted with universal support, as increasing use of high value services makes sense to employers and purchasers and generally increases revenues for providers and  health care organizations because more services are provided.

Addressing mis-use has generally been philosophically supported because, after all, how can someone morally support harming people in the system? Although philosophical support has been there, what to do to reduce or eliminate mis-use has been very controversial and progress has been slow.

But, work on over-use has been almost non-existent. Reducing over-use will directly impact health care organization's revenue. But now that cost has reared its head again as a major issue for purchasers, reducing over-use of services that provide little to no clinical value is back on the front burner.

In November 2008, the National Priorities Partnership, a group of 32 organizations convened by the National Quality Forum, announced 6 priorities, including reducing "overuse" of services that provide little to no clinical value (click here to learn more about all 6 priorities). The Partnership actually listed potential areas of over-use that should be addressed.

The over-use that seems to be front and center is diagnostic imaging. Significant work is being conducted
in both Washington state and Minnesota. Click here to read Bruce Seigel's (National Director of the Aligning Forces for Quality project) blog post on how organizations in these states are addressing overuse of imaging services by publicly reporting physician use of imaging services and establishing community-wide standars for appropriate use of imaging.

Memphis Medical Society Quarterly Magazine Reports on MBGH's eValue8 Project

Read the Winter 2010 edition of the Memphis Medical Society Quarterly magazine's highlights of the results of MBGH's 2009 eValue8 health plan evaluation, starting on page 8 of the pdf.  Click here for an on-line copy of the magazine.

We're Likely to Continue to See a Decline in Small Physician Practices

Atul Gawande's latest article in the New Yorker magazine compares the current health care quality and efficiency crisis to a similar crisis experienced in agriculture in the early 1990s. Gawande points out that improvements in agriculture, driven by scientific and technological advances and evidence-based efficiencies, resulted in farm consolidation and the rise of big "agribusiness". And, the small farmer suffered as they became less competitive with larger, consolidated farms.

Gawande postulates that small physician practices may face a similar situation. Pressures for physicians to consolidate will only increase with the emphasis on performance measurement and outcomes-based payment methologies.Given this direction, we are likely to see the number of small practices continue to decrease.

Click here to read a summary of the article's points on small physician practices.

Click here to read Atul Gawande's complete article.

We Need a Holston Medical Group in Memphis!

We need a "Holston Medical Group" in Memphis!!! Blown away at the "Preparing for a New Healthcare Landscape" meeting by the clinical, administrative, & cost outcomes Holston Medical Group has achieved with their emphasis on electronic medical record, team approach to care, and general "accountable care organization" philosophy. Who is willing to do this in Memphis? Can't wait to get Dr. Jerry Miller to Memphis to share his knowledge & inspire change...