This recent study from the Brookings Institution compares value performance in healthcare in three states: New York, Vermont, and Wisconsin. Data bases developed in each state in addition to Medicare and Medicaid data was used to make the comparisons. Although it is difficult to compare across all three states, in Wisconsin there are certain communities where cost and quality are measurably a lot better.
The two counties in Wisconsin delivering the best cost and quality are Lacrosse and Outagamie. These counties are areas where Gunderson Lutheran and ThedaCare have large portions of market share. ThedaCare has well over 50 percent market share and has been on the lean journey for years. Gunderson has also been applying lean healthcare and competitors in both markets have begun to apply lean to some processes.
This exhaustive study is another set of evidence that costs can be improved at the same time quality improves and in this case across an entire community. There have been studies which suggest Medicare spending is low in these two counties because cost shifting to commercial payers is occurring. This study debunks that idea showing that Outagamie County is a better value county among all payers, fee for service Medicare, Medicare Advantage, Medicaid, and commercial insurance.
The study also points out the need for the development of standard cost and quality metrics as well as data sets that are comparative. The center has been working nationally to develop an all payor claims data base similar to the Wisconsin health information organization model which is described in the study. With such a data base value metrics could be created and comparisons made across all provider organizations in the country.
This ideal state is what we all should be aiming for.
“Eighteen counties (Brown, Calumet, Dane, Door, Dunn, Jackson, Jefferson, La Crosse, Monroe, Outagamie, Portage, Price, Shawano, Sheboygan, Trempealeau, Waupaca, Waushara, and Winnebago) were identified as providing health care that was better quality and lower cost than the statewide payer average across two or more payers according to two different quality metrics.48 These counties tend to cluster in the mid-eastern region of the state, along with a small group of counties along the middle of the western border. Based on clinical care factors, five of these counties ranked in the top 10 (La Crosse, Outagamie, Dane, Winnebago, and Waupaca).49 Jefferson and Brown counties also qualified in the top 20. Outagamie County was recognized as a high-value county across all payers for both of the quality metrics used in this study. La Crosse County is also notable for performing as a high-value county across all payers in the ASC admissions measure and across three payers (all but Medicaid) in the diabetes composite measure. These are the counties that Wisconsin might seek to learn best practices from and share those methods with other counties, should further analysis across several other measures demonstrate a consistent pattern.”
To read the articles, click below:
Image 3.15.1231578_EXEC_SUMM_Commission_rising_to_challenge_local_scorecard_2012_FINAL1Evaluating Community-Based Reforms in Care for Chronic Conditions2
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