SC Johnson

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SC Johnson Son, Inc.

• Center of Excellence
• Health Care Strategy
• Kevin W. McCabe, M.D.
• Corporate Medical Director
• August 16, 2006

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SC Johnson, A Family Company

• Racine, Wisconsin

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SC Johnson, A Family Company

• Founded in 1886 as a manufacturer of parquet
  flooring, S. C. Johnson Son, Inc. is a leading
  provider of innovative consumer products that
  make life easier and homes cleaner, safer and
  healthier for families around the world.

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SC Johnson, A Family Company

• In 1998 we framed our health care strategy around
  the question. . .

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SC Johnson, A Family Company

• How do we reduce health care inflation to a rate
  that we can afford so we can continue to provide
  health care benefits to our employees?

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SC Johnson Health Care Strategy

• In answer, we developed a Health Care Strategy
  that centers around the following 4 concepts

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SC Johnson Health Care Strategy

• Employees and dependents have a responsibility
  to be better stewards of their health and
  healthcare.

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SC Johnson Health Care Strategy

• Employees and dependents need to be more
  conscientious consumers of health care.

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SC Johnson Health Care Strategy

• SCJ will supply and equip employees and
  dependents with the tools and incentives to
  become better stewards and consumers.

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SC Johnson Health Care Strategy

• SCJ will work with local providers to improve the
  quality of care.

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Healthcare Principles The Ideal State

• The patient should be in a position to be his/her
  own best health advocate.
• Doctors and hospitals should provide both the
  highest quality health care and keep patients
  well including measuring and reporting how
  effectively they accomplish both.
• SCJ will actively enable the patient and
  providers to achieve these goals and as the
  primary payer of health care costs, SCJ expects
  accountability from both parties.

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SCJ Actions Taken to Support the Ideal State

• Actions supporting the patient as his/her own
  best health advocate are
• Smart Steps Disease Management
• Mayo E Healthcare/Ask Mayo clinical support tools
• Prescription drug formulary and mail order
  programs
• Healthy Choice program with health risk
  assessment Smart Steps Disease Management and
  lifestyle coaching
• Medical Centers of Excellence (MCOE) Programs
• Updated preventive care schedule
• Health Saving Account option (Flex 6)
• Overarching employee communication efforts

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SCJ Actions Taken to Support the Ideal State

• Actions supporting providers in delivering the
  highest quality care are
• Active Health Management (AHM)
• Medical Centers of Excellence (MCOE) Programs
• Continue a dialog with All Saints regarding their
  role as a community hospital
• UR/case management

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Why Medical Centers of Excellence?

• The quality and cost of health care varies
  dramatically from one institution to the next.
• There is no relationship of cost to quality.
• 1999 Institute of Medicine Report, To Err is
  Human estimated that medical errors in hospitals
  cause between 44,000-98,000 avoidable deaths each
  year and even more injuries.
• As opposed to most industries where the
  manufacturer pays to fix mistakes, mistakes in
  hospitals lead to more care and more charges that
  the patient (customer) pays for.

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Why Medical Centers of Excellence?

• (continued)
• These quality problems exact a human toll, not
  only in terms of lost lives and pain and
  suffering, but also create a huge economic burden
  in terms of direct costs of treating
  complications and in indirect costs of lost
  productivity and premature death.
• The Juran Institute estimates that 30 of all
  direct health care outlays today are the result
  of poor quality care consisting of overuse,
  misuse and waste.

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Why Medical Centers of Excellence?

• (continued)
• With national health expenditures roughly 1.7
  trillion in 2004, the 30 figure translates into
  510 billion spent each year as the direct result
  of poor quality.
• We would like to improve the odds of
  employees/dependents getting quality care.

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Center of Excellence Goals

• To educate employees that there are differences
  in quality among providers.
• To help employees see differences in qualities
  can have very significant effect on outcomes.

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Center of Excellence Goals

• To encourage the notion that employees must take
  responsibility to be better informed and more
  engaged managers of their own health.
• To create a desire in employees to seek out COEs.

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Centers of Excellence

• A regional Centers of Excellence program will
• Target high cost procedures where substantial
  variation in quality and cost of care exist.
• Utilize SCJs presence and reputation to get
  health care providers to compete on quality and
  value.

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Centers of Excellence, Plan Design

• Applies to all Flex choices
• Provider steerage mechanism
• Current steerage is 2x out of pocket maximum when
  non COE providers are used.
• Geography includes
• SE Wisconsin
• Lake County, Illinois
• Bay City, Michigan

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Centers of Excellence, Plan Design

• COE selection criteria was developed by a team
  consisting of outside consultants from Towers
  Perrin, key people from the SCJ Benefits
  Department and Corporate Medical Services.
• Selection Criteria was divided into 2 sections
• Clinical Quality Criteria - 65 pts.
• Health System Structure - 32 pts.

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Selection Criteria

• The key factors driving selection decision were
• Specific clinical criteria that is measurable and
  reportable, such as high case volume in the
  specified procedure, low mortality rates, low
  complication rates and appropriate length of
  stay.
• Hospital and surgical teams with a collaborative
  relationship focused on delivering consistent
  high quality care.
• Hospital and surgical teams willing to work with
  SCJ on expediting patient consultations and
  surgical procedures, as clinically appropriate.

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Selection Criteria

• (continued)
• The key factors driving our selection decision
  were
• Hospital is willing and able to provide relevant
  clinical data on SCJ MCOE cases as well as
  overall quality measures.
• Hospitals interested in patient satisfaction with
  care.
• Hospitals with recent or planned investments in
  facilities or treatment that specifically support
  a high quality of care for each designated MCOE
  would be viewed favorably.

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Reporting and Participation Standards

• We asked for the following information
• Describe your systems ability to support MCOE
  data gathering and reporting of quality and
  volume indicators.
• Will you be able to provide reports showing case
  volume and mortality and complication rates?
• Will you be able to track outcome results (i.e.,
  readmission rates, follow up care required)?
• Can you provide aggregate quality reports?

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Complications

• At both hospital and physician level, we sought
  information about
• Blood clots
• GI hemorrhage/ulcer
• Would infections
• Nosocomial infections

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Clinical Quality

• How is clinical quality defined at your
  institution? Provide organizational chart of
  your quality committee.
• Do you provide quality data to the state,
  Leapfrog Group or other monitoring entity?
• What quality measures do you measure and track?
• Did you know how your performance for the
  targeted services compares to other institutions?
• Provide quality data for the most recent 6
  quarters.
• Provide prior fiscal years data for volume,
  mortality, complication rates and ALOS (average
  length of stay).

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Clinical Quality

• (continued)
• Do you staff ICU/CUU with intensivists?
• Do you have an automated order entry system?
• Is your facility a magnet hospital?
• What are your RN staff turnovers and vacancy
  rates?
• Do you have common standard orders that all
  physicians use?

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Hospital Structure and Surgeon Collaboration

• Do you have a chief of the surgical subspecialty
  department? Please describe his/her role.
• How many surgeons have privileges to perform the
  MCOE covered procedures?
• Complete chart for volume of surgery for 2003 and
  2004 for each physician.
• Describe hospitals relationship with surgeon
  (i.e., employed, independent).
• Would your facility be willing to name a subgroup
  of surgeons for the COE?

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Hospital Structure and Surgeon Collaboration

• (continued)
• What criteria does your institution use to grant
  surgical privileges?
• Do your require all physicians to treat patients
  via protocols?
• How do you monitor physician compliance with
  protocols?
• Describe any efforts under way to reduce medical
  errors.

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Hospital Structure and Surgeon Collaboration

• (continued)
• If selected as an MCOE are you willing to discuss
  and implement a warranty of care?
• Has your program received any awards (i.e., US
  News and World Report - Best Hospitals)?

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MCOE Committee Selection Process

• Committee reviewed all RFIs.
• Weighted the answers with hospital and surgeon
  volume getting the most weighting.
• Reduced the list to 3-4 hospitals for each COE.
• Toured the finalist hospitals, met staff and
  surgeons.
• Summarized the visits and voted on which
  hospitals would be included in MCOE.

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MCOE Committee Selection Process

• Launched extensive communication to employees as
  COEs were selected for
• Joint Replacement
• Back Care
• Bariatric Surgery
• Coronary Bypass Surgery and Angioplasty
• Joint Replacement Program was initiated in
  January 2004.

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Centers Of Excellence - Obstacles

• Concept of guarantee of care
• Employee buy in that COEs are for their benefit
• Employees need to believe COEs are not a health
  care take away

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How Is It Working So Far?

• What are the indicators used to track progress?
• Centers need to provide quality outcome data on a
  yearly basis.
• Well be tracking our joint replacements to see
  if there is steerage toward COEs.
• Centers will provide us with patient satisfaction
  data.

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SC Johnson, A Family Company

• QUESTIONS?