health care call to action kansas healthcare collaborative summit tom evans, m.d. october 21, 2010...
TRANSCRIPT
Health Care Call to Action
Kansas Healthcare Collaborative Summit
Tom Evans, M.D.
October 21, 2010100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1835
Office: 515.283.9330 • Fax: 515.698.5130www.ihconline.org
• Discuss the new era of transparency and accountability
• Describe the forces behind the recent healthcare reform legislation
• Consider the role of accountable care organizations (ACOs) as new models in care delivery
• Explore potential statewide initiatives to improve health care in Kansas
Objectives
So…where are we?
A New Era…
• Development of evidence-based medicine
• National definition and standardization of clinical metrics
• Transparency for providers and consumers
• Industry shifts in practice
• Changes in reimbursement
• Value Driven Health Care
Era of Transparency & Accountability
• Connecting the System
Connect all health information systems
• Measure and Publish Quality
Every case, every procedure
• Measure and Publish Price
Standardize identical services and episodes of care
• Create Positive Incentives
Reward those who offer and those who purchase high quality, competitively priced healthcare
Value Driven Health Care
Collaboration across multiple lines:
• Healthcare Providers
• Healthcare Systems
• Healthcare Stakeholders
(Purchaser, Payer, Provider, and Patients)
Collaboration
Key Drivers of Healthcare Reform
• Access- Coverage for Services
• Menu- Services paid for
• Execution- Delivery of Services
Healthcare Reform
On the National Scene…
• Health Information Technology
• The HiTech Act
• Healthcare Reform
• HR 3590- The Patient Protection and Affordable Care Act
• HR 4872- The Health Care and Education Reconciliation Act
Reform Potpourri (PPACA or ACA)• Primary care bonus 10%
• GPCI increase 3.26%
• Health coverage mandate
• State-based exchanges
• Coverage of pre-existing conditions
• Dependent coverage
• Medicare quality reporting extended
• Fraud and abuse enforcement
• Health plan administrative simplification
Data capture and sharing
Advanced clinical processes
Improved outcomes
Bending the Curve
2009 2011 2013 2015
HIT-Enabled Health Reform
HITECH Policies 2011 Meaningful
Use Criteria (Capture/share
data)2013 Meaningful
Use Criteria(Advanced care processes with
decision support)
2015 Meaningful Use Criteria (Improved Outcomes)
‘Enabled’ Health Reform
Accountable Care Organizations
• Hot…but not really new
• Real goal: Increase value through better coordination
• Components: Vertical integration, eliminate waste & duplication, coordination of care
• Variable application
• And here…?
Accountable Care Organizations
16
• Evidence-based care• Information exchange• Transitions in care (e.g. readmits)• Medical home• Health coaches/navigators• Advanced home health• Pharmacy management
How do we tackle Care Coordination?
Critical Participants
• Lack of unified vision• Different
corporations• Cultures • Compensation• Facility ownership• Lack of urgency• Fear of unknown
• Inter-specialty conflict• External distracters &
influence• Lack of sufficient
physician leadership• History
Physician Alignment Challenges
Maintain current paymentsystem; maintain status quo
Change payment system
too quickly; providers likely to fail
Create transformational paymentsystem; Provider—payor
collaboration
Payment Conundrum
• Mutual respect & understanding– Change management– Business drivers
• Difficult conversations– Intellectual honesty
• Confidentiality required• Exclusivity not realistic
Provider-payer Collaboration
Against• Initial focus will be on
high population centers• Might go away…HMO
era• Rural areas…different
rules?• Insufficient panel size • Lack of infrastructure &
funding
For• By virtue of our
environment, we are a medical home
• CMS reimbursement will decline so might do better under value-based payment
• Individual practices are as busy (or busier) as urban practices
Rural ACO?
Statewide Collaboratives
• Initiative began in 2003, incorporated in 2005
• Community coalition to improve quality, safety and value
• Provider “convened”
• Public reporting and performance improvement
Iowa Healthcare Collaborative
• Align and equip Iowa health care providers for continuous improvement
• Promote responsible public reporting of healthcare information
• Raise the standard of healthcare in Iowa
IHC Cornerstones
• Conferences
• Learning Communities
• Website- www.ihconline.org
• Toolkits-Anticoagulation, Aortic Dissection, CA-UTI,
Culture of Safety, Healthcare-associated Infection, Lean in Healthcare, Medical Home, Medication Reconciliation, Narcotics, Obesity, Stroke, Tobacco Cessation, and Wristbands
Align and Equip
• Nationally standardized definitions
• Comparative presentation
• Objective data (vs. subjective data)
• Publicly available data sets
• Target transparency for both providers and consumers
• Actionable
Responsible Public Reporting
• Established national measures
• Common methodologies
• Ability to collect the data
• Validation
• Analysis
• Presentation
Complex Process
• The Iowa Report (six years of experience)
• Over 70 measures
• Data Sources: CMS, AHRQ, and voluntarily reported
• Interactive, web-based format
• Annual updates of data
What do we have now?
• Coordination of Care
• Lean applied to Healthcare
• Promote best practice in the hospital
• Healthcare-associated Infection
Raise the Standard of Care
• Coordination of Care
• Lean applied to Healthcare
• Promote best practice in the hospital
• Healthcare-associated Infection
Raise the Standard of Care
Hospital Learning Community
• From IHI 100K, to 5M, to I-Map
• Bundles of best practice
• Spread Exercise changes in 2010
Promote best practice in the hospital
5 Million Lives Campaign
•AMI•ADE•RRT •SSI•CLI•VAP
Spread Exercise
5 Million Lives Campaign
•AMI•ADE•RRT •SSI•CLI•VAP
•CHF•HAM•PU •SCIP•MRSA•BOB
Spread Exercise
• Coordination of Care
• Lean applied to Healthcare
• Promote best practice in the hospital
• Healthcare-associated Infection
Raise the Standard of Care
• HAI Voluntary Reporting Initiative
• Iowa Measures (2007)
Surgical Site Infection (CABG, Hip, Colon, Hyst)
Central line-associated Blood Stream Infections
Immunization of Healthcare Workers
• Iowa Measures (2008)
MRSA SSI and BSI
Healthcare-associated Infection
Influenza Vaccination of Healthcare Workers
National 44%
2010 Iowa Goal 95%
• 2009-10 ?
• 2008-09 79%
• 2007-08 76%
• 2006-07 68%
Influenza Vaccination of Healthcare Workers
National 44%
2010 Iowa Goal 95%
• 2009-10 91%
• 2008-09 79%
• 2007-08 76%
• 2006-07 68%
Our Response…
• A spirit of innovation
• A sense of ownership
• A focus on “nimbleness”
• A commitment to collaboration
Leadership
• Access- Coverage for Services
• Menu- Services paid for
• Execution- Delivery of Services
Healthcare Reform
• Access- Coverage for Services
• Menu- Services paid for
• Execution- Delivery of Services
“You pick two” – Jim Frogue
The only thing certain in the future is change...
Healthcare Reform
• Align and equip health care providers for continuous improvement
• Promote responsible public reporting of healthcare information
• Raise the standard of healthcare
Our Cornerstones for the future…