Health Care Call to Action Kansas Healthcare Collaborative Summit Tom Evans, M.D. October 21, 2010...

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…