Embed Size (px)
Citation preview
1
WelcomeMary Barker
Vice President, Publishing and Education
2
Webinar 4 Issue BriefPowerPoint File
• An email with links to these documents was sent to all registered participants
• Check your inbox for an email from the “California Hospital Association”
• For assistance, call CHA Education at (916) 552-7637
3
Anne McLeodSenior Vice President, Health Policy & InnovationCalifornia Hospital Association
Anne McLeod provides leadership in the development of CHA’s public policy objectives and develops innovative policy solutions for CHA’s members. Using her experience and extensive knowledge of federal and state health policies, Ms. McLeod represents hospitals’ interests and supports their future growth and success as they respond to the challenges they face going forward.
Staff
4
Pam ArlottoPresident & CEOMaestro Strategies
Pam Arlotto works with CEOs and the C-Suite to create value from their information technology and analytics investments. She is President and CEO of Maestro Strategies, an Atlanta-based healthcare management consulting firm. With more than 30 years of experience, Pam’s role as a national thought leader and change agent began as National President of the Healthcare Information & Management Systems Society (HIMSS). Recently she has conducted research with leaders from over 60 IDNs regarding the emerging organization structure and operating model for information technology, informatics, analytics and quality in the transition from volume to value.
Speakers
5
Robert W. YorkSenior Vice PresidentKaufman Hall
Rob York is a Senior Vice President of Kaufman Hall and leader of the Population Health Management division in the firm’s Strategy practice. He provides strategic services for a range of healthcare clients, including large healthcare systems, public/safety-net providers, academic medical centers and community hospitals. Mr. York’s responsibilities focus on developing strategies to help providers remain relevant and viable in the new healthcare environment based on rigorous market analysis, population and payer segment and demand analysis, and strategic partnership evaluation.
Speakers
6
1. Introduction
2. Transformation to High-Value Healthcare: The Role of HIT
3. Progress in California and the Nation
4. Drivers of IT Investment Strategy
5. The Care Management Platform
• Health Information Exchange
• Knowledge Management and Analytics
• Advanced Care Management
• Consumer and Patient Engagement
6. Vendor Management
7. Concluding Comments
Today’s Topics
7
Introduction
Rob York
8
Financing/Distribution System Competencies
Delivery System Competencies
Care Management
Care Management
Technology/Infrastructure (Claims-focused)
A Recap of the PHM Framework
Technology/Infrastructure(Medical records-focused)
Webinar 2
Webinar 3
Webinar 4
9
Clinical Components
Business Components
Effective Care Management Has Clinical and Business Components
Care Management
Care Transitions
Care Management
Contracting Arrangements
Network Services
Care Navigation
10
To succeed, executives must rethink:• Alignment of business, clinical and information
technology strategies • Information, people, process, and change implications• Value realized from HIT investments
Value-Driven HIT Is Essential for Population Health Management Business & Clinical Fundamentals
Traditional approaches to healthcare information technologywill not keep up
11
Transformation to High-Value Healthcare:
The Role of HIT
Pam Arlotto
12
New IT Capabilities Needed to Enable High-Value Healthcare
• Person-centered health and healthcare
• Comprehensive, coordinated team-based care
• 24/7 access and continuity of care
• Evidence-based care processes
• Real-time, predictive, prescriptive intelligence
• Fee for value
13
Enterprise strategy varies by market stage, competitive positioning, history,collaboration among key players, new entrants, organizational competencies, etc.
2010 2015 2020
Fee-for-Service PaymentHospital ConsolidationPractice Aquisition
Clinical IntegrationPatient EngagementCross-Venue Process RedesignPerformance MeasurementEarly-Stage Population Stratification
Risk ManagementPopulation Health ManagementRetail CareVirtual CareConsumer Behavior Management
© Copyright Maestro Strategies, LLC 2015
Transformation to High-Value Healthcare
Bricks & Mortar Healthcare
Transition Digital Health & Healthcare
14
“The future will be about getting the right information to the right person at the right time to make the right decision to create value.”
Implement EHR systems and align lean with traditional quality
functions
Build new informatics, analytics, transformation,
and innovation capabilities
Rethink IT and quality operating models
Weave digital capabilties into the fabric of new
business, care delivery, and payment models
Transformation to High-Value Healthcare: The Role of IT
© Copyright Maestro Strategies, LLC 2015
2010 2015 2020
Bricks & Mortar Healthcare
Transition Digital Health & Healthcare
15
Key Capabilities of 1.0 HIT
• Designed to support clinical care documentation within one entity
• Focused on the 1:1 relationship between the patient and the doctor
• Supported volume-based billing and compliance
• Emphasized compliance and litigation prevention
• Ensured proprietary ownership of the HIT “footprint” by the vendor
16
• Exchange information across a variety of providers
• Engage patients and their care teams virtually
• Ensure evidence-based practice across the care continuum
• Stratify individuals and populations by health status and health risk
• Provide “dashboards” and summary-of-care information
Key Capabilities of 2.0 HIT
17
• Consumers understand their health and risk profiles, which are digitally enabled; providers understand consumer needs and preferences
• Connected healthcare ecosystem integrates medical, social and community services
• Advanced population analytics help predict care requirements for population segments and assess performance of individual providers, sites and entities
• Disruptive innovations drive business model and care-delivery redesign
Key Capabilities of 3.0 HIT
18
Strategic Priorities• Improving cost management and efficiency • Increasing clinical integration• Expanding coordination of care• Improving quality and safety • Innovating and managing change
• Increasing patient engagement Capabilities of Value-Driven HIT • Hardwire standardized care practices• Support clinical decisions• Stratify patients and track disease status• Improve access and care management across time and geography• Integrate data across entities, processes, and functions• Improve communication across care teams• Measure and analyze care for individuals and populations• Automate routine work
Value-Driven HIT Supports Strategic Priorities
Source: AHA Series: Building a Leadership Team for the Healthcare Organization of the Future, 2014Adapted from Davenport, Process Innovation: Reengineering Work Through Information Technology
19
What Do We Know?
• HIT will underpin each health system’s transformation to high-value health and healthcare
• Each stage is evolutionary and additive
• Enterprise and HIT strategies may be at different stages
• There is no “one-size-fits-all” approach
• Health informatics and analytics should be part of IT/quality structure and operations
“For healthcare executives, the challenge is to think about their delivery networks and their healthcare
services with a new, multifaceted patient in mind —a patient who may be healthy or sick, who values
nurturing but wants independence, who craves information and flexibility, and who will make
choices based on perceptions of value that vary depending on each situation.”
Ken KaufmanChair, Kaufman Hall
20
Which stage best describes your enterprise strategy? (Select one)
1. 1.0: Bricks & Mortar Healthcare
2. 2.0: In Transition
3. 3.0: Digital Health & Connected Care
4. A Combination of 1.0 & 2.0
5. A Combination of All Three
6. Uncertain
Polling Question #1
21
Progress in California and the Nation
Pam Arlotto
22
Source: John Glaser, PhD, Hospital & Health Networks, February 2015
HITECH and Meaningful Use Drove Accelerated Adoption of HIT
• Hospital adoption of EHR systems has increased 5x 2008 levels
• In 2013, nearly 78% of office-based physicians had adopted some type of EHR system
• 70% of providers nationwide are using electronic prescribing through their EHRs, 10x 2008 rates
• Electronic health information exchange among hospital and outside providers grew 51% from 2008 to 2013
• Advanced health data analytics predicted to grow significantly, from a 10% adoption rate in 2011 to 50% by 2016
23
California Progress: Hospital Meaningful UsePercent of California Hospitals Paid by Medicare for Meaningful Use | National Average = 86%Hospitals Eligible to Participate in Medicare EHR Incentive Program onlySource: CMS EHR Incentive Program data, December 2014 and CMS Provider of Services data, December 2014Note: See www.dashboard.healthit.gov/dashboards/hospitals-medicare-meaningful-use.php for more information
24
California Progress: Physician Meaningful UsePercent of California Office-based Physicians Paid by Medicare for Meaningful Use National Average = 49%Source: CMS EHR Incentive Program data, December 2014 and SK&A Office-based Provider Database, 2013Note: See www.dashboard.healthit.gov/dashboards/physicians-medicare-meaningful-use.php for more information
25
California Progress
National Progress: Physician Meaningful Use
Source: CMS EHR Incentive Program data, December 2014 and SK&A Office-based Provider Database, 2013Note: See www.dashboard.healthit.gov/dashboards/physicians-medicare-meaningful-use.php for more information
26
National Progress: Hospitals Exchanging Clinical Care Summaries
Source: 2013 American Hospital Association Survey
Percent of Hospitals with Exchanging Clinical Care Summaries with Hospitals Outside their Health System | National Average = 29%
27Source: Modern Healthcare Health IT Survey, April 2015
• 11% able to routinely exchange electronic patient information with other providers across the country
• 71% optimistic they will be able to exchange a core patient data set by the end of 2017
National Progress: Electronic Data Exchange
Within Own System
Only24%
Regionally21%
Statewide17%
Across State
Borders6%
Nationwide11%
Not at all 21%
28
Which stage best describes your HIT progress? (Select one)
1. 1.0: Implementation of EHRs and Focus on MU
2. 2.0: Building Interoperability, Analytics, Care Management and Patient Engagement Capabilities
3. 3.0: Managing Risk, Enabling New Business Models and Value-Based Care
4. A Combination of 1.0 & 2.0
5. A Combination of All Three
6. Uncertain
Polling Question #2
29
Drivers of IT Investment Strategy
Pam Arlotto
30
HIT Investment Strategy
31
Provider Investment Will Depend on Provider PHM Role
Prepaid
FFS
Futu
re P
aym
ent M
odel
The extent of investment will depend on the PHM role
• Most Advanced: Population Health Manager in All Markets –Responsible for defining all aspects of IT strategy – consumer engagement, care management, analytics, interoperability, EHRs
• Advanced: Population Health Co-Manager – Will partner to deliver key components depending on specifics of market requirements
• Less Advanced: Population Health Multiproduct, Single Product, Contracting Participant – Will ensure EHRs and interoperability with more advanced population health management leaders
32
Example: CHRISTUS Health
“Our corporate IT strategy for population health management is dependent on a
variety of factors in each market – level of clinical integration, do they have
ACOs and PCMHs, clinician readiness, state laws, existing technology adoption,
etc. We must balance corporate standardization and the need to ‘localize’
specifics.”Luke Webster, MD, Vice President &
Chief Medical Information OfficerCHRISTUS Health
CHRISTUS Operating Locations
33
Example: Wisconsin StatewidePartnership
"Our vision is to use our collective resources wisely by being good
stewards of the clinical, administrative, IT, research, patient experience, care
management and other shared expertise within our systems. We want to provide better value in healthcare."
Greg Devine, President and CEO of the partnership
34
Together with Anthem, Vivity'sproviders will meld their health IT
systems, at first relying on Anthem's claims data system.
Anthem indicated it would expand the model to other
markets if it succeeds.
“Never has anything like this been done before, not a financial merger
but a quality merger.” Andrew Leeka, President & CEO
Good Samaritan Hospital
Example: Anthem and Vivity
35
Jim Davis, CEO of University Health System in Augusta, Georgia, recognizes that his market will
not transition from fee-for-service healthcare in the near future. “Fee-for-service will be with us for
a while. We are preparing by building a clinically integrated physician network, expanding our
primary care footprint and investing in information technologies such as EHR systems, performance
measurement tools and connectivity across our employed and affiliated physicians.”
Jim Davis, CEOUniversity Health System, Augusta, Georgia
Example: University Hospital
36
Press *1 to enter the queuePress *2 to remove yourself from the queue
Phone questions:
Questions?
Online questions:
Type your question in the Q & A box, hit enter
37
The Care Management Platform
Pam Arlotto
38
The Care Management Platform
© Copyright Maestro Strategies, LLC 2015
39
The Care Management Platform Will Drive New Business Models
40
• Strategy extends beyond the enterprise, entity, site, payer or provider
• No single vendor provides all components
• The care management platform is designed for new business models, care management process and population needs
• Informatics, analytics, quality, business and IT leaders collaborate
Care Management Platform Components
© Copyright Maestro Strategies, LLC 2015
41
“An interoperable health IT ecosystem makes the right data available to the right people at the right time.”
Source: Office of the National Coordinator, A Ten-Year Vision to Achieve an Interoperable Health IT Infrastructure, 2014
• Approaches to health information exchange:
- Select one integrated EHR vendor and standardize deployment
- Create a private HIE
- Support a “community” or medical trading area HIO
- Connect with national HIT infrastructure: direct, CCD transactions, etc.
• A network of networks
• Importance of technical, semantic (terminology) and process interoperability
Health Information Exchange
42
Health Information Exchange
... her neurologistin San Francisco
Jane sees her PCP in San Rafael
…her GYN inMill Valley
… is unexpectedly hospitalized while visiting
her daughter in San Diego
Jane’s StoryHow do these fourproviders see relevantInformation for Jane?
43
Health Information Exchange
Health Community
Care Collaboration Community
Aligned/ Contracted Community
Enterprise-Owned Entities Acute
Non-EnterpriseEHRs
State/Regional Platforms
Regional HIE platform
AmbulatoryVendor 1
Other Apps
Legal Medical Record
Jane sees her PCP inSan Rafael
…her GYN inMill Valley
… her neurologistin San Francisco
…is unexpectedly hospitalized while visiting her
daughter in San Diego
AmbulatoryVendor 2
Data Sharing/Integration/Interoperability Puzzle
44
Levels of Interoperability
• Optimal integration of computer systems into the work setting: user role definition, user interface, data presentation, engineered work design, information flow and collaboration
• Focus: Coordinates work processes
Process
• Ability of shared information to be understood by sender and receiver
• Focus: Communicates meaningSemantic
• Basic, hardware-based data exchange; focus on data, not its meaning
• Focus: Neutralizes distanceTechnical
45
• Tools for population identification, stratification and analysis to:- Define patient populations- Understand where patients receive their care- Examine population risks, characteristics and
care gaps- Measure performance
• Complexity and confusion- Hundreds of vendors in this evolving space - Organizations are often unclear about the
problem they are trying to solve and buy the wrong tools
- Differentiation needed between enterprise performance management and population health tools
• Data governance, operating model, and analytics skills and capabilities key to success
Knowledge Management and Analytics
46
The Universe of Healthcare Data
47
The Universe of Healthcare Data
48
• Rules-based care management workflow systems enable:- Team care planning
- Health assessment
- Health coaching for wellness, prevention and chronic disease management
- Transitions of care and referral management
- Providers and care managers to quickly view data on individual patients, specific risks and the standard of care for specific conditions
- Adherence alerts and reminders
• Results are personalized interventions, seamless co-morbidity management and counseling
• Many tools developed to support the health plan and payer market
Advanced Care Management
49
• Examine progress to-date, clarify actions needed to realize benefit and develop staged plan for improvement
• Develop a standard methodology to support targeted PHM programs and contracts
• Integrate with “structural” components such as CIN, PCMH, employer and payer contracts, PCP relationships, etc.
• Create plan for realizing ROI/value from available clinical analytics, care workflow, quality reporting and patient engagement tools
• Identify additional opportunities to add value –home monitoring, virtual interactions, etc.
Source: Institute for Health Technology Transformation, “Population Health Management: A Roadmap for Provider-Based Automation in a New Era of Healthcare,” http://ihealthtran.com/pdf/PHMReport.pdf, April 2012.
Designing Care Management Processes
50
Consumer and Patient Engagement
• Online patient education and targeted approaches to improve health
• Holistic personal care plans and partnerships between patients, families, community agencies, employers and retail health providers
• Mobile, telehealth/care and digital tools to enable self-care, patient engagement and behavior change
• Integrate devices, monitoring, communications and information technology to support digital care interventions
• “Open notes”: national initiative that makes provider documentation available and transparent to patients
51
Consumer-Focused Models
52
Population Segments
53
At-Risk & Stable
Healthy
• Home monitoring• Extended team care planning, medication compliance, scheduled reviews
and tracking of interventions• Patient and family member contribution to care team notes• Predictive and prescriptive views of outcomes and cost
• Health risk assessments, targeted calls, emails, text invitationsand routinized contact
• Online education, health coaching and group initiatives prediabetes, blood pressure control, weight management, etc.
• Wearable health monitoring technologies, mobile, smartphone-enableddevices
• Reminders for annual wellness check-ups and cancer screening services • Telehealth services provide easy access and routine interventions• Patient portals and personal health records – results review and tracking
• 24/7 services needed to keep patients in their home, avoid unnecessaryhospitalizations, support family caregivers and reduce the burdenon family physicians
• Patients and caregivers benefit from electronic communications of AdvanceDirectives and Powers of Attorney, specialized care pathways, painmanagement protocols, etc.
• New initiatives examining the role of tele-hospice
Critical
Chronic Simple&
Complex
Population Segments
54
Vendor Management
Pam Arlotto
55
Understanding the Vendor Marketplace
Vendor Categories DescriptionTraditional Provider HIT Vendors
Integrated EHR and revenue management modules provide foundational systems. Several vendors have emerging solutions for population health management. Some providers wait for these vendors to catch up; others move forward with other partners
IT Vendors Enterprise data warehouses support enterprise performance improvement and population health analytics, business intelligence, data normalization and data visualization tools to provide data analysis and dashboards
Niche Vendors & Startups Key categories for venture- and investor-backed software solutions: big data, healthcare consumer engagement, digital medical devices, interoperability, telemedicine, personalized medicine and population health management. Population health is one of the least mature sectors. New care management platforms provide integrated data exchange, analytics, care management workflow and patient engagement
Adjacent Players Payers, pharma, life sciences provide solutions in HIE, data and analytics, care management and patient engagement
56
Concluding Comments
Pam Arlotto
57
Recognize the Virtuous Cycle
“There is a virtuous cycle created by having the foundational IT systems in place, applying health
informatics skills to help make the systems ‘smart’, building analytics capabilities to inform decision
making and partnering with quality to drive performance improvement and transformed care
processes.”
John Fox, President and CEO of Beaumont Health
58
Press *1 to enter the queuePress *2 to remove yourself from the queue
Phone questions:
Questions?
Online questions:
Type your question in the Q & A box, hit enter
59
60
Registration remains open for the full, five-part webinar series.
Webinars are recorded and registrants that are not available the day of a program will be given access to the program recordings.
Register online at www.calhospital.org/population-health-webOr contact CHA Education at (916) 552-7637 [email protected]
It’s Not Too Late to Register!
61
Final Webinar
• Webinar 5: Leadership and Talent for Population Health Management October 6, 2015
