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…