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Health Care Reform and Its Impact on EMS:
Volume to Value, Improving Population Health and Other
Paradigm Shifts
The “Triple Aim” Better care for
individuals
Better care for populations
Reducing per capita costs
Hospitals Support
the Triple Aim
ACA Overview of Key Provisions
• Insurance Underwriting Changes
• Individual Mandate
• Employer Mandate
• Finance & Delivery Systems Redesign
• Cost Containment
CHBE Strategies
• Price Leader: The CHBE as a Driver of Low Premiums
• Service Center: The CHBE as a Consumer Destination
• Change Agent: The CHBE as a Catalyst of Finance and Delivery Reform
• Public Partner: The CHBE Aligned with Medi-Cal
Opportunities for Health Care Cost Reduction
Improved Inpatient CareProcesses Use of
lower-costtreatments Reduction in
Adverse EventsReduction in Preventable Readmissions
Improved ManagementOf ComplexPatients
Use of Lower-Cost SettingsAnd Providers
LowerTotalHealthCare Costs!
Hospitals and Specialists
Improved Preventionand Early Diagnosis
Improved PracticeEfficiency
Reduction in Unnecessary Tests and Referrals
Reduction in PreventableER Visits and Admissions
Primary Care Practices
Source: Harold D. Miller, Center for Health Care Quality and Payment Reform
All Providers
Improved Inpatient CareProcesses Use of
lower-costtreatments Reduction in
Adverse EventsReduction in Preventable Readmissions
Improved ManagementOf ComplexPatients
Use of Lower-Cost SettingsAnd Providers
LowerTotalHealthCare Costs!
Hospitals and Specialists
Improved Preventionand Early Diagnosis
Improved PracticeEfficiency
Reduction in Unnecessary Tests and Referrals
Reduction in PreventableER Visits and Admissions
Primary Care Practices
All Providers
MEDICAL HOME
Opportunities for Health Care Cost Reduction
Improved Inpatient CareProcesses Use of
lower-costtreatments Reduction in
Adverse EventsReduction in Preventable Readmissions
Improved ManagementOf ComplexPatients
Use of Lower-Cost SettingsAnd Providers
LowerTotalHealthCare Costs!
Hospitals and Specialists
Improved Preventionand Early Diagnosis
Improved PracticeEfficiency
Reduction in Unnecessary Tests and Referrals
Reduction in PreventableER Visits and Admissions
Primary Care Practices
All Providers
BUNDLING
Opportunities for Health Care Cost Reduction
Improved Inpatient CareProcesses Use of
lower-costtreatments Reduction in
Adverse EventsReduction in Preventable Readmissions
Improved ManagementOf ComplexPatients
Use of Lower-Cost SettingsAnd Providers
LowerTotalHealthCare Costs!
Hospitals and Specialists
Improved Preventionand Early Diagnosis
Improved PracticeEfficiency
Reduction in Unnecessary Tests and Referrals
Reduction in PreventableER Visits and Admissions
Primary Care Practices
All Providers
ACCOUNTABLE CARE ORGANIZATION
Opportunities for Health Care Cost Reduction
Concept• Define the “region” THE GEOGRAPHY– Local communities within the region– Identify the healthcare needs and available resources
• Identify the vision for the region– Articulate goals: region and local communities
• Structure the “delivery model” the “Network of Care”
Facility
Dr.
PAC Facility
CAH
Dr.
AmbulatoryCare
Dr.
Dr.
MG
MG
Dr.
FQHC
Dept. ofPublicHealth
CommunityClinics
MG
The Camden Group
AC
O
Stru
ctur
eHospital
SNF
Outpatient Clinics/Centers
Physicians
Home Health
Rehab
Behavioral Medicine
Pharmacy
ACO
ACO responsible for: Clinical care management (clinical integration) Capture data for continuum of care Measure and monitor costs and quality
Infrastructure(Provided or Contracted
ACO Operations)
Information TechnologyEMR, CPOE, PACSData warehouseReportingHIE
Care ManagementHospitalists and
IntensivistsCMODisease managementClinical protocolsAdvanced analytics and
modelingCall centerUtilization managementKnowledge management
Health NetworkDelivery network
Financial/Payment Systems
The Camden Group
Strategic Issues for Caregivers:
• Enhance efforts to improve quality
• Increase clinical and operational efficiencies
• Increase efforts to improve patient satisfaction
• Reduce avoidable readmissions
• Assess and strengthen planning for HIT
• Examine readiness for payment and care redesign
• Foster physician alignment and clinical integration
Strategic Issues for EMS:
• Continuation of below-Cost payment for Medi-Cal
• Increase in use of EMS providers
• Change in flow patterns
• Engage in hospital integration plans
• Educate/Prepare workforce
Jim Lott, Executive Vice PresidentHospital Association of Southern California
515 S. Figueroa St., Suite 1300Los Angeles, CA 90071-3300
(213) 538-0777 [email protected]
www.hasc.org
