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…