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Q-Care

Q-Care. and Physician Accountability in Health System Reform Board of Governors 9-07 Jack Lewin, MD CEO American College of Cardiology. Health System Reform is Essential and Imminent. Access, Quality, and Cost. Environmental Trends. Exploding new technologies

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Q-Care

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  1. Q-Care and Physician Accountability in Health System Reform Board of Governors 9-07 Jack Lewin, MD CEO American College of Cardiology

  2. Health System Reform is Essential and Imminent

  3. Access, Quality, and Cost

  4. Environmental Trends • Exploding new technologies • Government share of health care financing is increasing, as employer share declines • Budget constraints may force government to shift from health care reform to pure deficit reduction, forcing further rationing and disparities • Wal-Mart clinics, concierge care, and other unexpected developments

  5. Ramp Up to the 2008 Elections

  6. CV Environment • Cardiovascular disease number one killer • 43 percent of all Medicare dollars go to cardiovascular related treatment • Aging population demands more cardiovascular services • Looming shortage of cardiovascular specialists • Personal health behaviors/risks further increase future demand • Congress has directed DHHS (CMS) to oversee performance and quality.

  7. Health System Reform • Why reform is stalled • Everybody must bring something to the table • Government • Payers • Hospitals • Patients • Business • Physicians and health care providers

  8. Physicians and the Health Professions are NOT at the Table Single Payer Reform Employer Mandates Individual Mandates Voluntary Reform Approaches Reimbursement vs. Access

  9. Really Interesting Questions Can Health Care Professionals—e.g. Specialties like ACC---be Self- Regulating Entities? Can Physicians Overcome Conflicts of Self Interest to Do This Effectively? Is Government Going to Take Over Quality Measurement Regardless of What the Profession Does?

  10. What Should Physicians Bring to the Table? • Individual and collective professional responsibility for quality and value • Care that is • Patient-centered • Evidence-based • Cost-effective • Value vs. volume • Ethical

  11. The ACC Approach:Peer Review on a Macro Level

  12. QCARE • Continuous review of new science • Evidence-based guidelines and standards • Application of guidelines at the point of care • Data reporting and collection of clinical data through registries (NCDR) • Physician and hospital quality feedback and specific quality initiatives (D2B) • Education and lifelong learning based on measured gaps in quality and performance • Appropriate use of technology • Evaluation to further goal of continuous performance and outcomes improvement

  13. QCARE

  14. QCARE in Action

  15. Current Initiatives • Medicare • Private sector • Professional accountability (QCARE) • Other Specialty partnerships • NQF, NCQA, ABIM, AHRQ • Reality Testing* * 100 years of life expectancy * Decline n Rates of Death and HF in ACS, ’99-’06 (Fox, Eagle et al) * Financial Incentives for AMI care in P4P of no Avail • (Eric Peterson, JAMA 2007)

  16. Getting to the Holy Grail • Expedited Guidelines and Clinical Consensus Documents • Ambulatory data collection • EHR Adoption with Embedded GLs and Decision-Support Software • Financing comprehensive quality Improvement

  17. What Are the Barriers? • Suspicion about our ability to self-regulate • Conflicts • Self serving • Industry partnerships • Individual physician commitment • Significant resources needed to go from guidelines to practice • Time may be running out

  18. How Physicians Can Change the Future of Health Care Health care reform must focus on improving health and health care value for patients. Reform must be market based but physician led. Improving the value of health care is something only medical teams can do. Competition must be around improving results (outcomes). With such positive sum competition, patients will receive better care, physicians and providers will be rewarded for excellence, and costs will be contained. The goals must focus on increased value for patients; medical practice organized around medical conditions and care cycles, and a recognition that results (risk adjusted outcomes and costs) must be measured. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. --Michael Porter PhD

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