Health Care Reform: Where are the Pharmacists? Opportunities and Challenges for Pharmacists in Health Care Reform

1. Health Care Reform: Where are the Pharmacists?Opportunities and Challenges for Pharmacists in Health Care Reform Anthony D. Rodgers CMS Deputy Administrator Center for Strategic Planning June 2011

2. Rationale for CMS Strategic Direction To Transform the US Healthcare Delivery System “The US healthcare system produces significant level of unjustified variance in patient safety, healthcare cost, quality performance and health outcomes.”

3. The Three Part Aims of CMS Better care, better health, and lower costs through continuous improvement for all Americans

4. “What is the end of the game with Health Reform?”

5. The Essential Elements of a Transformed Healthcare System Informed and Activated Patient Productive Interactions Prepared Clinical Team Common Set of Patient Health Information • Electronic Health Records • Exchange of Health Information • Multi-disciplinary team • Coordinated Care Management • Web based health e-learning, • Electronic Care Planning • Self Care Management Tools

6. Supported by ACO or Integrated Care System Patient Centered Care Electronic Health Record & HIE Informed and Activated Patient Productive Interactions Prepared Clinical Team Supported By E-Health and Learning Tools Clinical and Value Based Integrated Care Management Decision Making

7. Integrated Health • Patient/Person Care Centered • Patient/Person centered Health Care • Productive and informed interactions between Family and Provider • Cost and Quality Transparency • Accessible Health Care Choices • Aligned Incentives for wellness • Integrated networks with community resources wrap around • Aligned reimbursement/cost Rapid deployment of best practices • Patient and provider interaction • Aligned care management • E-health capable • E-Learning resources Driving Health Care System Transformation Healthcare Delivery System 3.0 Healthcare Delivery System 2.0 Healthcare Delivery System 1.0 Accountable Care Episodic Non Integrated Care • Transparent Cost and Quality Performance • Results oriented • Access and coverage • Accountable Provider Networks Designed Around the patient • Focus on care management • and preventive care • Primary Care Medical Homes • Utilization management • Medical Management • Episodic Health Care • Sick care focus • Uncoordinated care • High Use of Emergency Care • Multiple clinical records • Fragmentation of care • Lack integrated care networks • Lack quality & cost performance transparency • Poorly Coordinate Chronic Care Management

8. CMS Strategic Plan Focus • Delivery System Transformation • ACO and Integrated Care Management Delivery System Models Diffusion • Medical/Health Home Diffusion • Electronic Health Record and HIE Infrastructure • Patient Safety • Reduce Hospital Readmission Rates • Reduce Hospital Acquired Conditions Rates and Patient Harm • Improve Care Transitions • Improved Medication Management • Cost and Quality • Value Base Purchasing • Aligned Performance Incentives and Penalties • New payment models • Quality and Cost Public Transparency and Accountability • Coverage and Access • Healthcare manpower capacity development (e.g. use of mid-levels, telemedicine) • Medicaid/CHIP expansion • Health Insurance Exchanges • Special Populations • Dual Eligible Individual • Complex Chronic Disease • Special Need Children • Frail Elderly and Disabled

9. Case Study # 1Health Delivery System Performance: Geographic Variation in Cost and Quality Outcomes

10. Hospital Referral Region Per Capita Spending Varies Dramatically Medicare per capita spending in Miami, FL is more than 2 times Medicare per capita spending in Honolulu, HI ! 10

11. Sample Data Table for High-Cost Hospital Referral Region (HRR) A ratio for each HRRxHCC

12. Sample Data Table for Low-Cost Hospital Referral Region A ratio for each HRRxHCC

13. Geographic Variation In Potentially Avoidable Hospitalizations

14. Potentially Avoidable Hospitalizations

15. Patient Settings : Variation in Results by Setting

16. Case Study #2Dual Eligible Beneficiary Population: Potentially Avoidable Hospitalizations

17. Current Dual Eligible Population Hospitalization Rates

18. Health Reform: Dual Eligible with Complex Chronic Disease

19. The CMS Strategic PlanSystematically guiding the Health Care System to achieve targeted measurable improvements in care management, cost reduction, and population health.

20. CMS Tools for Transforming the Delivery System

21. CMS Levers and Initiatives to Improve Care, Reduce Cost, & Impact Population Health • Policy Levers and Initiatives • Align the Healthcare Industry to CMS Strategic Aims and Direction • Initiate and Lead Major National Campaigns and Initiatives • 10th Scope of Work for QIOs • Program Policy Alignment • Payment Reform and Incentives • CMS Public Reporting, Public Access Databases • Graduate Medical Education policy and funding • Provide or Sponsor Learning Collaborative • Innovation Center Initiatives and Investments • Public-Private Partnering on strategic aims • Building Knowledge Resources - Health Information Databases, Collaborative Insight and Knowledge Discovery

22. Deploying Integrated Care Delivery System Models

23. An Accountable System for Beneficiary/Patient-Centered Care Accountable Care Design Elements Expected Outcomes Improved Care Coordination and Integrated Delivery of Care Increased Provision of Evidence-Based Care Results In Patient Activation and Increased Health Literacy Efficient Delivery of Care and Elimination of Waste Reduce and Contain Cost of Care Population Health Improvement

24. Advanced Primary Care Medical Home

25. Clinical Pharmacist Role in Health Care Reform • Patient Compliance • Comparative Effectiveness

26. Questions? Thank you!