Beacon Community Program Status Update to the Health IT Policy Committee

1. Beacon Community ProgramStatus Update to the Health IT Policy Committee Janhavi M. Kirtane (janhavi.kirtane@hhs.gov) Director of Clinical Transformation and Dissemination December 5, 2012

2. The Beacon Community Program: Where HITECH Comes to Life 17 communities each funded ~$12-16M over 3 yrs to: Build and strengthenhealth IT infrastructure and exchange capabilities - positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years. Improvecost, quality, and population health - translating investments in health IT in the short run to measureable improvements in the 3-part aim. Test innovative approaches to performance measurement, technology integration, and care delivery - accelerating evidence generation for new approaches.

3. 17 Diverse Communities Bangor Beacon CommunityBrewer, ME Western New York Beacon Community Buffalo, NY Beacon Community of Inland NorthwestSpokane, WA Southeastern Minnesota Beacon Community Rochester, MN Rhode Island Beacon Community Providence, RI Southeast Michigan Beacon Community Detroit, MI Keystone Beacon Community Danville, PA Central Indiana Beacon Community Indianapolis, IN Utah Beacon Community Salt Lake City, UT Greater Cincinnati Beacon Community Cincinnati, OH Colorado Beacon Community Grand Junction, CO Southern Piedmont Beacon Community Concord, NC Great Tulsa Health Access Network Beacon Community Tulsa, OK San Diego Beacon Community San Diego, CA Delta BLUES Beacon Community Stoneville, MS Hawaii County Beacon Community Hilo, HI Crescent City Beacon Community New Orleans, LA

4. Beacon Community Program Status We are here • Impact: As of September 2012, over 8,500 providers are participating in Beacon, with over 8 million lives affected • Early results: 17 out of 17 communities have at least 2 key measures trending positively • Partnerships • Beacon EHR Vendor affinity group • RWJ’s Aligning Forces for Quality • CMMI Pioneer ACOs • Paths for sustainability: 1 Beacon-Pioneer ACO program, 3 regions involved in CMMI’s Comprehensive Primary Care Initiative, with more to come • Dissemination: Nearly 150 on-line media clips highlighting Beacon work (an average of 20 per month, up from 2-3 articles in 2011), and nearly 50 in-person and on-line speaking events Source: Based on self-reported data from the Beacon Communities in community fact sheets and quarterly data submissions.

5. Beacon Community:Highlights from the last 30 days • Greater New Orleans Health Information Exchange (GNOHIE) launches with a focus on safety net providers • San Diego Beacon connects with Kaiser Permanente for Health Information Exchange • Keystone technology will allow any skilled nursing facility to share a patient’s information inexpensively and securely without an EHR (MDS-to-CCD Transformer aka the “gobbler”) • Central Indian Beacon remote monitoring technology helps slash re-admissions rate; pilot to be considered for expansion by a national hospital system

6. Health IT and Exchange Southeastern Minnesota Beacon Community Rochester, MN Rhode Island Beacon Community Providence, RI Southeast Michigan Beacon Community Detroit, MI • 7 communities with newly established exchange capabilities Great Tulsa Health Access Network Beacon Community Tulsa, OK San Diego Beacon Community San Diego, CA Delta BLUES Beacon Community Stoneville, MS Crescent City Beacon Community New Orleans, LA

7. Health IT and Exchange Health IT and Exchange Bangor Beacon CommunityBrewer, ME Western New York Beacon Community Buffalo, NY Southeastern Minnesota Beacon Community Rochester, MN Rhode Island Beacon Community Providence, RI Keystone Beacon Community Danville, PA 8 communities are using HIT to connect a broader group of care and wellness partners Public health: (5-CA, MN, NC, NY, UT) LTPAC: (4- ME, NY, RI, PA) Schools: (3-NC, NY, PA) Utah Beacon Community Salt Lake City, UT Southern Piedmont Beacon Community Concord, NC San Diego Beacon Community San Diego, CA

8. Improvement • For the first time, 17 out of 17 communities are improving at least two key measures over baseline Where are we seeing early results? From To Notes Process/intermediate outcome measures for chronic disease 57% 85% 61% 65% 96% 77% Bangor: LDL-C Control for patients with cardiovascular disease from Q4 2010 and Q3 2012 New Orleans: Diabetes HbA1c Screening rates from Q2 2011 and Q3 2012 Cincinnati: Proportion of their high-risk asthma patients rated "well controlled“ from Q1 2011 and Q3 2012 Preventative care, including cancer screenings 58% 67% Indiana: Colorectal cancer screening rate from Q1 2010 and Q2 2012 Source: Beacon Community October 2012 Data Submission, based on self-reported data from the Beacon Communities.

9. Improvement Where are we seeing early results? From To Notes Behavioral health, including depression screening 68% 50% 93% 84% Colorado: Depression screening for diabetics since the beginning of the Beacon intervention period Rhode Island: Depression screening from Q2 2011 and Q3 2012 Public health, including tobacco cessation advice 63% 75% Rhode Island: Tobacco cessation intervention from Q2 2011 and Q3 2012 Utilization (ED visits, admissions, readmissions) 21% 23% 14% Bangor: Hospital admission rate and ED visit rate (respectively) among its “high risk/high cost” patient cohort that have completed 12 months of care management 38% 40% 21% Keystone: 30-day Readmission Rate among KBC-managed patients with CHF from Q1 2011 and Q2 2012 Source: Beacon Community October 2012 Data Submission, based on self-reported data from the Beacon Communities.

10. Improvement IT-enabled care management is affecting utilization in Bangor… …and readmissions in Keystone

11. Improvement A focus on data is driving diabetes care improvement in Crescent City… …and colorectal cancer screening rates in Indiana

12. Innovation Bangor Beacon Community Western New York Beacon Community 13 communities are testing new models of patient-centered care Mobile: (5-CA, LA, MI, OH, UT) Tele-monitoring: (5-CA, IN, ME, MN, NY) Personalized CDS: (2-CO, OK) PHRs: (2-NY, PA) Southeastern Minnesota Beacon Community Southeast Michigan Beacon Community Keystone Beacon Community Central Indiana Beacon Community Utah Beacon Community Greater Cincinnati Beacon Community Colorado Beacon Community Southern Piedmont Beacon Community Great Tulsa Health Access Network Beacon Community San Diego Beacon Community Crescent City Beacon Community

13. Long-term Value to ONC Beacon Communities explore new frontiers of HIT Beacon Communities generate market and policy insights Beacon Communities inform ONC policy making ONC engages Beacons to serve as test beds for new standards and polices HIT and accountable care: Sub-committee proposed charter under development Standards & Interoperability Implementation Workgroup for pilots and testing HIT and behavioral health Privacy and security needs at the community level Others?

14. Long-term Value to the Country • Finish strong • ONC “Virtuous Circle” • National dissemination • 2012 & 2013 HITPC suggestions appreciated! 2013 Continuation of Existing Efforts (The Floor) Priority Opportunities for 2013 (Swinging for the Fences) • Community-led dissemination • ONC-led dissemination • Partnerships with national organizations • www.healthit.gov • On-line Beacon reference library: content and people • Peer-review publications • HIT-payment storyline • Creative ways to share knowledge • Distillation of most salient lessons • Flexibility for different audiences • Evidence of uptake (vs. passive dissemination) • New audiences: business community, payment pilot participants, others?

15. Next Steps PRELIMINARY Recommended Subcommittee on HIT and ACOs Broad Charge: Make recommendations to the Health IT Policy Committee on how health IT can support the business needs of accountable care models. Specific Charge: Within one year, make a series of recommendations to the Health IT Policy Committee on ways in which ONC can take steps to align with and support the business needs of accountable care models. Next steps: Collect and distill lessons from ONC-led ACO working group Draft proposed activities for sub-committee, in alignment with policy calendar for CMS and the ONC Consider membership of group to support charge