Health Care Call to Action Kansas Healthcare Collaborative Summit Tom Evans, M.D. October 21, 2010

1. Health Care Call to Action Kansas Healthcare Collaborative Summit Tom Evans, M.D. October 21, 2010 100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1835 Office: 515.283.9330 • Fax: 515.698.5130 www.ihconline.org

2. Objectives • • 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

3. So…where are we?

4. A New Era…

5. Era of Transparency & Accountability • • 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

6. Value Driven Health Care • • 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

7. Collaboration • Collaboration across multiple lines: • Healthcare Providers • Healthcare Systems • Healthcare Stakeholders • (Purchaser, Payer, Provider, and Patients)

8. Key Drivers of Healthcare Reform

9. Healthcare Reform • • Access- Coverage for Services • Menu- Services paid for • Execution- Delivery of Services

10. 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

11. 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

12. Bending the Curve Improved outcomes Advanced clinical processes Data capture and sharing

13. 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

14. Accountable Care Organizations

15. 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…?

16. How do we tackle Care Coordination? • Evidence-based care • Information exchange • Transitions in care (e.g. readmits) • Medical home • Health coaches/navigators • Advanced home health • Pharmacy management

17. Critical Participants

18. 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

19. Payment Conundrum

20. Provider-payer Collaboration • Mutual respect & understanding • Change management • Business drivers • Difficult conversations • Intellectual honesty • Confidentiality required • Exclusivity not realistic

21. 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?

22. Statewide Collaboratives

23. Iowa Healthcare Collaborative • • Initiative began in 2003, incorporated in 2005 • Community coalition to improve quality, safety and value • Provider “convened” • Public reporting and performance improvement

24. IHC Cornerstones • • Align and equipIowa health care providers for continuous improvement • • Promote responsible public reportingof healthcare information • Raise the standard of healthcarein Iowa

25. Align and Equip • • 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

26. Responsible Public Reporting • Nationally standardized definitions • Comparative presentation • Objective data (vs. subjective data) • Publicly available data sets • Target transparency for both providers and consumers • Actionable

27. Complex Process • Established national measures • Common methodologies • Ability to collect the data • Validation • Analysis • Presentation

28. What do we have now? • 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

29. Raise the Standard of Care • Coordination of Care • Lean applied to Healthcare • Promote best practice in the hospital • • Healthcare-associated Infection

30. Raise the Standard of Care • Coordination of Care • Lean applied to Healthcare • Promote best practice in the hospital • • Healthcare-associated Infection

31. Promote best practice in the hospital • Hospital Learning Community • • From IHI 100K, to 5M, to I-Map • Bundles of best practice • Spread Exercise changes in 2010

32. 5 Million Lives Campaign • AMI • ADE • RRT • SSI • CLI • VAP

33. Spread Exercise

34. 5 Million Lives Campaign • AMI • ADE • RRT • SSI • CLI • VAP • CHF • HAM • PU • SCIP • MRSA • BOB

35. Spread Exercise

36. Raise the Standard of Care • Coordination of Care • Lean applied to Healthcare • Promote best practice in the hospital • • Healthcare-associated Infection

37. Healthcare-associated Infection • • 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

38. Influenza Vaccination of Healthcare Workers • National 44% • 2010 Iowa Goal 95% • 2009-10 ? • 2008-09 79% • 2007-08 76% • 2006-07 68%

39. Influenza Vaccination of Healthcare Workers • National 44% • 2010 Iowa Goal 95% • 2009-10 91% • 2008-09 79% • 2007-08 76% • 2006-07 68%

40. Our Response…

41. Leadership • • A spirit of innovation • • A sense of ownership • • A focus on “nimbleness” • A commitment to collaboration

42. Healthcare Reform • • Access- Coverage for Services • Menu- Services paid for • Execution- Delivery of Services

43. 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...

44. Our Cornerstones for the future… • • Align and equip health care providers for continuous improvement • • Promote responsible public reportingof healthcare information • Raise the standard of healthcare