CMS: The “Triple Aim”

1. CMS: The “Triple Aim” Better Health for the Population Better Care for Individuals Lower Cost Through Improvement

2. Patient Centered Fee for Service Integrated Health • Patient Care Centered • Personalized Health Care • Productive and informed interactions between Patient and Provider • Cost and Quality Transparency • Accessible Health Care Choices • Aligned Incentives for wellness • Multiple integrated network and community resources • Aligned reimbursement/care management outcomes • Rapid deployment of best practices • Patient and provider interaction • Information focus • Aligned self care management • E-health capable Driving Healthcare System Transformation Un-managed Coordinated Care Accountable Care • Organized care delivery • Aligned incentives • Linked by HIT • Integrated Provider Networks • Focus on cost avoidance • and quality performance • PC Medical Home • Care management • Transparent Performance Management • Fee For Service • Inpatient focus • O/P clinic care • Low Reimbursement • Poor Access and Quality • Little oversight • No organized networks • Focus on paying claims • Little Medical Management

4. Social Determinants: the cultural, social, economic, health, and environmental conditions at the national, regional, community, and family levels that influence one’s life chances, including one’s future physical and behavioral health.

5. What Is Already Underway? ACA Payment and Delivery System Reforms Support a High Performance Health System • Primary Care and Medical Homes: three new Medicare pilots, several Medicaid initiatives; increased payment for primary care • Bundled payments: Medicare pilots for hospital and post-acute care, Medicaid initiatives • ACO: Broad responsibility for quality and cost of patient care, rewards for quality, shared savings • Value-based purchasing • More transparency on quality and cost • Meaningful use of health information technology Payment and Delivery System Integration Global Budget Pioneer ACOs Medicare Shared Savings Plan Payment Integration CMMI Acute Episode Bundled Payment Pilots Comprehensive Primary Care Initiative FFS and DRGs Small MD practice; unrelated hospitals Integrated delivery system Delivery System Integration Source: The Commonwealth Fund, The New Wave of Innovation: How the Health Care System Is Reforming, (New York: Columbia Journalism Review, November 2011); A. Shih, K. Davis, S. Schoenbaum, A. Gauthier, R. Nuzum, and D. McCarthy, Organizing the U.S. Health Care Delivery System for High Performance (New York: The Commonwealth Fund, Aug. 2008); A. Dreyfus, The Alternative Quality Contract and ACOs: Lessons for Policy-Makers, presentation to 2012 Bipartisan Congressional Health Policy Conference, January 22, 2012.

6. Leadership • Adaptive vs technical • Collaborative • Stakeholders • Content • Process • Facilitation • Philadelphia transformation • Why, what, how • Institute for Health Improvement • Will, ideas, execution

7. Going Forward Drucker’s Five Questions: • What is our business (mission) • Who is our customer • What does the customer consider value • What are our results • What is our plan

8. Some questions for your planning • What innovations will negatively affect your market share and competitive advantage? • How do you decide what new innovations to adopt and leverage? • Will you spread your competencies across the continuum of care?