Federal Partnerships: Supporting Mental Health and Substance Abuse Integration into Mainstream Health Care

1. Federal Partnerships: Supporting Mental Health and Substance Abuse Integration into Mainstream Health Care Betsy L. Thompson, MD, DrPH Chief Medical Officer, CMS, Region IX Health Information Technology Regional Forum July 21, 2011

2. The Healthcare Quality/Value Challenge • U.S. spends more per capita on healthcare than any other country in the world • Quality is often inferior to that of other nations • Significant variation in quality and cost by geographic location • Serious disparities in the quality of health care by race, and socioeconomic status

3. Highlighted CMS Levers

4. Value Driven Care • Goal: Transformation from passive payer to active purchaser of higher quality, more efficient health care • Tools: measurement, payment incentives, public reporting, conditions of participation, coverage policy, Quality Improvement Organizations

5. The “Three-Part Aim” Better Health for the Population Better Care for Individuals Lower Cost Through Improvement

6. Return on Investment from HIT Wide Spread Adoption of Electronic Health Information (EHI) Technologies for Better Outcomes , Lower Cost , Improve Population Health Improving Health Care Quality, Cost Performance, Population Health Better Outcomes ROI of EHI at Point of Care: • Improved Patient Safety • Reduced Complications Rates • Reduced Cost per Patient Episode of Care • Enhanced cost & quality performance accountability • Improved Quality Performance • Improve Community Health Surveillance Lower Costs Population Health

7. Timeline for Delivery System Reform and Transformation, 2011-2019

8. Health Care Delivery System Transformation

9. What is Meaningful Use? • Meaningful Use is using certified EHR technology to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • All the while maintaining privacy and security • Meaningful Use mandated in law to receive incentives

10. What are the Requirements?Clinical Quality Measures Selected CQMs– must complete 3 of 38 • Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment • Smoking and Tobacco Use Cessation, Medical Assistance: • Advising Smokers and Tobacco Users to Quit • Discussing Smoking and Tobacco Use Cessation Medications • Discussing Smoking and Tobacco Use Cessation Strategies • Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: a) Initiation, b) Engagement

11. Medicare Shared Savings Program • Mandated by Section 3022 of the Affordable Care Act • Establishes a Shared Savings Program using Accountable Care Organizations (ACOs) • Must be established by January 1, 2012 • Notice of proposed rulemaking issued March 31st 2011 • CMS is seeking comments on the proposal. Comment period ended June 6, 2011

12. Medicare Shared Savings Program Goals • The Shared Savings Program is a new approach to the delivery of health care aimed at reducing fragmentation, improving population health, and lowering overall growth in expenditures by:  • Promoting accountability for the care of Medicare fee-for-service beneficiaries • Improving coordination of care for services provided under Medicare Parts A and B • Encouraging investment in infrastructure and redesigned care processes

13. Shared Savings Program Vision ACOs will promote the delivery of seamless, coordinated care that promotes better care, better health and lower growth in expenditures by: • Putting the beneficiary and family at the center • Remembering patients over time and place • Attending carefully to care transitions • Managing resources carefully and respectfully • Proactively managing the beneficiary’s care • Evaluating data to improve care and patient outcomes • Using innovation focused on the three-part aim • Investing in care teams and their workforce

14. The Center for Medicare & Medicaid Innovation: Achieving Better Healthcare, Better Health, at Reduced Costs

15. The Current System • Greatest Acute Care in the World: People come from around the world to be treated • But: 46 Million Americans lack coverage • Uncoordinated – Fragmented delivery systems with variable quality • Unsupportive – of patients and healthcare providers • Unsustainable – Costs rising at twice the inflation rate

16. A Transformed System • Affordable • Accessible – to care and to information • Seamless and Coordinated • High Quality – timely, equitable, safe • Person and Family-Centered • Supportive of Clinicians in serving their patients needs

17. Initial Projects • Multi-payer Advanced Primary Care Practice Model (MAPCP) • Medicaid Health Home State Plan Option • Federal Coordinated Health Care Office State Demonstrations • Contracts awarded to 15 states. • Federally Qualified Health Center Advanced Primary Care Practice Demonstration • Accountable Care Organizations (ACOs) • Partnership for Patients

18. Partnership for Patients • New public-private partnership – supporting healthcare providers working toward higher quality care. • Goals are: • Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  • Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. 

19. Partnership for Patients • Join the Partnership for Patients – Sign the Pledge! • We’re asking hospitals, clinicians, employers, labor unions, advocacy organizations, and states to commit to our goals. • Go to http://www.healthcare.gov/ and click on • Submit an application for the Care Transitions Program (Section 3026 of the Affordable Care Act) • $500 million in funding to community-based organizations partnering with eligible hospitals for care transition services

20. Health Care System Transformation Maturity Optimize Care Level of Health System Transformation Maturity Managed Performance Level of Health System Transformation Maturity Initial Level of Health System Transformation Maturity Integrated Health Accountable Care Episodic Non Integrated Care • Patient Care Centered • Patient 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 • 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 Home • 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

21. Summary • Real health reform dependent on meeting the triple aim of: • Better care • Better health • Lower costs • Requires all of us working together 21

22. Thank you! Contact info: betsy.thompson@cms.hhs.gov