Reforming Health Care in America Union Delegates Conference

1. Reforming Health Care in AmericaUnion Delegates Conference George C. Halvorson Chairman and CEO, Kaiser Permanente March 26, 2011

2. Care Delivery Requirements and Agendas from the Affordable Care Act

3. Health Care Reform Bill – Over a Thousand “Shalls”

4. 75 % of the “Shalls” • Deal with Care • (Less than 25 % deal with insurance)

5. Focus on • -- Chronic Care • -- Team Care • -- Connected Care • -- Safer Care • -- Continuously Improving Care • -- Becoming a Culture of Learning For Care

6. The new law requires a first time ever • care improvement plan for America.

7. National Strategy for Quality Improvement in Health Care March 2011 http://www.healthcare.gov/center/reports 7

8. Making Care Safer Agenda One -- http://www.healthcare.gov/center/reports 8

9. Ensuring Person and Family Centered Care Agenda Two -- http://www.healthcare.gov/center/reports 9

10. Promoting Effective Communication and Coordination of Care Agenda Three -- http://www.healthcare.gov/center/reports 10

11. Promoting the Most Effective Prevention and Treatment of the Leading Causes of Mortality Starting with Cardiovascular Disease Agenda Four -- http://www.healthcare.gov/center/reports 11

12. Working with Communities to Promote Wide Use of Best Practices to Enable Healthy Living Agenda Five -- 12

13. Making Quality Care More Affordable Agenda Six -- http://www.healthcare.gov/center/reports 13

14. The bill is rich in care improvement provisions. • (most invisible to the general public)

15. ACA PROVISION REGARDING CARE Requires HHS Secretary to develop a National Strategy to Improve Health Care Quality to improve health outcomes and efficiency, identify areas for improvement, address gaps in comparative effectiveness information and data gathering, and improve research and dissemination of best practices. National strategy must be updated annually.

16. ACA PROVISION REGARDING CARE Requires AHRQ, and CMS to develop quality measures conforming to National Strategy; requires HHS Secretary to develop, periodically update provider-level outcome measures for hospitals and physicians, including 10 outcome measurements for acute and chronic diseases by March 2012 and 10 outcome measurements for primary and preventive care by March 2013.

17. ACA PROVISION REGARDING CARE Establishes Medicaid Quality Measurement Program, requiring state Medicaid plans to report on state-specific health quality measures, as determined by the HHS Secretary; requires HHS Secretary to test, validate, and develop the quality measures.

18. ACA PROVISION REGARDING CARE Creates a quality measures reporting system for long-term care hospitals, inpatient rehabilitation facilities, cancer hospitals, and hospice programs.

19. ACA PROVISION REGARDING CARE Creates an Interagency Working Group on Health Care Quality to coordinate quality activities across 23 federal departments.

20. ACA PROVISION REGARDING CARE Care Continuity Establishes the Community-Based Care Transitions Program to improve home-based chronic care management for Medicare beneficiaries with multiple chronic conditions.

21. ACA PROVISION REGARDING CARE Establishes interdisciplinary community health teams, created by grants and contracts to eligible organizations from the HHS Secretary, to facilitate collaboration between primary care providers and community-based prevention, patient education, and other resources.

22. ACA PROVISION REGARDING CARE Condition-Specific Care Improvement Creates a National Congenital Heart Disease Surveillance System to track epidemiological data on heart disease and identify areas for prevention and outreach.

23. ACA PROVISION REGARDING CARE Establishes Centers of Excellence for Depression - a network of organizations developing, implementing evidence-based treatment and prevention standards; foster communication with stakeholders; leverage community resources; and promote use of electronic health records to coordinate and manage treatment of depressive disorders.

24. ACA PROVISION REGARDING CARE Creates National Diabetes Report Card: biennial, publically-available report of aggregate prevention, quality of care, risk factors, and outcomes data for diabetic patients.

25. ACA PROVISION REGARDING CARE Modifies the Medicare physician fee schedule to incorporate payments that vary based on the quality of care provided. The modifier will be applicable to specific physicians and physician groups, as determined by HHS, beginning January 1, 2015, and will apply to all physicians and physician groups starting January 1, 2017.

26. ACA PROVISION REGARDING CARE Modifies the Medicare physician fee schedule to incorporate payments that vary based on the quality of care provided. The modifier will be applicable to specific physicians and physician groups, as determined by HHS, beginning January 1, 2015, and will apply to all physicians and physician groups starting January 1, 2017.

27. ACA PROVISION REGARDING CARE Rating System - The Secretary shall develop a rating system that would rate qualified health plans offered through an Exchange in each benefits level on the basis of the relative quality and price. The Exchange shall include the quality rating in the information provided to individuals and employers through a required Internet portal.

28. Medicare Advantage Quality Stars CMS rates Medicare Advantage plans on a scale of one to five stars. Health plans achieving four or more stars receive additional quality payments. Five Stars = Excellent Performance Four Stars = Above Average Performance Three Stars = Average Performance Two Stars = Below Average Performance One Star = Poor Performance

29. Medicare Advantage Quality Requirements Quality scores for Medicare Advantage plans are based on 36 standard performance measures that are derived from four sources: Healthcare Effectiveness Data and Information Set (HEDIS) Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Outcomes Survey (HOS) CMS administrative data, including information about member satisfaction, plans’ appeals processes, audit results, and customer service

30. Hospital Value-Based Purchasing Program Designed to provide incentive payments to hospitals that meet set performance standards for certain quality measures. Program will reward hospitals for improving patients’ experiences of care, while making care safer by reducing medical mistakes. Significant departure from current system, which rewards hospitals for reporting quality data through the Hospital Inpatient Quality Reporting Program.

31. ACA PROVISION REGARDING CARE Safe hospitals are a priority – ACA reduces Medicare payments to hospitals for hospital-acquired conditions and preventable readmissions; imposes monetary penalty on hospitals with the worst rates of hospital-acquired conditions.

32. ACA PROVISION REGARDING CARE Allows Accountable Care Organizations (ACOs), groups of Medicare providers that voluntarily meet quality thresholds, to share in cost savings; ACO regulations are being developed now.

33. ACA PROVISION REGARDING CARE Establishes an Office of Women’s Health

34. ACA PROVISION REGARDING CARE Establishes an Office of Minority Health

35. ACA PROVISION REGARDING CARE Awards grants to states for programs that incentivize Medicaid beneficiary participation in tobacco cessation, weight control, and other health promotion programs to help prevent or manage chronic disease.

36. ACA PROVISION REGARDING CARE Creates a Medicaid demonstration program requiring states to reimburse qualified mental health care institutions for services to stabilize Medicaid beneficiaries experiencing an emergency psychiatric condition.

37. ACA PROVISION REGARDING CARE Promotes employer-based wellness programs through assessment, technical support on implementation, and grants to small employers.

38. ACA PROVISION REGARDING CARE Increases funding for the National Health Service Corps, community health centers, school-based health centers, and nurse-managed clinics.

39. ACA PROVISION REGARDING CARE Creates an evidence-based national education campaign to increase awareness about breast cancer.

40. ACA PROVISION REGARDING CARE Cross-Cutting - Innovation Creates a new Center for Medicare and Medicaid Innovation (CMMI) within CMS to test and evaluate payment and service delivery models that reduce costs and maintain or improve quality of care.

41. Aligned Elements of the Recovery Package

42. Health Care IT • To promote adoption and improve the performance of the health care system, the HITECH Act was signed into law in 2009. • The Act addresses obstacles to the adoption of EHRs and provides substantial financial incentives for the adoption and meaningful use of certified EHR technology. 

43. Meaningful Use • Meaningful use criteria include quality measurements that will be built on over the next several years. • The goal is to build a system that supports clinical practice, research, public health, and the health of individual patients.

44. The entire agenda includes • Seventeen Billion Dollars to fund Health Care IT. • (with meaningful use requirements needed to receive the money)

45. So What About Kaiser Permanente? • How do we fit the new care agenda?

46. -- Team Care • -- Data Supported Care • -- Focus on Patients with Chronic Care Needs • -- Connected Care • -- Consistently Improving Care • -- Safe Care

47. -- Sepsis • -- Pressure Ulcers • -- Central Line Infections • -- HAI’s

48. We are the proof point that care can be much safer.

49. Sepsis • -- #1 cause of death in California hospitals • -- 24% of seniors who die in hospitals die of sepsis • -- Triple the percentage who die in hospitals from cancer Sources: California Office of Statewide Health Planning and Development (OSHPD)

50. Up to a third of sepsis patients die from the disease. Sources: California Office of Statewide Health Planning and Development (OSHPD)