Welcome. Mary Barker Vice President, Publishing and Education

Transcription

1 Welcome Mary Barker Vice President, Publishing and Education 1 1

2 Webinar 4 Issue Brief PowerPoint File An with links to these documents was sent to all registered participants Check your inbox for an from the California Hospital Association For assistance, call CHA Education at (916) Staff Anne McLeod Senior Vice President, Health Policy & Innovation California Hospital Association Anne McLeod provides leadership in the development of CHA s public policy objectives and develops innovative policy solutions for CHA s members. Using her experience and extensive knowledge of federal and state health policies, Ms. McLeod represents hospitals interests and supports their future growth and success as they respond to the challenges they face going forward. 3 2

3 Speakers Pam Arlotto President & CEO Maestro Strategies Pam Arlotto works with CEOs and the C-Suite to create value from their information technology and analytics investments. She is President and CEO of Maestro Strategies, an Atlanta-based healthcare management consulting firm. With more than 30 years of experience, Pam s role as a national thought leader and change agent began as National President of the Healthcare Information & Management Systems Society (HIMSS). Recently she has conducted research with leaders from over 60 IDNs regarding the emerging organization structure and operating model for information technology, informatics, analytics and quality in the transition from volume to value. 4 Speakers Robert W. York Senior Vice President Kaufman Hall Rob York is a Senior Vice President of Kaufman Hall and leader of the Population Health Management division in the firm s Strategy practice. He provides strategic services for a range of healthcare clients, including large healthcare systems, public/safety-net providers, academic medical centers and community hospitals. Mr. York s responsibilities focus on developing strategies to help providers remain relevant and viable in the new healthcare environment based on rigorous market analysis, population and payer segment and demand analysis, and strategic partnership evaluation. 5 3

4 Today s Topics 1. Introduction 2. Transformation to High-Value Healthcare: The Role of HIT 3. Progress in California and the Nation 4. Drivers of IT Investment Strategy 5. The Care Management Platform Health Information Exchange Knowledge Management and Analytics Advanced Care Management Consumer and Patient Engagement 6. Vendor Management 7. Concluding Comments 6 Introduction Rob York 7 4

5 A Recap of the PHM Framework Delivery System Competencies Webinar 2 Care Management Webinar 3 Financing/Distribution System Competencies Technology/Infrastructure (Medical records-focused) Webinar 4 Technology/Infrastructure (Claims-focused) 8 Effective Care Management Has Clinical and Business Components Care Transitions Clinical Components Care Management Care Management Care Navigation Contracting Arrangements Business Components Network Services 9 5

6 Value-Driven HIT Is Essential for Population Health Management Business & Clinical Fundamentals To succeed, executives must rethink: Alignment of business, clinical and information technology strategies Information, people, process, and change implications Value realized from HIT investments Traditional approaches to healthcare information technology will not keep up 10 Transformation to High-Value Healthcare: The Role of HIT Pam Arlotto 11 6

7 New IT Capabilities Needed to Enable High-Value Healthcare Person-centered health and healthcare Comprehensive, coordinated team-based care 24/7 access and continuity of care Evidence-based care processes Real-time, predictive, prescriptive intelligence Fee for value 12 Transformation to High-Value Healthcare Bricks & Mortar Healthcare Transition Digital Health & Healthcare Fee-for-Service Payment Hospital Consolidation Practice Aquisition Clinical Integration Patient Engagement Cross-Venue Process Redesign Performance Measurement Early-Stage Population Stratification Risk Management Population Health Management Retail Care Virtual Care Consumer Behavior Management Copyright Maestro Strategies, LLC 2015 Enterprise strategy varies by market stage, competitive positioning, history, collaboration among key players, new entrants, organizational competencies, etc. 13 7

8 Transformation to High-Value Healthcare: The Role of IT Bricks & Mortar Healthcare Transition Digital Health & Healthcare Implement EHR systems and align lean with traditional quality functions Build new informatics, analytics, transformation, and innovation capabilities Rethink IT and quality operating models Weave digital capabilties into the fabric of new business, care delivery, and payment models Copyright Maestro Strategies, LLC 2015 The future will be about getting the right information to the right person at the right time to make the right decision to create value. 14 Key Capabilities of 1.0 HIT Designed to support clinical care documentation within one entity Focused on the 1:1 relationship between the patient and the doctor Supported volume-based billing and compliance Emphasized compliance and litigation prevention Ensured proprietary ownership of the HIT footprint by the vendor 15 8

9 Key Capabilities of 2.0 HIT Exchange information across a variety of providers Engage patients and their care teams virtually Ensure evidence-based practice across the care continuum Stratify individuals and populations by health status and health risk Provide dashboards and summaryof-care information 16 Key Capabilities of 3.0 HIT Consumers understand their health and risk profiles, which are digitally enabled; providers understand consumer needs and preferences Connected healthcare ecosystem integrates medical, social and community services Advanced population analytics help predict care requirements for population segments and assess performance of individual providers, sites and entities Disruptive innovations drive business model and care-delivery redesign 17 9

10 Value-Driven HIT Supports Strategic Priorities Strategic Priorities Improving cost management and efficiency Increasing clinical integration Expanding coordination of care Improving quality and safety Innovating and managing change Capabilities of Value-Driven HIT Increasing patient engagement Hardwire standardized care practices Support clinical decisions Stratify patients and track disease status Improve access and care management across time and geography Integrate data across entities, processes, and functions Improve communication across care teams Measure and analyze care for individuals and populations Automate routine work Source: AHA Series: Building a Leadership Team for the Healthcare Organization of the Future, 2014 Adapted from Davenport, Process Innovation: Reengineering Work Through Information Technology 18 What Do We Know? HIT will underpin each health system s transformation to highvalue health and healthcare Each stage is evolutionary and additive Enterprise and HIT strategies may be at different stages There is no one-size-fits-all approach Health informatics and analytics should be part of IT/quality structure and operations For healthcare executives, the challenge is to think about their delivery networks and their healthcare services with a new, multifaceted patient in mind a patient who may be healthy or sick, who values nurturing but wants independence, who craves information and flexibility, and who will make choices based on perceptions of value that vary depending on each situation. Ken Kaufman Chair, Kaufman Hall 19 10

11 Polling Question #1 20 Progress in California and the Nation Pam Arlotto 21 11

12 HITECH and Meaningful Use Drove Accelerated Adoption of HIT Hospital adoption of EHR systems has increased 5x 2008 levels In 2013, nearly 78% of office-based physicians had adopted some type of EHR system 70% of providers nationwide are using electronic prescribing through their EHRs, 10x 2008 rates Electronic health information exchange among hospital and outside providers grew 51% from 2008 to 2013 Advanced health data analytics predicted to grow significantly, from a 10% adoption rate in 2011 to 50% by 2016 Source: John Glaser, PhD, Hospital & Health Networks, February California Progress: Hospital Meaningful Use Percent of California Hospitals Paid by Medicare for Meaningful Use National Average = 86% Hospitals Eligible to Participate in Medicare EHR Incentive Program only Source: CMS EHR Incentive Program data, December 2014 and CMS Provider of Services data, December 2014 Note: See for more information 23 12

13 California Progress: Physician Meaningful Use Percent of California Office-based Physicians Paid by Medicare for Meaningful Use National Average = 49% Source: CMS EHR Incentive Program data, December 2014 and SK&A Office-based Provider Database, 2013 Note: See for more information 24 National Progress: Physician Meaningful Use California Progress Source: CMS EHR Incentive Program data, December 2014 and SK&A Office-based Provider Database, 2013 Note: See for more information 25 13

14 National Progress: Hospitals Exchanging Clinical Care Summaries Percent of Hospitals with Exchanging Clinical Care Summaries with Hospitals Outside their Health System National Average = 29% Source: 2013 American Hospital Association Survey 26 National Progress: Electronic Data Exchange Not at all 21% Within Own System Only 24% 11% able to routinely exchange electronic patient information with other providers across the country Nationwide 11% 71% optimistic they will be able to exchange a core patient data set by the end of 2017 Across State Borders 6% Statewide 17% Regionally 21% Source: Modern Healthcare Health IT Survey, April

15 Polling Question #2 28 Drivers of IT Investment Strategy Pam Arlotto 29 15

16 HIT Investment Strategy 30 Provider Investment Will Depend on Provider PHM Role Prepaid The extent of investment will depend on the PHM role Future Payment Model Most Advanced: Population Health Manager in All Markets Responsible for defining all aspects of IT strategy consumer engagement, care management, analytics, interoperability, EHRs Advanced: Population Health Co-Manager Will partner to deliver key components depending on specifics of market requirements Less Advanced: Population Health Multiproduct, Single Product, Contracting Participant Will ensure EHRs and interoperability with more advanced population health management leaders FFS 31 16

17 Example: CHRISTUS Health CHRISTUS Operating Locations Our corporate IT strategy for population health management is dependent on a variety of factors in each market level of clinical integration, do they have ACOs and PCMHs, clinician readiness, state laws, existing technology adoption, etc. We must balance corporate standardization and the need to localize specifics. Luke Webster, MD, Vice President & Chief Medical Information Officer CHRISTUS Health 32 Example: Wisconsin Statewide Partnership "Our vision is to use our collective resources wisely by being good stewards of the clinical, administrative, IT, research, patient experience, care management and other shared expertise within our systems. We want to provide better value in healthcare." Greg Devine, President and CEO of the partnership 33 17

18 Example: Anthem and Vivity Together with Anthem, Vivity's providers will meld their health IT systems, at first relying on Anthem's claims data system. Anthem indicated it would expand the model to other markets if it succeeds. Never has anything like this been done before, not a financial merger but a quality merger. Andrew Leeka, President & CEO Good Samaritan Hospital 34 Example: University Hospital Jim Davis, CEO of University Health System in Augusta, Georgia, recognizes that his market will not transition from fee-for-service healthcare in the near future. Fee-for-service will be with us for a while. We are preparing by building a clinically integrated physician network, expanding our primary care footprint and investing in information technologies such as EHR systems, performance measurement tools and connectivity across our employed and affiliated physicians. Jim Davis, CEO University Health System, Augusta, Georgia 35 18

19 Questions? Phone questions: Press *1 to enter the queue Press *2 to remove yourself from the queue Online questions: Type your question in the Q & A box, hit enter 36 The Care Management Platform Pam Arlotto 37 19

20 The Care Management Platform Copyright Maestro Strategies, LLC The Care Management Platform Will Drive New Business Models 39 20

21 Care Management Platform Components Strategy extends beyond the enterprise, entity, site, payer or provider No single vendor provides all components The care management platform is designed for new business models, care management process and population needs Informatics, analytics, quality, business and IT leaders collaborate Copyright Maestro Strategies, LLC Health Information Exchange Approaches to health information exchange: - Select one integrated EHR vendor and standardize deployment - Create a private HIE - Support a community or medical trading area HIO An interoperable health IT ecosystem makes the right data available to the right people at the right time. - Connect with national HIT infrastructure: direct, CCD transactions, etc. A network of networks Importance of technical, semantic (terminology) and process interoperability Source: Office of the National Coordinator, A Ten-Year Vision to Achieve an Interoperable Health IT Infrastructure,

22 Health Information Exchange Jane sees her PCP in San Rafael Jane s Story How do these four providers see relevant Information for Jane?... her neurologist in San Francisco her GYN in Mill Valley is unexpectedly hospitalized while visiting her daughter in San Diego 42 Health Information Exchange Data Sharing/Integration/Interoperability Puzzle is unexpectedly hospitalized while visiting her daughter in San Diego Health Community Non-Enterprise EHRs State/Regional Platforms her neurologist in San Francisco Care Collaboration Community Regional HIE platform her GYN in Mill Valley Jane sees her PCP in San Rafael Aligned/ Contracted Community Enterprise- Owned Entities Acute Other Apps Ambulatory Vendor 2 Ambulatory Vendor 1 Legal Medical Record 43 22

23 Levels of Interoperability Process Optimal integration of computer systems into the work setting: user role definition, user interface, data presentation, engineered work design, information flow and collaboration Focus: Coordinates work processes Semantic Ability of shared information to be understood by sender and receiver Focus: Communicates meaning Technical Basic, hardware-based data exchange; focus on data, not its meaning Focus: Neutralizes distance 44 Knowledge Management and Analytics Tools for population identification, stratification and analysis to: - Define patient populations - Understand where patients receive their care - Examine population risks, characteristics and care gaps - Measure performance Complexity and confusion - Hundreds of vendors in this evolving space - Organizations are often unclear about the problem they are trying to solve and buy the wrong tools - Differentiation needed between enterprise performance management and population health tools Data governance, operating model, and analytics skills and capabilities key to success 45 23

24 The Universe of Healthcare Data 46 The Universe of Healthcare Data 47 24

25 Advanced Care Management Rules-based care management workflow systems enable: - Team care planning - Health assessment - Health coaching for wellness, prevention and chronic disease management - Transitions of care and referral management - Providers and care managers to quickly view data on individual patients, specific risks and the standard of care for specific conditions - Adherence alerts and reminders Results are personalized interventions, seamless co-morbidity management and counseling Many tools developed to support the health plan and payer market 48 Designing Care Management Processes Examine progress to-date, clarify actions needed to realize benefit and develop staged plan for improvement Develop a standard methodology to support targeted PHM programs and contracts Integrate with structural components such as CIN, PCMH, employer and payer contracts, PCP relationships, etc. Create plan for realizing ROI/value from available clinical analytics, care workflow, quality reporting and patient engagement tools Identify additional opportunities to add value home monitoring, virtual interactions, etc. Source: Institute for Health Technology Transformation, Population Health Management: A Roadmap for Provider-Based Automation in a New Era of Healthcare, April

26 Consumer and Patient Engagement Online patient education and targeted approaches to improve health Holistic personal care plans and partnerships between patients, families, community agencies, employers and retail health providers Mobile, telehealth/care and digital tools to enable self-care, patient engagement and behavior change Integrate devices, monitoring, communications and information technology to support digital care interventions Open notes : national initiative that makes provider documentation available and transparent to patients 50 Consumer-Focused Models 51 26

27 Population Segments 52 Population Segments Healthy At-Risk & Stable Wearable health monitoring technologies, mobile, smartphone-enabled devices Reminders for annual wellness check-ups and cancer screening services Telehealth services provide easy access and routine interventions Patient portals and personal health records results review and tracking Health risk assessments, targeted calls, s, text invitations and routinized contact Online education, health coaching and group initiatives prediabetes, blood pressure control, weight management, etc. Chronic Simple & Complex Critical Home monitoring Extended team care planning, medication compliance, scheduled reviews and tracking of interventions Patient and family member contribution to care team notes Predictive and prescriptive views of outcomes and cost 24/7 services needed to keep patients in their home, avoid unnecessary hospitalizations, support family caregivers and reduce the burden on family physicians Patients and caregivers benefit from electronic communications of Advance Directives and Powers of Attorney, specialized care pathways, pain management protocols, etc. New initiatives examining the role of tele-hospice 53 27

28 Vendor Management Pam Arlotto 54 Understanding the Vendor Marketplace Vendor Categories Traditional Provider HIT Vendors IT Vendors Niche Vendors & Startups Adjacent Players Description Integrated EHR and revenue management modules provide foundational systems. Several vendors have emerging solutions for population health management. Some providers wait for these vendors to catch up; others move forward with other partners Enterprise data warehouses support enterprise performance improvement and population health analytics, business intelligence, data normalization and data visualization tools to provide data analysis and dashboards Key categories for venture- and investor-backed software solutions: big data, healthcare consumer engagement, digital medical devices, interoperability, telemedicine, personalized medicine and population health management. Population health is one of the least mature sectors. New care management platforms provide integrated data exchange, analytics, care management workflow and patient engagement Payers, pharma, life sciences provide solutions in HIE, data and analytics, care management and patient engagement 55 28

29 Concluding Comments Pam Arlotto 56 Recognize the Virtuous Cycle There is a virtuous cycle created by having the foundational IT systems in place, applying health informatics skills to help make the systems smart, building analytics capabilities to inform decision making and partnering with quality to drive performance improvement and transformed care processes. John Fox, President and CEO of Beaumont Health 57 29

30 Questions? Phone questions: Press *1 to enter the queue Press *2 to remove yourself from the queue Online questions: Type your question in the Q & A box, hit enter

31 It s Not Too Late to Register! Registration remains open for the full, five-part webinar series. Webinars are recorded and registrants that are not available the day of a program will be given access to the program recordings. Register online at Or contact CHA Education at (916) or education@calhospital.org 60 Final Webinar Webinar 5: Leadership and Talent for Population Health Management October 6,

32 Thank you Anne McLeod Pam Arlotto Rob York 62 32