Beyond the EHR: What s Next?
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1 Beyond the EHR: What s Next? Trudi Matthews Senior Policy Advisor Kentucky REC
2 What s the Problem? U.S. health care system is the most expensive in the world and has mediocre health outcomes. Spending is projected to double by 2020 ($2.6 trillion to $5.2 trillion). By 2020 health care will consume 21 percent of the GDP. 46 million Americans are uninsured or underinsured. As much as 30% of spending is on wasteful, ineffective care. There is tremendous unexplained variation in health care spending.
3 The Triple Aim
4 Policy Framework for Achieving the Triple Aim
5 How do I get from here to there?
6 A journey of a thousand miles begins with a single step Meaningful Use Care Delivery Innovation (PCMH) Payment Innovation EHR + Health Information Exchange + Quality Improvement
7 Step 1: Meaningful Use of EHRs Stage 1 (underway) Stage 2 (early stages) Stage 3 (TBD)
8 Step 2: New Models of Care Delivery PCMH** Emphasis on primary care Does not include hospitals or specialists No risk Attribution often assigned based on most recent visit ACOs Emphasis on primary care May or may not include hospitals, specialists Risk Attribution patients assigned on plurality of care
9 Patient Centered Medical Home (PCMH) Extreme Makeover Uncoordinated care Over loaded schedule Physician & practice centric Arbitrary quality improvement projects Lack of clear leadership & support Engaged leadership & team based approach Open access, same day scheduling Planned care Patient engagement & self management Care coordination Data directed quality improvement
10 Meaningful Use Overlap PCMH reinforces incentives to use HIT facilitated by EHR, registries, HIE MU practices wellprepared for PCMH MU language embedded in PCMH Standards
11 Patient Centered Medical Neighborhood Primary Care Specialty Care Inpatient Care Emergency Care Urgent Care Laboratory Services Physical Therapy / Rehabilitation Mental Health Home Health Services Pharmacy Durable Medical Equipment Social Work Community Support Agencies
12 Interested in starting the PCMH journey? Ky REC offers expert PCMH training, coaching and resources to guide your practice through the recognition process. Individualized Services & Cohort Model 4 PCMH NCQA Certified Content Experts
13 Step 3: New Payment Models Incentive Payments Shared Savings or Risk Sharing Bundled Payments Capitation Global Capitation (full risk) Partial Capitation (partial risk)
14 Common Payment Innovation Elements Patient attribution Empanelment High Risk Patient Identification & Care Management Care Coordination across the Medical Neighborhood Patient Engagement & Experience of Care
15 New Opportunities to Advance Transformation in Kentucky
16 Practice Transformation Network (PTN) A new funding opportunity from CMS that UK & KY REC are applying for University of Kentucky will be Prime for a 5 state proposal (KY, IN, OH, TN, AL) Recruitment Goal: help 150,000 clinicians nationwide at least 1,000 in KY; min 5K across region Aim: help practices transition through 5 Phases of Transformation and be ready to participate in Value-Based Purchasing/ payment innovation Timeline: Due Feb 5, 2015; Funding Overview Estimated Start: June 2015, Funding for Four Years Min. 20% small, rural and underserved practices
17 Transforming Clinical Practice Goals 1 Support more than 150,000 clinicians in their practice transformation work Improve health outcomes for millions of Medicare, Medicaid and CHIP beneficiaries and other patients Reduce unnecessary hospitalizations for 5 million patients Generate $1 to $4 billion in savings to the federal government and commercial payers Sustain efficient care delivery by reducing unnecessary testing and procedures 6 Build the evidence base on practice transformation so that effective solutions can be scaled 17
18 S2 & S3MU PQRS & VBM CEUs & Certification Requiremts PCMH Recognition New Payment Models TCPI PTN RECRUIT Perform Environmental Scans, Practice Readiness Assessments Recruit PCPs and Specialists, Esp. Small Practices, Rural & Underserved Areas Form Strategic Partnerships with Payers, State Govt., Associations, Patient Advocates CHAMPION Spread Culture Change, QI Methods, Tools, Best Practices Engage Leadership, Build Practice Team Identify Top Performers Provide Coaching, Mentoring & TA Support Patient & Family Engagement Create Peer Groups to Coordinate Care across Medical Neighborhoods Coordinate with CMS TCPI Team on Learning Sessions, Webinars, Change Package, & Communities of Practice FACILITATE Support Care Planning, Team Based Care, Empanelment, Same Day & After Hours Access, Patient Self Management, Shared Decision Making, Patient Navigator, Peer Support Models Connect Medical Neighborhood; Improve Care Management, Coordination, Care Transitions Offer Training, Webinars on QI, PT, Certification Conduct Small Tests of Change, Rapid Evaluation and Spread among PTN Participants MEASURE Data Driven Performance Improvement Collect Monthly Quality Measures from Practices, Report Data Quarterly to CMS Promote IT Interoperability & Meaningful Use, EHR/Registry Use & Optimization, HIPAA Compliance, Data Exchange, Telehealth Monitor operational, utilization, patient experience of care data Program Alignment is Critical for Success and Impact
19 UK PTN Strategy 1. Outreach and recruitment in 3 Waves: Fall 2015, Spring 2016, Spring PTN Learning Collaboratives (18 mos 2 years) Twice per year Learning Sessions with expert faculty interacting with practice teams elearning Courses with CEU credits for practice staff Monthly Data Reporting on 6 7 ecqm measures Practice Dashboard for performance feedback 3. Technical assistance and coaching to practices 4. Multi Payer engagement and alignment
20 Why Pursue Practice Transformation? Patients like it. Patients are healthier. More joy and satisfaction in the long run. Practices prepared to thrive in the future. END GOAL: Practices can finally get paid for doing the right things. The future is already here it s just not evenly distributed. William Gibson
21 How do you eat this elephant? One bite at a time.
22 Toll Free: 888 KY REC EHR Phone: (859) Website: Facebook: facebook.com/ehrresource Kentucky Regional Extension Center 2355 Huguenard Drive, Suite 100 Lexington, KY 40503
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