CMS ACO Regula-on: A Health IT Briefing. Health System/Medical Group Perspec-ve Keith Figlioli, SVP Healthcare Informa>cs, Premier Alliance

Transcription

1 CMS ACO Regula-on: A Health IT Briefing Health System/Medical Group Perspec-ve Keith Figlioli, SVP Healthcare Informa>cs, Premier Alliance Text: Keith Figlioli will review the proposed ACO regula>on in terms of strategic IT planning and readiness of healthcare providers to support the successful development of ACOs. State Health IT System Perspec-ve Kris>ne Mar>n Anderson, Senior VP, Booz Allen Hamilton Kris>ne Mar>n Anderson will review the key data management requirements of the proposed ACO regula>on and discuss the Thank strategic you! IT considera>ons, challenges, and opportuni>es for state health IT systems and health informa>on exchanges in order to meet these health informa>on requirements.

2 The Premier Healthcare Alliance Cost Reduc-on Group Purchasing & Supply Chain Improvement, Labor Management Quality Improvement Quality Measurement & Benchmarking, Safety Surveillance Over 2,400 hospitals, more than 70,000 non-acute sites Using the power of collaboration to improve the health of communities Nation s largest clinical/operational/supply chain comparative databases 2010 member validated savings of $1.4 billion Safety, Diversity and Environmentally Preferred Purchasing programs $36 billion in annual group purchasing volume 2006 recipient of Malcolm Baldrige National Quality Award Four-time recipient of Ethisphere s Most Ethical Companies award. Risk Mi-ga-on Liability, Benefits & Risk Management Advocacy Shaping policy and advocadng for members Execu-on Engine Comprehensive, accelerated approach to improving financial, operadonal and clinical performance.

3 Challenging Issues for our Members Track 1 Track 2 Cuts to Exis-ng FFS System Market basket reduc>ons DSH cuts Nonpayment for anything preventable or unnecessary Disrupt Exis-ng System Bundled Payments Innova>on Center Demonstra>ons ACOs

4 Answering performance ques>ons becoming increasingly complex with exis>ng siloed systems and processes Answered with isolated data silos. Today s Issues Track 1 How do I engage and align with my physicians? How do I reduce costly physician preference items? How do I lower my readmissions, hospital- acquired condi>ons, hospital acquired infec>ons, etc? How do I get my informa>on faster? How do I deal with all of this data? Tomorrow s Issues Track 2 Answered only with integrated data from many disparate sources. How do I sustain my opera>ons in a climate of decreased reimbursement and increased economic instability? How do I manage and predict / realize reimbursement for specific pa>ent popula>ons? How do I iden>fy and coordinate care for specific chronic popula>ons? How do I use data from all of my partners across the con>nuum to deliver high quality care while reducing costs? How do I manage across care sesngs as payment models evolve to demand this? How do I ensure that my physicians are providing the highest standard of care, while using resources efficiently and consistent with clinical effec>veness studies? How do I con>nue to compete in an environment that is increasingly transparent? How do I meet increasingly complex overlapping regulatory requirements (Meaningful Use, Repor>ng Hospital Quality Data for Annual Payment Update, Ongoing Professional Prac>ce Evalua>on, etc.)?

5 Member hospitals have been preparing for these reforms Popula0on total value Systema0c improvement (Inpa0ent value) 2.0 Payer Partners Insurers Employers States CMS Process Improvement (Inpa0ent focus)

6 HIT is at the heart of the accountable care and higher value A group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. Payor Partners Insurers CMS Employers Core Components People Centered Health Home High-Value Network Population Health Data ACO Leadership Payor Partnerships 6

7 42 states collaborate to redesign care 28 systems in 29 markets represen>ng 120+ hospitals, 5,000+ MDs and more than 1.5M accountable care covered lives 67 systems in 86 markets represen>ng 300+ hospitals, 12,000+ MDs and more than 3.6M accountable care covered lives

8 HIT in this model requires far more than EHR REQUIREMENTS Predic>ve modeling Registries EHR interfaces Reminder systems Claims and clinical data warehouses Episode of care analysis systems Specifica>ons for integrated claims and clinical databases Pa>ent portal op>ons Health enabling informa>on exchange (HIE) alterna>ves DATA SOURCES TO BE MINED Medical records Clinical outcomes data Pa>ent billing systems Payor data Quality measures abstracts Charge master Physician, payor, service line u>liza>on data Infec>on surveillance data Labor, produc>vity and throughput records Adverse drug events

9 Accountable Care Road Map Functionality and Value Delivered - Involve People - Build Health Home(s) - Enhance Inpa-ent Value - Achieve - Meaningful Use - Implement ACO Structure - Establish ACO Opera-ons - Establish Payor Rela-onships - Assess Popula-on - Coordinate Care - Enhance Outpa-ent Care - Assist Care Coordina-on - Execute Agreements - Improve Access - Op-mize Care - Coordinate Specialty Care - Facilitate Clinical Integra-on - Leverage Market Opportuni-es - Transparent Popula-on Data - Ac-vate People - Manage Popula-ons - Integrate Care - Support ACO Sustainability - Centralize Medical Management - Care Delivery Collabora-on - Improve Experience - Improve Health - Improve Efficiencies - Triple Aim Innova-on % Risk % Risk % Risk % Risk % Risk Clinical Integra>on Clinical Integra>on Clinical Integra>on Clinical Integra>on Clinical Integra>on ROI ROI ROI ROI ROI Triple Aim Triple Aim Triple Aim Triple Aim Triple Aim Rhythm Cycle & Priority Sequence Over Time

10 IMPLICATIONS

11 State HIT issues States do have significant authority to impact HIT Text: State wide health insurance exchanges Regional extension centers Medicaid EHR incen>ve payments 14 states have approved plans from CMS Mul>- campus hospitals Stage 2 meaningful use Thank you!

12 Thank you! For more informa-on, please visit: 12