The New Health Care Model. Axel Arroyo, MD MPH

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1 The New Health Care Model Axel Arroyo, MD MPH

2 Past Learning Objectives Which are the reasons behind these changes? To review the reasons of this transformation. To review Legislative initiatives (ARRA, PPACA and HITECH) Present What is happening right now? To learn about the EHR and Meaningful use concepts. To discuss the Medicare/Medicaid incentive program. Future Why we are doing all these changes? To mention the new health care and financial models Population Health Management Patient-Centered Medical Home Accountable Care Organizations

3 Program Targets Learning Healthcare System CMS Incentives Meaningful Use EHR Adoption EHR Certification

4 Health Care System Transformation Health Information Exchange EHR Adoption and Meaningful Use

5 Volume vs Value Based System Volume Based System Value Based System

6 Volume vs Value Based System Volume Value Based Based 2012 Low financial accountability for cost of care High financial accountability for cost care. Defines population as patients who present at doctor s office. Defines population as every patient in the provider organizations panel, regardless of whether they present at the doctor s office. Minimal infrastructure to manage more than the sickest/most complex patients. Must have infrastructure to manage the entire population. Culture rewards volume and operational efficiency. Culture rewards optimization of cost and quality.

7 Learning System POPULATION HEALTH MANAGEMENT

8 Population Health Management To address health needs at all points along the continuum of health and well being through participation, engagement and targeted interventions for the population to improve clinical and financial outcomes. Healthy Acute Episode Chronic Disease End of Life

9 Conceptual PHM Framework Population monitoring/identification Health Assessment Risk Stratification Care Continuum No or Low risk Moderate risk High risk Health Management Interventions Health Promotion, Wellness Health Risk Management Care Coordination/Advocacy Disease/Case Management Organizational Interventions (Culture/Environment) Person Tailored Interventions Community Resources Operational Measures Psychosocial Outcomes Behavior Change Clinical and Health Status Productivity, Satisfaction, QOL Financial Outcomes

10 Health Care System Transformation Population Health Management Health Information Exchange EHR Adoption and Meaningful Use

11 Learning System PATIENT CENTER MEDICAL HOMES

12 Patient-Center Medical Home (PCMH) Is essentially delivery of holistic primary care based on ongoing, stable relationships between patients and their personal physicians. It is characterized by : A personal physician who is the first contact for his/her patients and who provides continuous and comprehensive care. A physician-led care team that takes collective responsibility for care. The personal physician will provide for all of a patient s health needs and arrange referrals to other health professionals as needed. Care coordination across all care settings, facilitated by information technology and health information exchange. An emphasis on delivering highquality, safe care in partnership with patients and their families. Enhanced access to care through open scheduling, expanded hours, and improved communication among physicians, staff, and patients via secure and other modes.

13 PCMH Recognition (National Committee for Quality Assurance-NCQA) Standard categories (9) Access and Communication Patient Tracking and Registry Functions Care Management Patient Self-Management and Support Electronic Prescribing Test Tracking Referral Tracking Performance Reporting and Improvement Advanced Electronic Communication

14 Health Care System Transformation Patient-Center Medical Home Population Health Management Health Information Exchange EHR Adoption and Meaningful Use

15 Learning System ACCOUNTABLE CARE ORGANIZATIONS

16 Accountable Care Organizations (ACO) An organization of healthcare providers that can receive additional funds from Medicare if it can demonstrate that it provides higherquality care at reduced costs to a defined group of patients. An ACO must measure (using sophisticated IT infrastructure) Quality Outcomes Patient satisfaction Cost

17 Accountable Care Organizations (ACO) Shared-saving Programs Legal structure that allows for receiving/distributing payments. Governance must include representation from clinical, administrative participants & patients. Participation- is a 3-year commitment, requires a minimum of 5,000 beneficiaries. There are 65 measures (Patient/Caregiver assessment, Care Coordination, Patient Safety, Preventive Health). Shared-Savings- calculations for incentive earnings (cost reduction and quality performance requirements).

18

19 Health Care System Transformation Accountable Care Organizations Patient-Center Medical Home Population Health Management Health Information Exchange EHR Adoption and Meaningful Use

20 Value Based-Purchasing Buyers should hold providers of health care accountable for both cost and quality of care. Brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. Focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be contrasted with more limited efforts to negotiate price discounts, which reduce costs but do little to ensure that quality of care is improved.

21 Health Care System Transformation Summary Value based Purchasing Employers Employees Accountable Care Organizations Patient-Center Medical Home Population Health Management Health Information Exchange EHR Adoption and Meaningful Use

22 For more information rec.psm.edu

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