Transforming Healthcare: Information Technology Tools for Accountable Care Organizations Keith Figlioli, MBA Senior Vice President Informatics

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1 Transforming Healthcare: Information Technology Tools for Accountable Care Organizations Keith Figlioli, MBA Senior Vice President Informatics April 6, 2011

2 The Premier Healthcare Alliance 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. Cost Reduction Group Purchasing & Supply Chain Improvement, Labor Management Quality Improvement Quality Measurement & Benchmarking, Safety Surveillance Risk Mitigation Liability, Benefits & Risk Management Advocacy Shaping policy and advocating for members Execution Engine Comprehensive, accelerated approach to improving financial, operational and clinical performance.

3 Journey to High Value Healthcare Population Health (Continuum of Care value) Systematic Improvement (Inpatient value) 2.0 Payer Partners Insurers Employers States CMS Process Improvement Pay for Performance (Inpatient focus)

4 National Success through Pay for Performance Avg. improvement from 4Q03 to 3Q09 in all clinical areas Clinical (24 quarters) Improvement Area (percentage points) 55.7% Heart Attack 26.0% Heart Bypass 59.4% Pneumonia 68.1% Heart Failure 58.1% Hip & Knee 66.7% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Evidence-based Care Improvements CMS/Premier HQID Project Participants Appropriate Care Score: Trend of Quarterly Median (5th Decile) by Clinical Focus Area October 1, June 30, 2009 (Year 1, 2, 3, and 4 Final Data; Year 5 and 6 Preliminary) Heart Attack Heart Bypass Surgery Pneumonia Heart Failure Hip and Knee SCIP Stroke 4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 Clinical 4Q05 Focus 1Q06 Area2Q06 3Q06 4Q06 1Q07 2Q07 3Q07 4Q07 1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09

5 QUEST: Evolving to systemic improvement Year 1 18 Months Year 2 Lives saved 8,043 14,649 22,164 Dollars saved $577M $1.036B $2.13B Patients receiving EBC 24,818 41,130 43,741

6 Accountable Care: Population Value A group of providers willing and capable of accepting accountability for the total cost and quality of care for a defined population. Core Components People Centered Payor Partners Insurers Employers States CMS Health Home High-Value Network Population Health Data ACO Leadership Payor Partnerships

7 Challenges to widespread HIT utilization Silos lead to a disconnected business and IT infrastructure Islands of computing create inefficiencies and underutilized assets Missing or competing data standards, limited interoperability Struggle with regulatory compliance, volume of information, data integrity and security Resource constraints and difficulty managing complexity/change Volume of data points and quality measures, in widely dispersed locations Limited use among providers 6

8 HIT at the heart of the accountable care framework Builds patient centric systems of care Improves quality and cost for delivery system components Coordinates care across participating providers Uses IT, data and reimbursement to optimize results Builds payer partnerships & accepts accountability for the total cost of care Assesses and manages population health risk Reimbursed based on savings & quality value 7 7

9 Building population IT and data management infrastructure Need to manage data across the continuum of care to enable population health Connect system participants via real time interactivity Link EHR with population management and payment systems Analyze and report based on quality metrics Wire the population to accept responsibility for ongoing care 8

10 HIT in this model requires far more than EHR REQUIREMENTS Predictive modeling Registries EHR interfaces Reminder systems Claims and clinical data warehouses Episode of care analysis systems Specifications for integrated claims and clinical databases Patient portal options Health enabling information exchange (HIE) alternatives DATA SOURCES TO BE MINED Medical records Clinical outcomes data Patient billing systems Payer data Quality measures abstracts Charge master Physician, payer, service line utilization data Infection surveillance data Labor, productivity and throughput records Adverse drug events 9

11 Premier Coordinated Care HIT Capability Maturity Model TM Enabling technology for accountable care organizations Premier 2011 Premier, Inc.

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