Care Delivery Transformation in Academic Health Centers

Transcription

1 Care Delivery Transformation in Academic Health Centers William B. Borden, MD Associate Professor of Medicine Director of Healthcare Delivery Transformation George Washington University

2 Chest pain 67 year old man Diabetes High blood pressure High cholesterol History of stroke Former smoker

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6 Acute care Hospital Coronary angiogram 3-vessel coronary artery bypass surgery Aggressive medical management

7 Post-acute care Sub-acute rehabilitation

8 Cardiology follow-up Initial visit Patient says minimal therapy at rehab Given all meds on one prescription from rehab He didn t fill any meds Next visit Taking all meds Feeling better

9 Barriers to quality care Patient factors Language Education Social Financial System factors Fragmented care Lack of accountability

10 Care Delivery Transformation National Policy GW MFA Implementation Academic Health Centers

11 Care Delivery Transformation National Policy GW MFA Implementation Academic Health Centers

12 Health system performance - The Commonwealth Fund, June 2014

13 Health care costs nationally - The Commonwealth Fund, June 2014

14 Health care costs per person - The Commonwealth Fund, June 2014

15 Health care value Value = Outcomes Cost

16 Affordable Care Act Coverage Expansion Delivery System Reform

17 National Quality Strategy Promoting the most effective prevention & treatment strategies Making quality of care more affordable Working with communities to promote healthy living Better Care Healthy People & Communities Affordability Effective communication & coordination of care Making care safer Engaging patients/families

18 Affordable Care Act Coverage Expansion Delivery System Reform Pilot Operational

19 Medicare Innovation Center

20 Medicare Innovation Center Quality Costs OR Innovation Model Pilots Evaluation Quality Costs Then Scale nationally OR Quality Costs

21 Value-based purchasing Hospitals Inpatient/outpatient quality reporting HITECH (hospital) Hospital Value-Based Purchasing Hospital readmission reduction program Healthcare acquired conditions Physicians Physician Quality Reporting System Physician Value-Based Payment Modifier HITECH (providers) E-prescribing

22 Value-based purchasing ESRD Quality Incentive Seamless Care Organizations Other Amb Surgery Quality Reporting Inpatient Psych PPS-Exempt Cancer Hospital Post-acute/Long-term care Nursing Home Quality Initiative Home Health Quality Initiative Inpatient Rehabilitation Facility Quality Reporting Long-Term Care Hospital Quality Reporting

23 HVBP Early Effects Ryan AM, et al. Health Services Research

24 AMI VBP Model Mean Points Persistently poor Intermittently poor Never poor High unemployment Not high unemployment Entire county Portion of county No portion of county High prevalence non-hs grads Not high prevalence non-hs grads <13.5% college graduates % college graduates % college graduates >=26.3% college graduates Attainment Score Improvement Score Blend Score P<0.001 for all Blend Score comparisons within characteristic except: - Extent of HPSA; P=0.348 Borden, WB, et al. Circ Card Qual Outcomes, 2012.

25 AMI Modified Model Mean Points Persistently poor Intermittently poor Never poor High unemployment Not high unemployment P<0.05 for all Blend Score comparisons within characteristic except: - Extent of unemployment; P= Extent of HPSA; P= Non-HS graduates in workforce; P=0.157 Entire county Portion of county No portion of county High prevalence non-hs grads Not high prevalence non-hs grads <13.5% college graduates % college graduates % college graduates >=26.3% college graduates Attainment Score Improvement Score Blend Score Borden, WB, et al. Circ Card Qual Outcomes, 2012.

26 Accountable care organization A healthcare organization that assumes responsibility for the total quality and cost of care for a population of patients over a period of time

27 Medicare ACO structure Population Attributed through primary care or specialists Quality measures Patient / Caregiver experience Care coordination / Patient safety Preventive health At-risk populations Shared savings Target for population total cost Savings shared b/w ACO & Medicare (up +/- down)

28 Medicare ACOs Medicare Shared Savings Program Voluntary operational program Pioneer ACO CMMI pilot Advanced Payment ACO CMMI pilot

29 ACOs total - Muhlestein D. Health Affairs

30 ACOs by type - Muhlestein D. Health Affairs

31 Patients in ACOs by state - Muhlestein D. Health Affairs

32 MSSP year 1 results Shared Savings -

33 Pioneer year 1 results Shared Savings - Releases/2013-Press-Releases-Items/ html

34 Pioneer year 2 results Shared Savings -

35 Alternative Quality Contract - Song Z, et al. NEJM

36 Alternative Quality Contract - Song Z, et al. NEJM

37 Care Delivery Transformation National Policy GW MFA Implementation Academic Health Centers

38 MFA clinical transformation mission To provide better health, better health care, and control costs through improved quality of care, coordination of care, patient experience, and population health management.

39 Mid-Atlantic ACO Partnership among 5 practices George Washington University Medical Faculty Associates >90% of ACO patients

40 Strategy Understand patient population Focus on high opportunity patients Quality Care Strengthen care continuum Manage patient panels

41 Long-Term Vision High-risk patients Rising-risk patients Low-risk patients

42 Care Delivery Transformation National Policy GW MFA Implementation Academic Health Centers

43 Triple mission Health Innovation Community Policy Clinical Care Research Education - Borden WB, et al. Acad Med. In press.

44 Health Innovation Community Policy Clinical care Advanced specialty care Significant free care Improvements in patient safety Community outreach Economic benefits Consolidation of resources Research Bedside-tobench-bedside research Medical technology into practice Integrated AHC and community research programs Health services research examines quality and efficiency Education Train next generation of all providers (MD, RN, techs, etc) Novel education techniques Medical capital of any region Medicare support of training provides lever for future needs - Borden WB, et al. Acad Med. In press.

45 Thank you William Borden, M.D.