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.
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.
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
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.)?
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)
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
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
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
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 % Pop @ Risk % Pop @ Risk % Pop @ Risk % Pop @ Risk % Pop @ 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
IMPLICATIONS
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!
Thank you! For more informa-on, please visit: www.premierinc.com 12