Health Care Reform and Its Impact on EMS: Volume to Value, Improving Population Health and Other Paradigm Shifts

The Triple Aim Better care for individuals Better care for populations Reducing per capita costs Hospitals Support the Triple Aim

ACA Overview of Key Provisions Insurance Underwriting Changes Individual Mandate Employer Mandate Finance & Delivery Systems Redesign Cost Containment

CHBE Strategies Price Leader: The CHBE as a Driver of Low Premiums Service Center: The CHBE as a Consumer Destination Change Agent: The CHBE as a Catalyst of Finance and Delivery Reform Public Partner: The CHBE Aligned with Medi-Cal

Opportunities for Health Care Cost Reduction Improved Inpatient Care Processes Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! Hospitals and Specialists Improved Prevention and Early Diagnosis Improved Practice Efficiency Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Primary Care Practices Source: Harold D. Miller, Center for Health Care Quality and Payment Reform All Providers

Improved Inpatient Care Processes Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! Hospitals and Specialists Improved Prevention and Early Diagnosis Improved Practice Efficiency Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Primary Care Practices All Providers MEDICAL HOME Opportunities for Health Care Cost Reduction

Improved Inpatient Care Processes Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! Hospitals and Specialists Improved Prevention and Early Diagnosis Improved Practice Efficiency Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Primary Care Practices All Providers BUNDLING Opportunities for Health Care Cost Reduction

Improved Inpatient Care Processes Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! Hospitals and Specialists Improved Prevention and Early Diagnosis Improved Practice Efficiency Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Primary Care Practices All Providers ACCOUNTABLE CARE ORGANIZATION Opportunities for Health Care Cost Reduction

Concept Define the region THE GEOGRAPHY –Local communities within the region –Identify the healthcare needs and available resources Identify the vision for the region –Articulate goals: region and local communities Structure the delivery model the Network of Care Facility Dr. PAC Facility CAH Dr. Ambulatory Care Dr. MG Dr. FQHC Dept. of Public Health Community Clinics MG The Camden Group

ACO Structure Hospital SNF Outpatient Clinics/ Centers Physicians Home Health Rehab Behavioral Medicine Pharmacy ACO ACO responsible for: Clinical care management (clinical integration) Capture data for continuum of care Measure and monitor costs and quality Infrastructure (Provided or Contracted ACO Operations) Information Technology EMR, CPOE, PACS Data warehouse Reporting HIE Care Management Hospitalists and Intensivists CMO Disease management Clinical protocols Advanced analytics and modeling Call center Utilization management Knowledge management Health Network Delivery network Financial/Payment Systems The Camden Group

Strategic Issues for Caregivers: Enhance efforts to improve quality Increase clinical and operational efficiencies Increase efforts to improve patient satisfaction Reduce avoidable readmissions Assess and strengthen planning for HIT Examine readiness for payment and care redesign Foster physician alignment and clinical integration

Strategic Issues for EMS: Continuation of below-Cost payment for Medi-Cal Increase in use of EMS providers Change in flow patterns Engage in hospital integration plans Educate/Prepare workforce

Jim Lott, Executive Vice President Hospital Association of Southern California 515 S. Figueroa St., Suite 1300 Los Angeles, CA (213)