Advancing Quality Healthcare Through National, State and Local Community Collaboration Robert Jackson MD, MMM Board Chair and President, Southeastern Michigan Health Information Exchange (SEMHIE)

Hugh Macleod

T he Concept of the Beacon Community 3 Care Delivery Innovations Provider Feedback & Measurement Payment Reform HIT Foundation: Meaningful Use of EHRs and HIE Improved Quality & Efficiency

The Ultimate Goal is Improved Health Health IT: Electronic Health Records and Information Exchange Innovative Care Delivery Processes and Payment Reform 4 Sustainable Health Outcomes: Quality, Efficiency, Population Health

Achieving the National Beacon Vision: ONC Focuses on Five Domains  Leadership & Stewardship  HIT & Meaningful Use  Clinical Transformation  Data & Performance Measurement  Sustainability and Payment Reform 5

Achieving the National Beacon Vision: 31 Month Roadmap 6 Phase 1: Program Launch (September 2010-October 2010) Phase 2: Implementation & Refinement (October Dec 2012) Phase 3: Evaluation & Dissemination (Jan Mar 2013)

Dr. David Blumenthal Presents Beacon Award To ‘Team Detroit’

Andre Gide

Team Detroit $16.2M Beacon Award  Grant Awardee:  SEMHA, the Southeast Michigan Health Association, is the fiduciary for SEMHIE, the Southeast Michigan Health Information Exchange  Beacon Implementation:  SEMHIE will implement Beacon through the Southeast Michigan Beacon Community Collaborative (SEMBCC)  Beacon Funding:  $16.2 Million from HITECH Act  $27.8 Million non-federal funds (stakeholder in-kind & cash)

Vision  The Detroit area has a patient-centric electronically connected system of care that that emphasizes holistic care management, where there are no barriers to the flow of patient health information to the appropriate care providers, are well-informed and actively engaged in managing their health

Project Mission:  The overarching purpose of our project is to improve Diabetes Mellitus (DM) care and associated outcomes while reducing costs. at the place and time needed.

Strategy  Guided by culturally oriented behavior change models, we will do this by:  Expanding interoperability and health information exchange  In our underserved and disadvantaged community  To bring comprehensive and actionable clinical information to providers.

Beacon Team Detroit: Project Objectives  Improve continuity, quality and safety of care for underserved patients with chronic diabetes in  Detroit, Hamtramck, Highland Park, Dearborn and Dearborn Heights, Michigan  Diabetes has a very high prevalence among the target population: 12.8 percent of adults, or 93,000 people.

Project Objectives  Improve the quality and efficiency of diabetes care and reduce cost  Redesign patient care work processes  Develop community-wide patient care coordination  Apply quality improvement and other change management strategies

Abraham Lincoln

Team Detroit’s Technical Goals  Make comprehensive patient information available at point of care  Leverage existing advanced technologies  Extend SEMHIE’s SSA architecture for Beacon  Increase technical interoperability among providers  Include a broad spectrum of community health care settings (health systems, emergency departments, primary care physicians, FQHCs, free-clinics)

The Beacon Community Project Will Address  Outcomes of healthcare in the U.S. are poor compared to most developed countries  Care process quality is sub-par; impacting health outcomes  Care cost is very high and rising  Patient satisfaction is low  Clearly healthcare can perform better

Causes of Quality Issues  Quality data is scattered and not in easily usable formats  Providers are paid for service utilization, not quality results  Shortage of Primary care physicians  Costs of chronic care are prohibitive to many patients  High number of un-/under-insured

Provider Incentives are Misaligned  Health payment is heavily weighted to volume rather than quality of services.  Each health plan is different.  Different metrics  Different weights  Patients don’t have the information to judge quality of care

Mother Teresa

How Will Beacon Impact Care?  To help patients negotiate the transitions of care smoothly  An ER visit will trigger the navigator to help the patient follow up with their PCP “home”.  Patients will be assisted in these transitions by these patient navigators.  VODI has already used this model effectively; we will expand and hope to enhance it.

Beacon Will Provide Care Coordinators  More clinical, a nurse; will facilitate the PCP  For instance they will help the patient achieve the care quality landmarks needed.  Encourage compliance by educating and actively engaging the patient on an ongoing basis.  Reducing perceived or actual barriers that prevent a patient from optimal care.

Beacon Will Experiment  With methods to more fully engage the patient will messaging back and forth  Likely will use cell phone technology as it is somewhat ubiquitous  We need to work with them on their terms to engage.  We will learn from the other 17 Beacon communities and continually transform

Sam Levenson

Next Steps for Beacon Team Detroit  Complete data evaluation baseline – Nov 2010  Continue roll-out of SEMHIE’s SSA architecture for Beacon  Initiate provider assessments  Engage additional core team participants from key stakeholder groups for balance – Join us!!

Summary  Team Detroit will enhance the care of patients with Diabetes Mellitus in these 5 cities  Activate providers of healthcare and patients  Support them with Patient Navigators for care transitions  Engage and Educate patients with Care Coordinators  Measure quality and improve it  Support these efforts with Information Technology.

Beacon Team Detroit Contacts  Gary Petroni, SEMHA, Center for Population Health Director; Fiduciary, Beacon Grant  Robert Jackson, M.D., Chairman, SEMHIE; Initial Beacon Executive Medical Director  Helen Hill, Program Manager, Public-Private Initiatives, SEMHIE; Initial Beacon Program Director

Major Stakeholders in SE Michigan Beacon Community Collaborative  AFL-CIO Employer Purchasing Coalition  Ascension Health  Beaumont Hospitals  Blue Cross Blue Shield of Michigan  CareEvolution, Inc.  CSC  Detroit Medical Center  Detroit Wayne County Health Authority  General Motors  Greater Detroit Area Health Council  Health Alliance Plan  Henry Ford Health System  HIMSS  HIMSS IHE  Joint Venture Hospital Laboratories

Major Stakeholders in SE Michigan Beacon Community Collaborative  Juvenile Diabetes Research Foundation  Internet2  M-CEITA  my1HIE  Michigan Academy of Family Practice  Michigan Coalition of HIT  Michigan Department of Community Health  Michigan Department of Technology, Management and Budget  Michigan Health and Hospitals Association  Michigan Health Information Management Association

Major Stakeholders in the SE Michigan Beacon Community Collaborative  MPRO  Oakland County Medical Society  Oakwood Healthcare System  Oakwood Primary Care Physicians PC  Object Management Group  Picis  PRISM  MI-HIMSS  Michigan Organization of Diabetes Educators  Michigan Primary Care Association  Michigan State Medical Society/MSMS Connect  Michigan State University Institute for Health Care Studies  Molina Healthcare

Major Stakeholders in the SE Michigan Beacon Community Collaborative  Trinity Health  University Bank  Visiting Nurse Association of Southeast Michigan  Wayne County Medical Society of Southeast Michigan  Wyandotte Independent Physicians Association  Voices of Detroit Initiative  Promia  Southeastern Michigan Health Association  Southeast Michigan Health Information Exchange  St. John Providence Health System  Summit Health Institute for Research and Education  Thomson Reuters

Mark Twain

Core Team Participants NameOrganizationTitle Gary PetroniSEMHA and Center for Population Health Executive Director Rob Jackson, MDMedical DirectorOakwood Primary Care Physicians Helen HillHenry Ford Health System Director IT Consulting & HIE Verniece AnthonyGDAHCExecutive Director Leland Babitch, MDDetroit Medical CenterVP and CMIO Elizabeth BriodyPRISMVP Cultural Improvement Lee CastiglioniTrinity Health SystemSenior Enterprise Architect

Core Team Participants NameOrganizationTitle Jean ChenowethThomson ReutersSVP Performance Improvement and Top 100 Hospitals Terrisca Des Jardinsmy1HIEVP Strategic Partnerships and Initiatives John DoddCSCHHS Fellow Mark EisnerObject Management Group (OMG) CTO James Fisher CSCPartner Joe Fortuna, MDPRISMCEO

Core Team Participants NameOrganizationTitle David FosterThomson ReutersChief Scientist, Center for Healthcare Improvement John Frownfelter, MDHenry Ford Health System CMIO Inpatient Services Denise HolmesMichigan State University Associate Dean; Institute for Health Care Studies Adam JablonowskiWayne County Medical Society Executive Director Vik KheterpalCareEvolutionPrincipal

Core Team Participants NameOrganizationTitle Jeanette KlanowSt. John Providence Health System Director Application Services Laura KolkmanMosaica PartnersPresident Steven KorzeniewskiMPRODirector of Statistical Analysis Resource Group and Chief Scientific Officer Mike Kramer, MDTrinity Health SystemVP and CMIO Donna LaGoshOakland County Medical Society Executive Director Ken LordObject Management Group (OMG) Board Member

Core Team Participants NameOrganizationTitle Ben LouagieMSMS CONNECT Executive Director Rebecca MolesworthThomsonReutersProgram Manager Charles MundtMichigan State UniversityIHCS Outreach Specialist Julie MoranTrinity Health SystemTrinity Information Systems Division Director of SE Mich Katherine OberstMichigan State UniversityIHCS Research

Core Team Participants NameOrganizationTitle Charlie O’NeillObject Management Group (OMG) VP Engineering Carole PritchardHFHSOneIT Corporate Director Stephen RanziniUniversity BankPresident and CEO Devorah RichGreater Detroit Area Health Council Senior Program Manager Jackie RosenblattMPRODirector Quality Improvement Jack ShawJoint Venture Hospital Laboratories Executive Director

Core Team Participants NameOrganizationTitle Lucille SmithVoices of Detroit InitiativeExecutive Director Paula SmithSVP and CIOOakwood Health System Mick TalleyUniversity BancorpIndependent Director; Chair Audit Committee Nancy WalkerWilliam Beaumont HospitalDirector Revenue Cycle, Maternal Child Health Larry YuhaszThomson ReutersDirector Strategy and Business Development