American Association of Colleges of Pharmacy Anthony D. Rodgers Deputy Administrator February 2011

CMS Three Part Aims for Healthcare Delivery System Improvement Better care for individuals through seamless coordinated health care. Reduced costs through continuous improvement. Better health for populations.

Strategic Aims and Priorities CMS Business Environments Achieving CMS Three Part Aims and Priorities Through Improvements to CMS Business Environments Strategic Aims and Priorities CMS Business Environments CMS Strategic Aims Better care Lower per capita cost Better health for populations Strategic Priority Areas Excellence in operations Improved care delivery Integrated care Prevention and community health CMS Business Operations Enterprise Management Strategic Enterprise Planning Policy and regulatory levers ACA implementation Cost containment strategies Public Information and Customer Service Innovation It will be unclear to the audience what the difference is between Strategic Aims and Strategic Priority Areas

Sample Data Table for High-Cost HRRs (2007 Data) A ratio for each HRRxHCC

Sample Data Table for Low-Cost HRRs (2007 Data) A ratio for each HRRxHCC

Driving Health Care System Transformation Healthcare Delivery System 3.0 Integrated Health Patient/Person Care Centered Patient/Person centered Health Care Productive and informed interactions between Family and Provider Cost and Quality Transparency Accessible Health Care Choices Aligned Incentives for wellness Integrated networks with community resources wrap around Aligned reimbursement/cost Rapid deployment of best practices Patient and provider interaction Aligned care management E-health capable E-Learning resources Healthcare Delivery System 2.0 Healthcare Delivery System 1.0 Accountable Care Episodic Non Integrated Care Transparent Cost and Quality Performance Results oriented Access and coverage Accountable Provider Networks Designed Around the patient Focus on care management and preventive care Primary Care Medical Homes Utilization management Medical Management Episodic Health Care Sick care focus Uncoordinated care High Use of Emergency Care Multiple clinical records Fragmentation of care Lack integrated care networks Lack quality & cost performance transparency Poorly Coordinate Chronic Care Management

CMS AIMS CMS aims to: 1. Measurably improve care provided to all patients in all settings while reducing cost by continuous improvement, 2. That every Medicare, Medicaid, and insured beneficiary receive seamless coordinated care, 3. That population health status is improved by organizing the delivery system and raising community health capacity.

CMS 2011 Focus Delivery System Transformation Patient Safety ACO Diffusion Medical/Health Home Diffusion Patient Safety Hospital Readmission Rates Hospital Acquired Conditions Rates Improve Care Transitions Cost and Quality Value Base Purchasing Aligned Performance Incentives

CMS Tools for Transforming the Delivery System Shared Savings, Episode- based Bundled Payments, Value-base payments, and Partial Capitation ACO’s and Medical Homes HealthCare Delivery System Transformation Electronic Health Records and HIE Payment Reform Quality and Cost Transparency Service Delivery Redesign Investments

Essential Elements of The Patient Centered Care of a Transformed Healthcare System Seamless & Coordinated Care Informed, Activated Patient Productive Interactions Prepared Clinical Team The advisory committee told us that good outcomes are the result of productive interactions between an informed, activated patient (and their family or caregivers) and a prepared, proactive practice team. This is what the chasm report calls continuous healing relationship. Wagner EH, Davis C, Schaefer J, Von Korff M, Austin B. A survey of leading chronic disease management programs: Are they consistent with the literature? Managed Care Quarterly. 1999;7(3):56-66 Common Set of Patient Health Information Requires Electronic Health Records and Exchange of Health Information Requires new web based Health E-Learning, Electronic Care Planning and Self Care Management Tools

An Accountable System for Beneficiary-Centered Care Accountable Care Design Elements Expected Outcomes Focus on Beneficiary /Patient Quality and Cost Impact Accountable for Continuum of Care improvements Transformative Clinical Leadership and Governance Structure Organized Care Management Process, Including Prevention Alignment Around Performance and Outcome Measurements Effective Use of Health Information Technologies Ability to Manage Clinical Knowledge and Skills for Effective Teams Learning Organization Able to Adapt to Change Improved Care Coordination and Integrated Delivery of Care Increased Provision of Evidence-Based Care Patient Activation and Increased Health Literacy Results In Efficient Delivery of Care and Elimination of Waste Reduced, Contained, and Sustained Cost of Care Population Health Improvement

Discussion