2014 Summit Co-Convener:Founder: Patient Safety Science & Technology Summit 2014

2014 Summit Co-Convener:Founder: Patrick Conway, MD, MSc Chief Medical Officer, Centers for Medicare and Medicaid Services

2014 Summit Co-Convener:Founder: Patient Safety Efforts at CMS

2014 Summit Co-Convener:Founder: Discussion Quality Levers –Quality Improvement Organization funding –Clinical Standards and Survey and Certification –Value-based Purchasing CMS Innovation Center –New Models of Care Delivery –Partnership for Patients Future Vision

2014 Summit Co-Convener:Founder: Our Aims Better Health for the Population Better Care for Individuals Lower Cost Through Improvement

2014 Summit Co-Convener:Founder: The Six Goals of the CMS Quality Strategy Make care safer by reducing harm caused in the delivery of care Strengthen person and family engagement as partners in their care Promote effective communication and coordination of care Promote effective prevention and treatment of chronic disease Work with communities to promote healthy living Make care affordable

2014 Summit Co-Convener:Founder: Quality Improvement Organization Work to Reduce Harm There are 53 Quality Improvement Organizations (QIOs) across 50 states and territories Hundreds of millions of dollars in QI investment Focused on multiple areas of harm and demonstrating results such as: –53% Relative Improvement Rate in the reduction of Central-line associated bloodstream infections –Over 85,000 fewer days with urinary catheters for beneficiaries Hospitals with higher than expected rates targeted

2014 Summit Co-Convener:Founder: Nursing Home Highlight: Quality Care Collaborative Ensure that every nursing home resident receives the highest quality of care. Strives to instill quality and performance improvement practices, eliminate healthcare acquired conditions, and dramatically improve resident satisfaction Over 5000 nursing homes engaged and generating results –Decreased anti-psychotic use in dementia residents –Decreased pressure ulcers and falls –Reduction in healthcare acquired infections and conditions

2014 Summit Co-Convener:Founder: Reduced Potential for Adverse Drug Events 2,629 more beneficiaries have INRs within Therapeutic Range

2014 Summit Co-Convener:Founder: 2,966 Pressure Ulcers Prevented or Healed

2014 Summit Co-Convener:Founder: QIO Program Culture Change: Next Generation of Work Next statement of work was released in Dec 2013 Support Beneficiaries and their families and engage patients in all improvement activities Learning collaboratives to drive transformation Innovative ideas flow from the field Measure and review often, while responding quickly to data High reliability methods and utilize implementation science Leverage partnerships and collaborations to drive improvement Clear aims and continuous testing and learning to improve results

2014 Summit Co-Convener:Founder: Clinical Standards and Survey and Certification Responsible for quality and safety standards for providers (Conditions of Participation) and their enforcement Significantly updated Hospital Conditions of Participation with more to come in the future Working to update Home Health and Long-term care clinical standards Survey and Certification guidance and enforcement (e.g. working to finalize guidance on inpatient monitoring) Work with accreditors such as Joint Commission on shared goals of improved quality and safer systems

2014 Summit Co-Convener:Founder: Transparency and Value-based Purchasing Hospital Compare and other websites with performance measures and downloadable raw data (e.g. HAIs, patient safety composite) Hospital Value-based purchasing with over $1 billion allocated to hospitals based on performance on quality and efficiency measures (including patient safety) Finalized measures for the Healthcare Acquired Condition program which will negatively adjust payment by 1% to the bottom quartile of performers on key HAI measures and patient safety composite

2014 Summit Co-Convener:Founder: National Results Over 44% reduction nationally in central line associated bloodstream infections Over 22% reduction nationally in surgical site infections Positive results in multiple other areas of harm

2014 Summit Co-Convener:Founder: Discussion Quality Levers –Quality Improvement Organization funding –Clinical Standards and Survey and Certification –Value-based Purchasing CMS Innovation Center –New Models of Care Delivery –Partnership for Patients Future Vision

2014 Summit Co-Convener:Founder: Delivery system and payment transformation PUBLIC SECTOR Future State – People-Centered Outcomes Driven Sustainable Coordinated Care Systems New Systems and Approaches  Value-based purchasing  ACOs Shared Savings  Episode-based payments  Medical Homes  State Innovation  Data Transparency, etc Current State – Producer-Centered Volume Driven Unsustainable Fragmented Care Systems FFS Payment Systems PRIVATE SECTOR

2014 Summit Co-Convener:Founder: CMS Innovations Portfolio: Testing New Models to Improve Quality Initiatives Focused on the Medicaid Population Medicaid Emergency Psychiatric Demonstration Medicaid Incentives for Prevention of Chronic Diseases Strong Start Initiative Medicare-Medicaid Enrollees Financial Alignment Initiative Initiative to Reduce Avoidable Hospitalizations of Nursing Facility Residents Accountable Care Organizations (ACOs) Medicare Shared Savings Program (Center for Medicare) Pioneer ACO Model Advance Payment ACO Model Comprehensive ERSD Care Initiative Primary Care Transformation Comprehensive Primary Care Initiative (CPC) Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration Independence at Home Demonstration Graduate Nurse Education Demonstration Bundled Payment for Care Improvement Model 1: Retrospective Acute Care Model 2: Retrospective Acute Care Episode & Post Acute Model 3: Retrospective Post Acute Care Model 4: Prospective Acute Care Capacity to Spread Innovation Partnership for Patients Community-Based Care Transitions Million Hearts Health Care Innovation Awards State Innovation Models Initiative

2014 Summit Co-Convener:Founder: Innovation is happening broadly across the country

2014 Summit Co-Convener:Founder: Partnership for Patients 40% Reduction in Preventable Hospital Acquired Conditions –1.8 Million Fewer Injuries –60,000 Lives Saved 20% Reduction in Preventable 30-Day Readmissions –1.6 Million Patients Recover Without Readmission CMS investing almost $1 billion Potential to save billions Broad national engagement – almost 80% of hospitals as well as consumers, employers, payers, and others

2014 Summit Co-Convener:Founder: Ten Areas of Focus Hospital Engagement Networks are required to address ten areas of focus: Adverse Drug Events Catheter-Associated Urinary Tract Infections Central Line Associated Blood Stream Infections Injuries from Falls and Immobility Obstetrical Adverse Events Pressure Ulcers Surgical Site Infections Venous Thromboembolism Ventilator-Associated Pneumonia Preventable readmissions

2014 Summit Co-Convener:Founder: Medicare All Cause, 30 Day Hospital Readmission Rate

2014 Summit Co-Convener:Founder: Partnership for Patients: Over 3500 Hospitals Reducing Harm and Improvement Accelerating

2014 Summit Co-Convener:Founder: The “3T’s” Road Map to Transforming U.S. Health Care Key T1 activity to test what care works Clinical efficacy research Key T2 activities to test who benefits from promising care Outcomes research Comparative effectiveness Research Health services research Key T3 activities to test how to deliver high-quality care reliably and in all settings Quality Measurement and Improvement Implementation of Interventions and health care system redesign Scaling and spread of effective interventions Research in above domains T1T2T3 Basic biomedical science Clinical efficacy knowledge Clinical effectiveness knowledge Improved health care quality & value & population health Source: JAMA, May 21, 2008: D. Dougherty and P.H. Conway, pp The “3T’s Roadmap to Transform U.S. Health Care: The ‘How’ of High-Quality Care.”

2014 Summit Co-Convener:Founder: Future Vision Technology and innovation focused on eliminating patient harm Best practices spread rapidly Payment and incentive systems reward eliminating harm and improved patient outcomes Electronic health records, monitoring, and data analytics utilized to drive improvement Learning from other industries (e.g., reliability science, LEAN, etc) applied to health care Systems redesign achieves better health, better care, and lower costs through improvement

2014 Summit Co-Convener:Founder: Contact Information Dr. Patrick Conway, M.D., M.Sc. CMS Chief Medical Officer CMS Deputy Administrator for Quality and Innovation

2014 Summit Co-Convener:Founder: Patient Safety Science & Technology Summit 2014