1. IHA P4P Summit March 2009 Jack Lewin, M.D. CEO
Aligning Payment, Accountability and Opportunity in Specialty Care: Part II
IHA P4P Summit
March 2009
Jack Lewin, M.D.
CEO

2. Part II: How Do We Promote Continuous Quality and Value Improvement Networks?

3. Pay for Performance:
The Current Status

4. Examples of Real Progress
Integrated Healthcare Association (California)
Bridges to Excellence
Geisinger
Kaiser Permanente
PQRI
Accountability Organization concept
Purchasing cooperatives (PBGH, etc.)

5. Challenges

6. The Cost Issue
HELP! 6
Health Care Costs
(zillions!) 4 2
Time

7. The ACC Vision Turbocharged guidelines
Clinical decision support and EMRs
NCDR
Lifelong learning
Continuous Quality Improvement (CQI)
Value, efficiency and decreased variation
Patient empowerment

8. Beyond NQF Measures:
Stretch Goals

9. PQRI (or IHA) Version 2.0

10. Reduce Readmissions from Heart Failure
Medicare report coming in May
Excellence in Transitions to Care with IHI

11. Appropriate Use Criteria
Improve quality
Reduce Costs
Provide decision support for diagnostic imaging, CAD treatment
Echo CT MR
SPECT-MPI
Stress testing
Multi-modality

12. Quality First

13. QCARE in Action

14. NCDR

15. But what about the outpatient environment?

16. Quality First Networks
CQI
Transparency
“Learning” systems
Patient satisfaction
Payment incentives
Infrastructure assistance

17. What about the patient?

18. Patient in the Center O.O.P.s Informed Choices
Responsibility for lifestyle and adherence
“Boomers …”

19. CardioSmart

20. The Hurdles HIT adoption Interoperability
Relevant performance measures
Registries and data-tracking platforms
Privacy and patient identifiers
A business case for CQI

21. “The right objective for health care is to increase value for patients, which is the quality of patient outcomes relative to the dollars expended.”
- Michael Porter

22. Principles of Health Care Reform
Universal access to basic care
Public/private financing
A focus on patient value – the highest quality of care at the most effective cost
Payment reforms to enable and reward quality care and value
Coordination across sources and sites of care
Health care provider professionalism and partnership with patients

23. Payment reform is critical.
Episodes of care/bundling
Incentives for quality, efficiency and improved outcomes
Incentives for improved coordination of care (PCMH)

24. Who will help us?