1. Health Care Call to Action Kansas Healthcare Collaborative Summit Tom Evans, M.D. October 21, 2010 100 E. Grand Ave., Ste. 360 Des Moines, IA 50309-1835 Office: 515.283.9330 Fax: 515.698.5130 www.ihconline.org

2. Discuss the new era of transparency and accountability Describe the forces behind the recent healthcare reform legislation Consider the role of accountable care organizations (ACOs) as new models in care delivery Explore potential statewide initiatives to improve health care in Kansas Objectives

3. So…where are we?

4. A New Era…

5. Development of evidence-based medicine National definition and standardization of clinical metrics Transparency for providers and consumers Industry shifts in practice Changes in reimbursement Value Driven Health Care Era of Transparency & Accountability

6. Connecting the System Connect all health information systems Measure and Publish Quality Every case, every procedure Measure and Publish Price Standardize identical services and episodes of care Create Positive Incentives Reward those who offer and those who purchase high quality, competitively priced healthcare Value Driven Health Care

7. Collaboration across multiple lines: Healthcare Providers Healthcare Systems Healthcare Stakeholders (Purchaser, Payer, Provider, and Patients) Collaboration

8. Key Drivers of Healthcare Reform

9. Access- Coverage for Services Menu- Services paid for Execution- Delivery of Services Healthcare Reform

10. On the National Scene… Health Information Technology The HiTech Act Healthcare Reform HR 3590- The Patient Protection and Affordable Care Act HR 4872- The Health Care and Education Reconciliation Act

11. Reform Potpourri (PPACA or ACA) Primary care bonus 10% GPCI increase 3.26% Health coverage mandate State-based exchanges Coverage of pre-existing conditions Dependent coverage Medicare quality reporting extended Fraud and abuse enforcement Health plan administrative simplification

12. Data capture and sharing Advanced clinical processes Improved outcomes Bending the Curve

13. 2009201120132015 HIT-Enabled Health Reform HITECH Policies 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) ‘Enabled’ Health Reform

14. Accountable Care Organizations

15. Hot…but not really new Real goal: Increase value through better coordination Components: Vertical integration, eliminate waste & duplication, coordination of care Variable application And here…? Accountable Care Organizations

16. 16 Evidence-based care Information exchange Transitions in care (e.g. readmits) Medical home Health coaches/navigators Advanced home health Pharmacy management How do we tackle Care Coordination?

17. Critical Participants

18. Lack of unified vision Different corporations Cultures Compensation Facility ownership Lack of urgency Fear of unknown Inter-specialty conflict External distracters & influence Lack of sufficient physician leadership History Physician Alignment Challenges

19. Maintain current payment system; maintain status quo Change payment system too quickly; providers likely to fail Create transformational payment system; Provider—payor collaboration Payment Conundrum

20. Mutual respect & understanding –Change management –Business drivers Difficult conversations –Intellectual honesty Confidentiality required Exclusivity not realistic Provider-payer Collaboration

21. Against Initial focus will be on high population centers Might go away…HMO era Rural areas…different rules? Insufficient panel size Lack of infrastructure & funding For By virtue of our environment, we are a medical home CMS reimbursement will decline so might do better under value-based payment Individual practices are as busy (or busier) as urban practices Rural ACO?

22. Statewide Collaboratives

23. Initiative began in 2003, incorporated in 2005 Community coalition to improve quality, safety and value Provider “convened” Public reporting and performance improvement Iowa Healthcare Collaborative

24. Align and equip Iowa health care providers for continuous improvement Promote responsible public reporting of healthcare information Raise the standard of healthcare in Iowa IHC Cornerstones

25. Conferences Learning Communities Website- www.ihconline.org Toolkits- Anticoagulation, Aortic Dissection, CA-UTI, Culture of Safety, Healthcare-associated Infection, Lean in Healthcare, Medical Home, Medication Reconciliation, Narcotics, Obesity, Stroke, Tobacco Cessation, and Wristbands Align and Equip

26. Nationally standardized definitions Comparative presentation Objective data (vs. subjective data) Publicly available data sets Target transparency for both providers and consumers Actionable Responsible Public Reporting

27. Established national measures Common methodologies Ability to collect the data Validation Analysis Presentation Complex Process

28. The Iowa Report (six years of experience) Over 70 measures Data Sources: CMS, AHRQ, and voluntarily reported Interactive, web-based format Annual updates of data What do we have now?

29. Coordination of Care Lean applied to Healthcare Promote best practice in the hospital Healthcare-associated Infection Raise the Standard of Care

30. Coordination of Care Lean applied to Healthcare Promote best practice in the hospital Healthcare-associated Infection Raise the Standard of Care

31. Hospital Learning Community From IHI 100K, to 5M, to I-Map Bundles of best practice Spread Exercise changes in 2010 Promote best practice in the hospital

32. 5 Million Lives Campaign AMI ADE RRT SSI CLI VAP

33. Spread Exercise

34. 5 Million Lives Campaign AMI ADE RRT SSI CLI VAP CHF HAM PU SCIP MRSA BOB

35. Spread Exercise

36. Coordination of Care Lean applied to Healthcare Promote best practice in the hospital Healthcare-associated Infection Raise the Standard of Care

37. HAI Voluntary Reporting Initiative Iowa Measures (2007) Surgical Site Infection (CABG, Hip, Colon, Hyst) Central line-associated Blood Stream Infections Immunization of Healthcare Workers Iowa Measures (2008) MRSA SSI and BSI Healthcare-associated Infection

38. Influenza Vaccination of Healthcare Workers National 44% 2010 Iowa Goal 95% 2009-10 ? 2008-09 79% 2007-08 76% 2006-07 68%

39. Influenza Vaccination of Healthcare Workers National 44% 2010 Iowa Goal 95% 2009-10 91% 2008-09 79% 2007-08 76% 2006-07 68%

40. Our Response…

41. A spirit of innovation A sense of ownership A focus on “nimbleness” A commitment to collaboration Leadership

42. Access- Coverage for Services Menu- Services paid for Execution- Delivery of Services Healthcare Reform

43. Access- Coverage for Services Menu- Services paid for Execution- Delivery of Services “You pick two” – Jim Frogue The only thing certain in the future is change... Healthcare Reform

44. Align and equip health care providers for continuous improvement Promote responsible public reporting of healthcare information Raise the standard of healthcare Our Cornerstones for the future…