Tony rogers presentation 2011 Utah Health IT Conference

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Health Information Technology, Promontory conference presentation, June 2011

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Tony rogers presentation 2011 Utah Health IT Conference

  1. 1. 2011 ConferenceUtah Promontory HIE/Technology CMS Strategic Direction Anthony Rodgers Deputy Administrator Center for Strategic Planning June 2011
  2. 2. The Role of the Center for Strategic Planning• Policy: Provide policy research, formulation, translation, and evaluation.• Delivery System and Market Analysis: Provide management decision support, insights, and long range analysis.• Information: Public Medicare and Medicaid data resources and reports for comparative effectiveness research, community health indicators, Beacon communities and others.• Knowledge Discovery: Research, evaluate and gather intelligence and develop new data sources to increase organizational knowledge about key performance outcomes and delivery system effectiveness.• Enterprise Management Performance Reporting: Provide management with delivery system, health plan, program, and operational performance data for the purpose of managing strategic goals.• CMS Strategic Planning: Monitor goal achievement, and internal consultation.• Enterprise Strategic Business Planning: Plan, design, develop, and modernize, CMS business processes and information systems.
  3. 3. 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.
  4. 4. 2008 Data Table for High-Cost HRRs Ratios of 2008 HRR Standardized Cost to National Average for Selected HCC Groupings LA - TX - LA - LA - FL - Fort FL - FL - Fort LA - LA - Baton LA - FL - Miami Monroe McAllen Alexandria Shreveport Lauderdale Bradenton Myers TX - Tyler Metairie Rouge Lafayette Diabetes W/O Complication 1.66 1.34 1.46 1.19 1.27 1.20 1.24 1.19 1.10 1.06 1.19 1.09Chronic Obstructive Pulmonary Disease(COPD) 1.42 1.29 1.33 1.23 1.27 1.10 1.05 1.05 1.24 1.10 1.28 1.21 Vascular Disease 1.24 1.06 1.23 1.07 1.33 1.19 1.09 1.07 1.26 1.20 1.11 1.08 Breast, Prostate, Colorectal & Other Cancersand Tumors 1.17 1.20 1.43 1.19 1.15 1.25 1.32 1.28 1.12 1.04 1.07 1.05 Specified Heart Arrhythmias 1.24 1.23 1.13 1.26 1.29 1.24 1.13 1.14 1.17 1.06 1.06 1.12 Specified Heart Arrhythmias & CongestiveHeart Failure (CHF) 1.10 1.20 1.45 1.43 1.35 1.29 1.10 1.04 1.20 1.20 1.21 1.13 Metastatic Cancer & Acute Leukemia 1.15 0.80 1.22 1.26 0.96 1.14 1.33 1.28 1.08 1.01 1.34 1.05 Rheumatoid Arthritis & InflammatoryConnective Tissue Disease 1.24 1.30 1.32 1.29 1.29 1.26 1.14 1.11 1.15 1.21 1.25 1.21 CHF & COPD 1.28 1.27 1.21 1.23 1.31 1.33 0.88 1.02 1.26 0.77 1.41 1.18 Diabetes W/O Complication & CHF 1.38 1.39 1.23 1.55 1.17 1.02 0.99 1.20 1.10 1.33 1.14 1.34Lymphatic, Head and Neck, Brain & OtherMajor Cancers 1.22 1.18 1.36 1.53 0.91 1.22 1.22 1.24 1.26 1.00 1.18 0.94 Vascular Disease & COPD 1.42 1.59 0.94 0.93 1.13 1.05 1.03 1.09 1.21 1.21 1.20 1.37Diabetes W/ Renal or Peripheral CirculatoryManifestation 1.68 1.63 1.57 1.33 0.92 1.25 1.01 1.05 1.29 0.83 1.44 1.70COPD & Diabetes W/O Complication 2.27 1.19 1.38 1.59 1.02 1.26 1.06 1.03 1.13 1.29 0.92 1.19Vascular Disease & Diabetes W/OComplication 1.76 1.12 1.58 1.38 1.24 1.09 1.61 0.89 1.17 1.07 1.02 1.19Major Depressive, Bipolar, & ParanoidDisorders 1.76 2.20 1.32 1.99 1.51 1.31 1.47 1.09 1.11 1.29 1.52 1.47 Diabetes W/ Neurologic or Other SpecifiedManifestation 2.17 1.34 1.62 0.85 1.42 1.21 1.34 1.17 1.56 0.96 1.36 1.23 Lung, Upper Digestive Tract, & Other SevereCancers 1.14 1.21 1.22 0.95 0.96 1.13 1.25 1.06 1.26 0.56 1.03 1.06 Renal Failure 1.42 1.63 1.64 1.27 1.20 1.18 1.03 0.98 1.11 1.32 1.37 1.36CHF & COPD & Specified Heart Arrhythmias 1.24 1.63 1.56 1.41 1.47 1.20 1.04 1.01 1.03 1.52 1.52 1.14 Diabetes W/O Complication & CHF &Specified Heart Arrhythmias 1.15 1.40 1.25 1.62 1.47 1.07 0.96 0.99 1.15 0.93 1.45 1.18Ischemia or Unspecified Stroke 1.24 1.16 1.59 1.38 1.32 1.29 0.98 1.08 1.16 1.41 1.38 1.08 CHF 1.14 1.37 1.27 1.57 1.38 1.14 1.08 1.08 1.14 1.23 1.34 1.28Study Cohort minus beneficairies in aboveHCC Groupings 1.91 1.37 1.72 1.31 1.29 1.24 1.10 1.03 1.14 1.27 1.28 1.27
  5. 5. 2008 Data Table for Low-Cost HRRs Ratios of 2008 HRR Standardized Cost to National Average for Selected HCC Groupings CA - NM - CA - VT - CA - San Mateo NY - Alameda OR - AK - CA - San CA - San HI - Albuquerque OR - Eugene Sacramento Burlington County Rochester County Medford Anchorage Jose Francisco Honolulu Diabetes W/O Complication 0.77 0.80 0.82 0.83 0.74 0.85 0.77 0.80 0.87 0.79 0.76 0.62Chronic Obstructive PulmonaryDisease (COPD) 0.88 0.86 0.79 0.86 0.93 0.84 0.84 0.76 0.74 0.92 0.71 0.56 Vascular Disease 0.92 0.93 0.83 0.74 0.89 0.86 1.09 0.85 0.82 0.92 0.85 0.68 Breast, Prostate, Colorectal &Other Cancers and Tumors 0.86 0.88 0.89 0.84 0.88 0.94 0.95 0.82 0.93 0.92 0.82 0.73 Specified Heart Arrhythmias 0.94 0.76 0.86 0.91 0.85 0.89 0.86 0.83 0.86 0.91 0.93 0.73 Specified Heart Arrhythmias &Congestive Heart Failure (CHF) 0.82 0.80 0.78 0.96 0.94 0.92 1.02 0.77 0.91 0.83 1.12 0.79 Metastatic Cancer & AcuteLeukemia 0.98 0.95 0.89 0.77 0.85 0.88 0.85 0.75 0.94 0.86 0.85 0.64 Rheumatoid Arthritis &Inflammatory Connective TissueDisease 0.78 0.86 0.81 0.84 0.85 0.84 0.67 0.98 0.73 0.86 0.86 0.68 CHF & COPD 0.75 0.66 0.81 0.85 0.72 0.92 0.90 0.75 0.64 0.74 0.79 0.73 Diabetes W/O Complication & CHF 0.97 0.69 0.79 0.80 1.08 0.97 0.71 0.93 0.95 0.58 0.76 0.68Lymphatic, Head and Neck, Brain &Other Major Cancers 0.91 0.84 0.78 0.77 0.92 0.93 0.97 1.06 0.81 0.81 0.80 0.66 Vascular Disease & COPD 1.08 0.81 0.79 0.68 0.62 0.76 0.95 1.20 0.73 0.83 0.76 0.71Diabetes W/ Renal or PeripheralCirculatory Manifestation 0.77 0.87 0.67 0.65 0.77 1.00 0.70 0.87 0.95 0.79 0.76 0.70COPD & Diabetes W/OComplication 0.77 0.76 0.79 0.75 0.72 0.67 0.95 0.71 0.78 0.69 0.59 0.63Vascular Disease & Diabetes W/OComplication 0.85 0.91 0.82 0.92 0.67 0.59 0.69 0.82 0.73 0.73 0.89 0.68Major Depressive, Bipolar, &Paranoid Disorders 0.79 0.68 0.80 0.82 0.73 0.77 0.97 0.86 0.79 0.67 0.79 0.58 Diabetes W/ Neurologic or OtherSpecified Manifestation 0.92 0.79 0.70 0.68 0.77 0.83 0.79 0.64 0.64 0.78 0.75 0.67 Lung, Upper Digestive Tract, &Other Severe Cancers 0.85 0.66 0.73 0.74 1.21 0.78 0.67 0.64 1.13 0.91 0.93 0.60 Renal Failure 0.94 0.70 0.89 0.82 0.73 0.77 0.89 0.72 0.73 0.87 0.99 0.71CHF & COPD & Specified HeartArrhythmias 0.81 0.69 0.74 0.82 0.90 0.75 0.98 0.81 0.88 1.00 0.88 0.79 Diabetes W/O Complication & CHF& Specified Heart Arrhythmias 0.87 0.59 0.73 0.76 1.03 0.72 1.14 0.67 1.05 1.05 0.76 0.73Ischemia or Unspecified Stroke 0.83 0.83 0.81 0.83 0.74 0.69 0.81 0.75 0.53 0.76 0.94 0.69 CHF 0.87 0.85 0.69 0.82 0.86 0.82 0.85 0.75 0.93 0.70 0.88 0.63Study Cohort minus beneficairies inabove HCC Groupings 0.75 0.72 0.77 0.76 0.77 0.84 0.92 0.71 0.71 0.79 0.81 0.63
  6. 6. Managing the Cost and Quality Factors CMS’ goal is to align the health care delivery system to better manage all of the factors that impact the cost and quality of careValuePerformance Making Transparent the Factors that Contribute to Cost and Quality Cost of Care Variation in Episodes Of Care Quality of Care
  7. 7. Steering theHealthcareDelivery Systemto the CMSTargeted AimsTools to steer healthcare delivery system to target aims:1. Innovation Center Initiatives2. Payment Reforms3. ACO and Medical Home Initiatives4. Quality Incentives and Penalties5. Special Emphasis on Dual Eligible Individuals, HealthDisparities, and Chronically Ill Populations6. Public Reporting of Performance Information7. Patient Safety and Delivery System Initiatives8. Beacon Community Initiatives
  8. 8. Driving Health Care System Transformation Healthcare Delivery System 3.0 Healthcare Delivery System 2.0 Integrated Healthcare Delivery System 1.0 Health Accountable Episodic Care Non Integrated • Patient/Person Care Centered Care – Patient/Person centered Health Care – Productive and informed interactions • Transparent Cost and Quality between Family and Provider Performance – Cost and Quality Transparency• Episodic Health Care – Results oriented – Accessible Health Care Choices – Sick care focus – Access and coverage – Aligned Incentives for wellness – Uncoordinated care • Integrated networks with community – High Use of Emergency Care • Accountable Provider Networks resources wrap around – Multiple clinical records Designed Around the patient • Aligned reimbursement/cost Rapid – Fragmentation of care • Focus on care management deployment of best practices and preventive care• Lack integrated care networks – Primary Care Medical Homes • Patient and provider interaction – Aligned care management• Lack quality & cost performance – Utilization management – E-health capable transparency and public information – Medical Management – E-Learning resources – Public Access to Cost and Quality Data• Poorly Coordinate Chronic Care Management
  9. 9. Barriers to Health Care Delivery System Transformation Enhancing Adoption of Health System Performance Competencies Transformation Health Information Barrier Technology Clinical Care Knowledge Infrastructure Barrier Barrier Integrated Care Accountable Care Personalized Episodic/ Patient-CenteredUncoordinated Health Care Management
  10. 10. CMS Tools For Overcoming Barriers to Healthcare System Transformation Shared Savings, Episode- based Electronic Health ACOs andBundled Payments, Records and Medical Homes Value-base payments, and HIE Partial Capitation Service Payment HealthCare Delivery System Delivery Reform Redesign Transformation Investments Quality and Cost Transparency
  11. 11. Essential Elements of The Patient Centered Care of a Transformed Healthcare System Seamless & Coordinated Care Informed, Activated Productive Prepared Interactions Clinical Patient Team Requires new web based Requires Meaningful UseHealth E-Learning, Electronic Care Electronic Health Records and Planning, and Exchange of Health Information Self Care Management Tools Common Set of Patient Health Information
  12. 12. An Accountable System for Beneficiary-Centered Care Accountable Care Design Elements Expected Outcomes Improved Care Accountable for Continuum of Coordination and Care improvements Integrated Delivery of Care Learning Transformative Clinical Increased Provision of Organization Able to Adapt to Leadership and Governance Evidence-Based Care Change Structure Patient Activation and Focus on Results In Increased Health Literacy Beneficiary /Patient Ability to Quality and Organized Care Efficient Delivery of Care Manage Clinical Knowledge and Cost Impact Management Process, and Elimination of WasteSkills for Effective Including Teams Prevention Reduced, Contained, and Sustained Cost of Care Alignment Effective Use of Health Around Performance and Population Health Information Technologies Outcome Measurements Improvement
  13. 13. Advanced Medical Home Fully E-Health Capable Remote Advanced Bio-metric Care Monitoring Management Capable Capable Horizontally Community Integrated Practice With TranslationalInteroperable HIT Medical Research Site Home 3.0 Community Connected to Health Community Surveillance Resource Interfaces Databases Psycho/Social Patient Evaluation And E-Learning Intervention Center 13
  14. 14. Rethinking the CMS Business Architecture to Support Health Delivery System Transformation
  15. 15. Rethinking the CMS Business Operations Information Technology Framework Business Architecture Shared Business Business B2B Process Business Intelligence Operations Capacity Applications ToolsInformation Architecture Service Oriented Technical Architecture Business Technical Data Data Services FunctionalityManagement Layer Standards Technical Application Services Architecture Integrated Data Data Technology TechnologyProcessing Repository Solutions Standards
  16. 16. CMS Business Intelligence and Knowledge Management Analytics Tool Suite Business •Predictive Modeling Tools IntelligenceExternal Data / Profiles •Episodes of Care Grouper Analytical • Business Intelligence Tools Support System Population Survey Performance Benchmarks •Geospatial/Simulation Tools Care Management Provider & ACO Analysis Quality & Cost Data MEGA DATA Fraud Detection Public & Specialized Data Sets Integrated Performance Analysis Data DataBeneficiary Data Management Claims/Encounter Repository Quality Analysis Health Data Profiles Medical/Drug U/R & Cost Population Translation Prescription Drug Standards Premiums / Cap Chronic Eligibility Data Disease Sub-databases Registries Policy and Program CMS Program Data Knowledge Development and Repository Public Reporting 16
  17. 17. State Level Electronic Health Record Deployment andHealth Information Exchange
  18. 18. Impact of HIT Better Outcomes , Lower Cost , Improve Population Health Improving Health Care Quality, Cost Performance, Population Health BetterR OI of EHI at P oint of Care: Outcomes• Improved Patient Safety• Reduced Complications Rates Lower• Reduced Cost per Patient Episode of Care Costs• Enhanced cost & quality performance accountability• Improved Quality Performance Population• Improve Community Health Surveillance Health
  19. 19. Building Blocks of Next Phase of the Health Information Exchange Platform Collaborative Knowledge ManagementValueAdded Web Services Application Security and Consent PolicyWebServices Data Analysis Applications Health Data Integration and Translation LayerPlatformServices Health Data Management Layer Health Data Publication Layer Data Sources Radiology Rx History Admin/Claims EHR Clinical Lab
  20. 20. The Expanding Role of State Level Health Information Exchange Organizations • Patient Registries • Accountable Care Information Organization Contributor • Medical Home • Multi-payer Initiatives • Electronic Health Application Record Service Provider • Personal Health Record • Qualified Entity Quality and Provider Profile Cost • Public Reporting Reporting • Support the Work of QIO’s •Beacon Community Health Community Information •Community Transformation
  21. 21. Evolving Health System Properties and Influences - - How the Pieces Align & Fit Together - - Quality Reporting PAYORS Incentives Bundled Payment SAFE, SEAMLESS COORDINATED CARE Shared Savings Medicare PROVIDERS Medicare Advantage Maintenance & Plans Hospice IRFs Certification Incentives Physicians Community Readmission Patients Care Penalty Medical Better Care Transitions Other Health Homes Better Health Programs Providers Centers Lower Cost Value Based Nursing Private Long Term Purchasing Facilities Medicaid Insurance Care Multiple Meaningful Psychiatric Sites Plans Facilities Use Incentives Accountable Care Organizations HAC Penalty Physician Value Modifier ExchangesCollaborative Improvement Projects & Networks Tool Foundation Transparency and Reporting Electronic Health Records Demonstrations Conditions of Participation QIO Technical Assistance Data Sharing Consumer Health Plan Labeling "Instead of payment that asks "How much did you do?" The new system clearly moves us toward payment that asks "How well did the patient do?" -- Don Berwick, CMS Administrator
  22. 22. Questions?Thank you!

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