Health Information Technology, Promontory conference presentation, June 2011

1. 2011 Conference
Utah Promontory HIE/Technology
CMS Strategic Direction
Anthony Rodgers
Deputy Administrator
Center for Strategic Planning
June 2011

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. 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. 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 1.09
Chronic 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 Cancers
and 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 & Congestive
Heart 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 & Inflammatory
Connective 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 1.34
Lymphatic, Head and Neck, Brain & Other
Major 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 1.37
Diabetes W/ Renal or Peripheral Circulatory
Manifestation 1.68 1.63 1.57 1.33 0.92 1.25 1.01 1.05 1.29 0.83 1.44 1.70
COPD & 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 1.19
Vascular Disease & Diabetes W/O
Complication 1.76 1.12 1.58 1.38 1.24 1.09 1.61 0.89 1.17 1.07 1.02 1.19
Major Depressive, Bipolar, & Paranoid
Disorders 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 Specified
Manifestation 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 Severe
Cancers 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 1.36
CHF & 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 1.18
Ischemia 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 1.28
Study Cohort minus beneficairies in above
HCC 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. 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 0.62
Chronic Obstructive Pulmonary
Disease (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 & Acute
Leukemia 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 Tissue
Disease 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 0.68
Lymphatic, 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 0.71
Diabetes W/ Renal or Peripheral
Circulatory Manifestation 0.77 0.87 0.67 0.65 0.77 1.00 0.70 0.87 0.95 0.79 0.76 0.70
COPD & Diabetes W/O
Complication 0.77 0.76 0.79 0.75 0.72 0.67 0.95 0.71 0.78 0.69 0.59 0.63
Vascular Disease & Diabetes W/O
Complication 0.85 0.91 0.82 0.92 0.67 0.59 0.69 0.82 0.73 0.73 0.89 0.68
Major 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 Other
Specified 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 0.71
CHF & COPD & Specified Heart
Arrhythmias 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 0.73
Ischemia 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 0.63
Study Cohort minus beneficairies in
above 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. 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 care
Value
Performance Making
Transparent the
Factors that
Contribute to
Cost and Quality
Cost of Care
Variation in
Episodes
Of Care
Quality of Care

7. Steering the
Healthcare
Delivery System
to the CMS
Targeted Aims
Tools to steer healthcare delivery system to target aims:
1. Innovation Center Initiatives
2. Payment Reforms
3. ACO and Medical Home Initiatives
4. Quality Incentives and Penalties
5. Special Emphasis on Dual Eligible Individuals, Health
Disparities, and Chronically Ill Populations
6. Public Reporting of Performance Information
7. Patient Safety and Delivery System Initiatives
8. Beacon Community Initiatives

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. 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-Centered
Uncoordinated Health Care
Management

10. CMS Tools For Overcoming Barriers to
Healthcare System Transformation
Shared Savings,
Episode- based Electronic
Health ACOs and
Bundled 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. 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 Use
Health 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. 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 Waste
Skills 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. Advanced Medical Home
Fully
E-Health
Capable
Remote Advanced
Bio-metric Care
Monitoring Management
Capable Capable
Horizontally Community
Integrated Practice
With Translational
Interoperable
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. Rethinking the CMS Business Architecture
to Support Health Delivery System
Transformation

15. Rethinking the CMS Business Operations
Information Technology Framework
Business Architecture
Shared Business
Business B2B Process
Business Intelligence
Operations Capacity
Applications Tools
Information Architecture Service Oriented Technical Architecture
Business Technical
Data
Data Services Functionality
Management
Layer Standards
Technical Application
Services Architecture
Integrated
Data
Data Technology Technology
Processing
Repository Solutions Standards

16. CMS Business Intelligence and Knowledge
Management
Analytics Tool Suite Business
•Predictive Modeling Tools Intelligence
External 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 Data
Beneficiary 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. State Level
Electronic Health Record
Deployment and
Health Information Exchange

18. Impact of HIT
Better Outcomes , Lower Cost , Improve
Population Health
Improving Health Care Quality,
Cost Performance, Population Health
Better
R 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. Building Blocks of Next Phase of the
Health Information Exchange Platform
Collaborative Knowledge Management
Value
Added Web Services Application
Security and Consent Policy
Web
Services
Data Analysis Applications
Health Data Integration and Translation Layer
Platform
Services Health Data Management Layer
Health Data Publication Layer
Data
Sources
Radiology Rx History Admin/Claims EHR Clinical Lab

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. 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 Exchanges
Collaborative 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. Questions?
Thank you!