Innovation Through the Lenses of HITECH and Health Reform

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Innovation towards Health System Transformation: The Intersection of ACOs, Technology and Health Reform

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Innovation Through the Lenses of HITECH and Health Reform

  1. 1. Innova&on  through  the  Lenses  of  HITECH  and  Health  Reform      Wil  Yu,  Innova&ons  Wil.Yu@HHS.gov  HHS  
  2. 2. Innova&on  Goals   •  Encourage innovations that will be required to help enhance health and well being for all Americans •  New products, services, ideas –  Support Meaningful Use and health information Exchange –  Support health reform –  Support of ONC and HHS strategy and priorities 2
  3. 3. Current  Context  for  Health  IT  Innova&on   •  Enacted legislation and current administration policies & rule-making have created new markets for health IT and healthcare (…and displaced old markets) •  Innovation will happen naturally in the marketplace whether or not we engage •  Innovation in the private sector cannot be sustained without pathways to true markets •  By encouraging and facilitating communication & collaboration, we can influence magnitude, timing, and velocity •  By encouraging and facilitating communication & collaboration, we can influence efficient deployment of resources – e.g. ideation, mkt. transparency, risk identification, search costs, etc. 3
  4. 4. Recovery  Act    /  HITECH  Programs   Obstacle Intervention Funds Allocated •  Medicare and Medicaid EHR Market Failure, Need for Incentive Programs for Meaningful •  $27.3 B Financial Resources Use Addressing Adoption •  Regional Extension Centers •  $643 M Difficulties •  Health IT Research/Resource Center •  $50 M Workforce Training •  Workforce Training Programs •  $84 M •  Strategic Health Information Addressing Technology •  $60 M Technology Advanced Research Challenges and Providing Projects (SHARP) Breakthrough Examples •  Beacon Communities Programs •  $250 M •  Policy Framework Addressed Privacy and Security •  New Privacy and Security Policies across all Programs •  NHIN, Standards and Certification •  $64.3 M Need for Platform for Health •  State Cooperative Agreement •  $548 M Information Exchange Program *estimate 4
  5. 5. How  it  all  fits  together   Regional Extension Centers ADOPTION Workforce Training Improved  Individual  &    Popula+on  Health   Outcomes     Medicare  and  Medicaid     Increased   Incen+ves  and  Penal+es   MEANINGFUL USE Transparency  &    Efficiency     Improved   Ability  to  Study  &   State Grants for Improve  Care  Delivery   Health Information ExchangeStandards & Certification Framework EXCHANGE   Privacy & Security Framework Health IT Research and Innovations 5
  6. 6. DC-­‐to-­‐VC  Engagements   •  Core Value: Promote engagements between diverse, but critical stakeholders necessary for early stage entrepreneurship and innovation •  Intense, bi-directional, communication •  In collaboration with White House Startup America Initiative 6
  7. 7. Prizes  and  Challenges  Inves&ng  in  Innova&ons  (i2)   •  Core Value: Encourage open innovation and community building •  Context: –  America Competes 2010 –  Alternative to Grants –  Alternative to Contracts •  Benefits: –  Engage new participants –  Community building •  2 years; 30+ challenges 7
  8. 8. Innova&on  Exchanges  for  Health  IT   •  Core Value: Convene sessions between groups of innovators and potential adopters towards short-term testbed opportunities •  Help innovators reach proof-of-concept stage •  Provide care organizations with access to leading edge technologies 8
  9. 9. Suppor&ng  Early  Stages  of    Innova&ons:  A  Framework   Concept Proof of Early Optimize Late + Prototype Concept Adoption + Adoption Ideation Refine Innovation risk and costhigh low 9
  10. 10. Suppor&ng  Early  Stages  of    Innova&ons:  A  Framework   Concept Proof of Early Optimize Late + Prototype Concept Adoption + Adoption Ideation Refine Innovation risk and costhigh low Innovation Scanning Innovations Exchange Beacon Communities i2 - Prizes and Challenges HIE Challenge Grants DC-to-VC Innovation Exchanges S&I: Direct / NwHIN SHARP CHDI / Health Data.gov 10
  11. 11. Innovation Center Activities  
  12. 12. The Innovation CenterMission Statement Be a constructive and trustworthy partner in identifying, testing, and spreading new models of care and payment that continuously improve health and health care for all Americans. 12  
  13. 13. A Future System•  Affordable•  Accessible – to care and to information•  Seamless and coordinated•  High Quality – timely, equitable, safe•  Person and Family-Centered•  Supportive of Clinicians in serving their patients needs•  Engaged with the community and ful lling its population s unique needs 13  
  14. 14.   Measures of Success1.  Better health care - Improve individual patient experiences of care along the IOM 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity2.  Better health - Focus on the overall health outcomes of populations by addressing underlying causes of poor health, such as: physical inactivity, behavioral risk factors, lack of preventive care, and poor nutrition3.  Reduced costs - Lower the total cost of care for Medicare, Medicaid and CHIP bene ciaries by improving quality of care and patient experience 14  
  15. 15. Innovation Center Menu of Options Global   Pioneer     Payment   ACO  –   ACOs   ACO  –   Track  2   Track  1   Medical     Homes              Bundled  Payments  for  Care                                              Improvement   Million  Hearts     Partnership  for   Pa&ents  Meaningful    Use  
  16. 16. Innovation Center Initiatives to Support Care Transformation  •  ACO Initiatives: Shared Savings Program, •  Medicaid Health Home State Plan Pioneer, Advance Payment, Learning Option Sessions •  State Demonstrations to Integrate•  Bundled Payments for Care Improvement Care for Dual Eligible Individuals•  Innovation Advisors Program •  Demonstration to Improve Quality•  Multi-Payer Advanced Primary Care of Care for Nursing Facility Practice Demonstration Residents•  Comprehensive Primary Care Initiative •  Financial Models to Support State•  Partnership for Patients Efforts to Coordinate Care for Medicare-Medicaid Enrollees•  Federally Quali ed Health Center (FQHC) Advanced Primary Care Practice •  Innovation Center Initiatives Demonstration Support Care Transformation 16  
  17. 17. Accountable Care Organizations  •  Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve•  Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors•  When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program 17  
  18. 18. ACO Types  •  Medicare offers several ACO programs, including:•  Medicare Shared Savings Program—a fee-for-service program•  Advance Payment Initiative—for certain eligible providers in the Shared Savings Program•  Pioneer ACO Model— population-based payment initiative for health care organizations and providers already experienced in coordinating care for patients across care settings 18  
  19. 19. Transforming Health Care Through Active Engagement  •  No one organization or region has a monopoly on innovation•  Innovators across the country have developed other effective care delivery and payment models•  These innovations offer us pathways to building a future health system that is more effective than the current system at improving health care, health, and lowering costs 19  
  20. 20. The Infrastructure Implications of Accountable Care  •  New IT infrastructure models will be required –  EMRs/Meaningful Use and health IT adoption –  Health information exchange and other•  Address challenges of care coordination and risk management at an organizational level and across potentially diverse organizations•  à Investments in data collection, integration, and analytics –  Population health management, cost analytics, risk modeling and predictive analytics•  à Investments in patient engagement –  Personal health records 20  
  21. 21. Innovation Imperative  •  Success of new models predicated on our ability to innovate•  New markets are being created but there is a window for proof-of-concept•  Magnitude and velocity of our ability to innovate will be critical to our ability to implement, learn, diffuse 21  
  22. 22. Introducing the Health Care Innovation Challenge•  The Innovation Center has received over 500 suggestions and ideas from across the country.•  This initiative is an open solicitation to innovators across the country to identify and test innovative service delivery/payment models including infrastructure support.•  This Challenge will strengthen the Innovation Center s current menu of options and will address unique needs of communities and populations across the country. 22  
  23. 23. Challenge Objectives•  Engage a broad set of innovation partners to identify and test new care delivery and payment models that originate in the eld and improve quality while lowering the total cost of care.•  Support innovators that can rapidly deploy care improvement models within six months of the award through new ventures or expansion of existing efforts.•  Identify new models of workforce development, training and deployment that support new models either directly or through new infrastructure activities. 23  
  24. 24. Challenge Area: Service/Payment Delivery Model  •  $1 billion to fund innovative service delivery and payment models to support those innovative models•  Successful proposals will –  De ne and test a clear pathway to sustainability (higher quality and lower total system cost) –  Demonstrate care improvement within six months of award –  Support care transformation with enhanced infrastructure activity –  Rapidly develop and deploy a health care workforce Proposals are encouraged to focus on high-cost/high-risk populations –  Including those with multiple chronic conditions, mental health or substance abuse issues, poor health status due to socioeconomic and environmental factors, or the frail elderly 24  
  25. 25.   Challenge Area: Infrastructure Support•  New types of infrastructure will enable others to learn from and support more effective and efficient system-wide function•  Enhancing infrastructure activity is critical to fully achieving better care, better health, and lower costs•  Examples: –  Implementation of registries –  Medication reconciliation systems –  Shared-decision making systems –  Innovation or Improvement Networks –  Community collaboratives 25  
  26. 26.   Challenge Area: Workforce Impact•  Transforming our health system requires transformation of our health workforce•  Need to identify and test new ways to create the workforce of the future that will deliver and support new care models.•  Examples: –  New roles and skills for existing health professionals –  New types of workers to support care transformation –  Team-based models to better utilize a mix of health providers 26  
  27. 27. Challenge Area: Speed to Implementation  •  Proposed models should be operational and capable of rapid expansion or sufficiently developed to be rapidly deployed.•  Proposals will be expected to deploy care improvement models within 6 months of the award.•  Training programs are eligible for funding but should be intensive, brief programs connected to the model being tested. 27  
  28. 28. Challenge Area: Pathway to Sustainability  •  Proposed models are expected to –  De ne and test a clear pathway to ongoing sustainability –  Inform future bene t design and/or payment approaches for CMS consideration and –  Provide recommendations for the scaling and diffusion of the proposed model•  Preference will be given to proposals that can achieve sustainability as soon as possible within 3 years.•  Examples of sustainability approaches: –  Public-private partnerships –  Multi-payer approaches –  Proposed service delivery agreements with entities such as ACOs or Advanced Primary Care models, mental health/public health systems 28  
  29. 29. Selection Criteria  •  Model Design•  Organizational Capacity•  Workforce•  Sustainability and Finances•  Evaluation 29  
  30. 30. Learning and Diffusion•  The Innovation Center will identify and diffuse successful practices that achieve better health care, better health, and lower costs•  Awardees will engage in shared learning activities designed to –  Bring organizations together to learn from one another –  Actively measure success –  Share breakthrough ideas to accelerate progress 30  
  31. 31. Eligible Applicants•  Provider groups •  Public-private partnerships•  Health systems •  Private sector organizations•  Payers •  Faith-based organizations•  Community-collaboratives•  For-pro t organizations•  Community-based organizations•  Local governments 31  
  32. 32. Innovation through the lenses ofHITECH and Health ReformWil YuDirector, InnovationsWil.Yu@HHS.govHHS

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