Using technology to improve quality


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Using technology to improve quality

  1. 1. Using Technology to Improve Quality<br />Charles DeShazer, MD<br />VP, Quality, Medical Informatics & Transformation<br />Dean Health System<br />Madison, WI<br />
  2. 2. Key Industry Assumptions<br />Current cost inflation curve is unsustainable<br />Payers are moving towards paying for value rather than volume<br />EHR will become a standard tool <br />Quality will become not only the “ticket to play” but also one basis of competition (value = quality/cost)<br />Primary care will be the engine for quality<br />
  3. 3. Overall Rank Ordering of Health System Characteristics 2010<br />Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).<br />Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).<br />
  4. 4. ACO model represents a shift of COST RISK to Providers through payment mechanisms…<br />
  5. 5. Complex Case Management<br />1000 Lives<br />25%<br />Disease/Demand Management<br />14,000 Lives<br />50%<br />15,000 Lives<br />15%<br />Health<br />Mgmt<br />70,000 Lives<br />10%<br />Population vs. Costs vs. Interventions<br />Example of 100,000 People in a Population<br /> % of <br />Cost<br />% of<br />Population<br />1%<br />14%<br />15%<br />70%<br />
  6. 6. 24 hours in the life of a PCP<br />“The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care,” a report from the American College of Physicians, 2006<br />Yarnall KS, et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93:635 <br />Ostbye T, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005; 3:209<br />
  7. 7. Therefore, managing costs (risk) means managing chronic and complex conditions (especially in the short term)<br /><ul><li>Quality initially will be the ticket to play and later become a key competitive measure
  8. 8. You will have to fix the PCP’s day in the process</li></li></ul><li>Kaiser Permanente Diabetes Care<br />Ohio region 2006<br />Large population of diabetic patients<br />Recently implemented EHR<br />No infrastructure for care management<br />Poor quality scores on HEDIS diabetic care<br />
  9. 9. Creation of Diabetic Care Model<br />Primary care restructuring as medical home<br />Added care management resources<br />Outsourced health coaching and outreach<br />Leveraged EHR for process management and communication<br />Created quality measurement dashboard with actionable drill-down, filtering and sorting capabilities<br />Developed standardized workflows aligned with Clinical Decision Support<br />Better leveraged non-physician staff<br />Enhanced patient engagement via education, PHR, email, behavioral health integration and outreach<br />
  10. 10. Results<br />Statistically significant improvement in 6 of 9 commercial and all Medicare HEDIS metrics within 1 year<br />Became one on the top performing regions in Diabetic care<br />3 years after implementation beginning to see decreased cost secondary to decreased strokes, heart attacks and amputations consistent with modeling (Achimedes)<br />
  11. 11. Does Use of EHRs Help Improve Quality?<br />“For patients with diabetes, 51 percent of those receiving care in an EHR practice received all the recommended care, as compared with 7 percent of those who received care in a paper-based practice.”<br />Source: 7/8/2011)<br />Better Health Greater Cleveland:<br />
  12. 12. Leverage Meaningful Use as a Springboard<br />
  13. 13. Key System Challenge is to address FRAGMENTATION <br />Poor Coordination of Care Is Common,Especially If Multiple Doctors Are Involved<br />Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2011.<br />** On average, Medicare beneficiaries see 6.4 MDs and fill 20 prescriptions annually. Beneficiaries with 5+ chronic conditions see 14 MDs and fill 57 prescriptions annually (Source: N Engl J Med 2007;356:1130-9)<br />
  14. 14. Key Technical Functions for Next Level Quality Management<br />EHR is necessary but not sufficient. The next level of quality management will require a Health Information Technology (HIT) “ecosystem” especially a robust analytic infrastructure. Standalone EHR may not be able to provide all of these functions.<br />
  15. 15. Provider Organizational Cultural Shifts<br />Critical Success Factors for Transformation<br />Now<br />Future<br />Volume Focus<br /> Value Focus<br />Physician Autonomy<br /> Organizational Standards<br />Independence<br />Interdependence<br />Physician Captain<br /> Physician Coach & Mgr<br />Accountability External<br /> Accountability Internal<br />HIT optional<br />HIT Core to Strategy<br />My data is my data<br />TRANSPARENCY!!<br />
  16. 16. Looking Ahead…<br />MU Stage 2 & 3<br />ICD-10<br />ACO development (success or flop?)<br />Evolution of Value-Based Reimbursement <br />Genomics<br />
  17. 17. QUESTIONS?<br />