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iHT2 Health IT Summit San Francisco 2013 - Opening Keynote, William Spooner, FCHIME, Senior VP & CIO, Sharp HealthCare "An Accountable Care Organization"


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William Spooner, FCHIME …

William Spooner, FCHIME
Senior Vice President & CIO
Sharp HealthCare

iHT2 Health IT Summit San Francisco - Opening Keynote, William Spooner, FCHIME, Senior VP & CIO, Sharp HealthCare "An Accountable Care Organization"

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  • 1. Opening KeynoteiHT2 2013 Health IT Summit Bill Spooner, SVP/CIO Tuesday, March 26, 2013
  • 2. AGENDA• HITECH and Health Reform – What David Muntz (probably) would have shared!• Innovation and Transformation• The Sharp Journey• Closing Messages 2
  • 3. What David Muntz (probably) would have shared . . .
  • 4. Impact of Meaningful Use Health IT: Hardwiring the 3-Part AimBetter healthcare Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient- Centeredness, Timeliness, Efficiency, and Equity. Better health Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care. Reduced costs Lowering the total cost of care while improving quality, resulting $ in reduced monthly expenditures for Medicare, Medicaid, and CHIP beneficiaries. Supporting new models of payment. Health Information Technology 44
  • 5. Who is helping?• The public – patients and consumers• The IT industry – HIT professionals and EHR vendors• The Health Care industry – all participants across the continuum• Professional and consumer organizations• Numerous and diverse Federal agencies 5
  • 6. Venture Capital Funding for Health ITReaches $1.4 Billion for 2012• July 2012, Dow Jones VentureSource – Predicted investments at $724.11 Million for 2012• January 2013, Rock News – Venture capital investments for 2012 estimated at $1.4 Billion – 46% more money – 56% more deals• January 11, 2013, Transparency Market Research – Global mHealth will grow at a compounded annual rate of 41.5% in the next five years – Will reach $10.2 billion by 2018 6
  • 7. HIT Industry – Size Estimates Size Source Supposed Market Definition Year ($ billions) 2009 1.3 Ambulatory EHR Revenue 2012 2.6 Frost & Sullivan 2013 3.0 2016 1.6 2009 1.0 Hospital EHR Revenue 2012 6.5 2009 0.6 Ambulatory MU (Software & Maintenance Costs) 2015 1.4 IDC Health Insights 2009 1.3 Inpatient MU (Software & Maintenance Costs) 2015 2.4 2008 12.5 2009 13.8 Kalorama EHR + Related Services Revenue 2010 15.7 2011 17.9 2012 5.3 2013 5.9 Millennium Research Group EHR Revenue 2014 6.6 2015 7.4 2016 8.3 EHR (end user purchases of components and 2009 2.2 MarketsandMarkets applications) 2015 6.1 US Health IT (EHR, Practice Management, CPOE, 2008 4.1 Global Market Direct eRx, Labs, Picture archiving, Radiology Images) 2015 11.5 7
  • 8. The Patient and Consumer picture source: 8
  • 9. Back in the Day… “The obedience of a patient to the prescriptions of his physician should be prompt and implicit. [The patient] should never permit his own crude opinions as to their fitness to influence his attention to them.” - AMA’s Code of Medical Ethics (1847) 9
  • 10. And Now…“Patients share the responsibility for their own health care…” - AMA’s current Code of Medical Ethics“Patients can … be a second set of eyes on our medical records. Icorrected the mistakes in my health record…Better to clean it upnow, not when there’s time pressure.” – Dave deBronkart (ePatient Dave) 10
  • 11. • Sphygmomanometer • Digestible – Blood pressure RFID Pills – Pulse NETWORK • Glucometer – Blood sugar • Bathroom Scale• Smart Band-Aids – Weight - Chemistry – Water loss/gain From Hank Fanberg Texas HIT Summit Jan 2011 11
  • 12. The Smart Home 12
  • 13. The Smart PatientFCC Issues Final Rule Allocating Wireless Spectrum for MBANs…wireless spectrum for medical body area networks starting Oct. 1, 2012… Modern Healthcare. September 2012 Picture source: Jack E. Brown 6/23/2012 13
  • 14. Consumer Engagement = Better Care 13% Hospital Readmit within 30 Days 28% 19% Experience a Medical Error 36% Suffer a health consequence from 13% poor communcation among providers 49% More Activated Patient Less Activated Patient AARP Magazine, July/August 2009 findings based on people over 50 years who have at least one chronic condition. 14 14
  • 15. There’s a Gap between Reality & Potential • 15% have renewed a prescription online • 10% have a personal health record (PHR) • 8% of consumers have e-mailed their provider 15
  • 16. Many C-suite Executives and Boards areSkeptical of the Value of HIT Investment“Some healthcare CEOs refer to IT as that “I estimate that about half of our ITblack hole you pour money into… never investment generates value . . . I justseeing results.” can’t figure out which half.” - Healthcare CEO - Healthcare CEO “While [the system] has helped [us] boost patient safety and medication administration processes, [we have] put quality of care and improving safety ahead of ROI and time savings.” - VP of Quality and Care Management 2010 Lecture by Lynn Vogel, PhD, at CHIME Boot Camp 16
  • 17. Defining the Value Proposition forInformation Technology Investments• Health IT – Is a significant expense in an increasingly resource constrained environment – Is moving from dread to desire (expectation) – Requires a new agility that didn’t exist and cannot necessarily be supported on existing foundations• New priorities have intensified competition for limited resources (e.g., clinic acquisitions, robotics, genomics)• With our IT investments, we have not excelled at – Defining value – Measuring value – Meeting deadlines – Getting comprehensive community buy-in 17
  • 18. Similarities & Differences (Moody and Walsh 1999) Time Decreases Value Integration Increases Value Operational Decision Support Information InformationPotential PotentialValue ($) Value ($) Statutory Time Increase in Integration Sharing Increases Value Use Increases Value Information Value ($) Value ($) Number of People Sharing Number of People Using 18
  • 19. Connect. Communicate. Collaborate.Office of National Coordinator • Browse the ONC website at: click the Facebook “Like” button to add us to your network • Contact us at: • Subscribe, watch, and share: @ONC_HealthIT Health IT and Electronic Health Records Health IT Buzz Blog 19
  • 20. Innovation and Transformation
  • 21. John Glaser on Innovation Practical innovation—the kind of innovation that genuinely improves patient care orworkflow and can be implemented by an organization today—is based on four cornerstones: • The Right Culture – Organizational fabric, directed at business or clinical value • The Right Questions – Vision, strategy, process, technology • The Right Processes – Portfolio, idea input, evaluation, pilots, impact assessment • The Right Tools in support of innovation Technology has no inherent ability to “cause” innovation. Its innovation value is determined by the context of its potential use. HHN Feb. 2008 21
  • 22. Innovation and Transformation• "Innovation" is Dead. Herald The Birth of "Transformation" as The Key Concept for 2009 – Bruce Nussbaum, December 31, 2008• Innovation and Transformation: a Lifecycle Model – Coffman and Kaufman, Innovation Labs, LLC• Innovation as the fuel of Transformation! 22
  • 23. Transformative (?) Alliances• Davita acquires Healthcare Partners• United Healthcare acquires Monarch• Cleveland Clinic & Community Health Systems partner• Aetna and United acquire I.T. firms• UPMC and Advisory Board form Evolent Health• Walmart and pharmacy chains expand Primary Care• Health Systems align – Trinity and Catholic Healthcare East – Hoag and St Joseph’s – Catholic Health Initiatives and Peace Health – Others• Hospitals acquire physician practices 23
  • 24. The Sharp Journey
  • 25. Sharp HealthCare• Largest health care system in San Diego – 2 affiliated medical groups, 7 hospitals, 3 skilled nursing facilities, a health plan, 21 outpatient clinics, 5 urgent care centers, home health, hospice, and home infusion programs – Market share leader and only health care system that increased market share each of the past 11 years• Largest private employer in San Diego – 15,000 employees, 2,600 affiliated physicians, 2,300 volunteers 25
  • 26. Sharp HealthCare • Grew from one hospital in 1955 to an integrated health care delivery system – Aligned physician partners – Integrated I.T. systems and infrastructure – Centralized system support services – Over 25 years experience in managing care under population- based payment structures – Sharp Health Plan, a 65,000 member, Knox Keene licensed commercial health plan 26
  • 27. Sharp’s Population Health Strategy Care coordination and population healthmanagement are not new concepts at Sharp Since 1980’s New in 2012 35,000 246,000 20,000 32,000 Capitated Capitated Commercial Pioneer ACO Senior Commercial ACO Beneficiaries Enrollees Enrollees Members (Medicare) 27
  • 28. Priority I.T. Requirements for ACO’s• Master Person Index - Registry – Methodology for effective patient identification• E.H.R.• Population Health/ Analytics – Evaluate all aspects of quality, access and cost of care.• Health Information Exchange – View the complete record across all providers• Patient Portal – Advance patient engagement, “stickiness”• Case/Care Management 28
  • 29. Health Information Exchange
  • 30. Patient PortalKey Facts:• Launched in February 2010• 100,000 patients signed up• Nearly 18,000 on mobile mySharp launched in May 2012• 750,000 logins in FY2012 – 195,000 lab results – 150,000 secure messages – 60,000 appointments scheduled – $2.3 million patient payments• CCHIT cert for Visit SummariesIn-house Developed• Cold Fusion• Oracle middleware• Links: – Allscripts, Cerner EHRs, GE PM – GE Practice Managemnt – dbMotion HIE 30
  • 31. Portal for Smart Device mySharp Mobile ― App for iPad, iPhone and by late Spring Android mobile devices 31
  • 32. NeHC Patient Engagement Framework 32
  • 33. Joseph M. Smith, MD, PhD, March 20, 2013 House Energy and Commerce Committee Subcommittee on Health 33
  • 34. Other Innovations! 34
  • 35. Exploratory with Qualcomm Life 35
  • 36. Illustrative Timelines for Key Initiatives ICD-10, MU, & Health ReformFederal Fiscal Year FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016ICD-10 Transition Transition to ICD-10 Partial ICD Code Set Freeze ICD-10 Implementation Transition to 5010 5010 Operational Transition to Next StandardAdministrativeSimplification Eligibility and Claim Status Remittance & Claims Health Plan ID Meaningful Stage 1 Stage 2 Stage 3 Use of EHRs Accountable Care Organizations Base/Performance Period Value Based Purchasing Health Reform Base/Performance Period Readmission Payment Penalties Initiatives Bundled Payment Base/Performance Period Hospital-Acquired Conditions Accounting for Disclosures HIPAA Privacy Changes Patient Copy of Electronic Records ICD-10 Implementation 36
  • 37. Messages• Health reform a catalyst – Care models demand technology – Technology creates opportunities – Reduced reimbursement require efficient, effective solutions• Feds have promoted technology advance – HITECH and CMMI grants – Meaningful Use• Feds have slowed technology advance – Priority required of health reform programs• Great time to be an I.T. professional – Investment in skills training increasing – Work environment more important than ever 37