Beacons and the Health 2 0 community


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Presentation by Dr Aaron McKethan, who's running the Beacon Communities project at ONC. This was the presentation he gave to the Health 2.0 Community in the webinar on July 21

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Beacons and the Health 2 0 community

  1. 1. Beacons and the Health 2.0 Community Office of the National Coordinator for Health Information Technology July 21, 2010
  2. 2. The HITECH Act Vision • A major transformation in American health care • Each patient receives optimal care through nationwide health information exchange • Programs and regulations to help overcome obstacles to adoption and Meaningful Use of electronic health records (EHRs) and to enable breakthrough advances in health and health care
  3. 3. The HITECH Act • Part of American Recovery and Reinvestment Act of 2009 (ARRA) • Goal: Every American to have an EHR by 2014 • Systematically addresses major barriers to adoption and Meaningful Use: – Money/market reform – Technical assistance, support, and better information – Health information exchange – Privacy and security
  4. 4. How HITECH Addresses Barriers to Adoption 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 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 *$27.3 B is high scenario
  5. 5. Unprecedented Moment for Health System Performance Improvement • HITECH Act • Affordable Care Act • Action at Local, Regional, and National Levels – Shared urgency to seize opportunities and address gaps – New communications and technology tools – Growing body of evidence about effective approaches – Strong and growing local leadership and collaboration
  6. 6. 6
  7. 7. “Tribes” of Health System Improvement: Different Interpretations, Strategies, and Tools 1. Quality Improvement Crusaders 2. Payment Reformers 3. Consumer Energizers 4. Health IT Champions 7
  8. 8. Tribe 1: Quality Improvement Crusaders Scientific evaluation methods and management techniques to achieve better patient outcomes • Data analysis and performance measurement - Provider feedback processes, evidence-informed guidelines • Management techniques - Lean manufacturing, continuous quality improvement • Learning and “best practices” - e.g., avoiding complications in the ICU, reducing hospital readmissions, improving care transitions, reducing infection and surgical-complication rates, etc. 8
  9. 9. Tribe 2: Payment Reformers Alternatives to volume-based payments to support systematic improvements in care and opportunities for slower spending growth • Fee-for-service payments drive toward more, not better care • Misalignment of primary care and technology-intensive services • Underdevelopment of value-increasing quality improvement and care coordination improvements 9
  10. 10. Tribe 3: Consumer Energizers Better information and appropriate incentives to help consumers improve their own health, save money, and achieve better outcomes • Providing better information to make better informed consumers • Consumer responsiveness to out-of-pocket costs • New value-based insurance design • Shared decision making/informed patient choice 10
  11. 11. Tribe 4: Health IT Champions Electronic infrastructure to support administrative simplification, error avoidance, and improved outcomes • Widespread adoption of electronic health records • Tools to support physicians in achieving high-value care - e.g., clinical decision support tools • Tools to help consumers make optimal health care decisions – e.g., personal health records 11
  12. 12. Tribal Approaches to Health System Reform • Quality improvement activities may be unsustainable due to volume-based payment methods • Payment reforms ineffective if unaccompanied by changes in provider practices and consumer behavior • Uncoordinated care subjecting even highly engaged and informed patients to fragmented care • Higher spending on technology with uncertain benefits  Yet…tribal approaches to health system reform are common 12
  13. 13. The Beacon Community Program • Goal: Demonstrate specific ways that communities can achieve sustainable health improvement and cost savings through complex health IT-enabled reforms • 15* demonstration communities that will: – Build and strengthen their HIT infrastructure and exchange capabilities and showcase the Meaningful Use of EHRs – Provide valuable lessons to guide other communities to achieve measurable improvement in the quality and efficiency of health services or public health outcomes *Two additional communities to be funded in Summer 2010
  14. 14. Round 1 Beacon Communities 14
  15. 15. Round 1 Beacon Communities Lead Organization Location Community Services Council of Tulsa Tulsa, Oklahoma Delta Health Alliance Stoneville, Mississippi Eastern Maine Healthcare System Brewer, Maine Geisinger Clinic Danville, Pennsylvania HealthInsight Salt Lake City, Utah Indiana Health Information Exchange Indianapolis, Indiana Inland Northwest Health Services Spokane, Washington Louisiana Public Health Institute New Orleans, Louisiana Mayo Clinic College of Medicine Rochester, Minnesota The Regents of the University of California, San Diego San Diego, California Rhode Island Quality Institute Providence, Rhode Island Rocky Mountain Health Maintenance Organization Grand Junction, Colorado Southern Piedmont Community Care Plan, Inc. Concord, North Carolina University of Hawaii at Hilo Hilo, Hawaii Western New York Clinical Information Exchange Buffalo, New York 15
  16. 16. Beacon Community 90-Day Workplan Program Goals Community Beacon “Community Objectives” encompassing Objectives CO CO cost, quality, and population health Measured MO MO MO MO Well-defined measurable improvement goals Outcomes Defining risks and barriers and establishing plans to prevent or mitigate them Outputs O O O O O O Operational and process results of core activities Activities A A A A A A Tasks/interventions leading to outputs Resources R R R R R R R R R R R R Resources needed to support activities and meet stated outcome goals Sustainability plan outlining provider reimbursement, program revenue, and other strategies 16
  17. 17. Geisinger Clinic (Keystone Beacon Program) Summary of 1 out of 10 Beacon/Geisinger Community Program Goals Objectives (Logic Models) Community Improve quality and efficiency among targeted patients with Chronic Objectives CO Obstructive Pulmonary Disease (COPD) and Heart Failure (HF) Reductions in hospital admissions, avoidable 30-day hospital Measured MO MO readmissions, and ED visits among target patients; increased access Outcomes to/utilization of primary care services among same patients Specific plans to prevent or mitigate implementation risks and barriers Outputs O O O O Medication reconciliation outputs, hospital discharge counseling, targeted case management contact, web-based portals, others Comprehensive HIT-enabled care model includes care process redesign Activities A A A A and teaming; integration across all systems of care, care protocols; performance feedback to patients and clinicians, and reminder systems Specific funding allotments to core activities phased in over new areas Resources R R R R R R R R and over time; dedicated administrative, IT, and clinical teams Sustainability plan: integration of accountable care payment model aligned with health IT-enabled performance improvement goals 17
  18. 18. Conclusion and Discussion Questions • What are new innovative tools and applications that can help “unite the tribes” in these and other communities? – Real-time data interfaces (providers and consumers) – Prizes, challenges – Data visualizations • How do we ensure that the lessons learned from communities participating in Beacon Communities are shared in a broader and dynamic learning network environment?