Health	  Reform,	  Accountable	  Care	  Models	  (ACOs)	  and	  Health	  IT	  -­‐	  	  Organiza@onal	  Impact	  	  	  	  W...
Thesis	    •  Leading facilities implementing MU  •  2011 - Achieving core ACOs competencies represents     need for excel...
Models	  to	  Watch	    •  ACOs  •  Medical Homes  •  Bundled Care Payments
Background:	  	  CMS	  Innova@on	  Center	  (CMMI)	  Ini@a@ves	    •    The Medicare Shared Savings Program       –  Provi...
ACOs	  -­‐	  Primary	  Care	  Responsibility	  in	  Flux	    •  Current       –    Emphasis on referral source            ...
ACOs	  -­‐	  Performance	  and	  U@liza@on	  Risk	    •  Performance Risk      –    Cost of care becomes paramount as bund...
Infrastructure	  Impact	    •  Requirements require team approach with organizational support     –    “Office of CIO will...
ACOs	  –	  Technological	  Infrastructure	    •  EMR                                  •    Risk modeling – financial      ...
Current	  Context	  for	  Health	  IT	  Innova@on	    •  Enacted legislation and current administration policies & rule-ma...
Current	  Context	  for	  Health	  IT	  Innova@on	    •  Health IT Market Sizes – new opportunities  •  Accountable Care O...
Health	  Reform,	  Accountable	  Care	  Models	  (ACOs)	  and	  Health	  IT	  -­‐	  	  Organiza@onal	  Impact	  	  	  	  W...
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Health reform, accountable care models ac os and health it - hospitals, organizational impact

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Health reform, accountable care models ac os and health it - hospitals, organizational impact

  1. 1. Health  Reform,  Accountable  Care  Models  (ACOs)  and  Health  IT  -­‐    Organiza@onal  Impact        Wil  Yu,  Innova@ons  Dept.  of  Health  and  Human  Services  Wil.Yu@HHS.gov  
  2. 2. Thesis   •  Leading facilities implementing MU •  2011 - Achieving core ACOs competencies represents need for excellence in: –  Network interconnectivity –  Clinical Knowledge Mgmt. –  Population Risk Mgmt. –  Patient Engagement –  Financial Operations •  Organizational response readiness and pace of technological innovation are both variables in flux
  3. 3. Models  to  Watch   •  ACOs •  Medical Homes •  Bundled Care Payments
  4. 4. Background:    CMS  Innova@on  Center  (CMMI)  Ini@a@ves   •  The Medicare Shared Savings Program –  Provide incentives for health care providers who agree to work together and become accountable for coordinating care for patients. –  Providers through this model and meet certain quality standards (based upon patient outcomes and care coordination among the provider team) may share in savings they achieve –  Higher the quality of care providers deliver, the more shared savings the providers may keep •  The Advance Payment Model –  Provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program who also would benefit from additional start-up resources to build the necessary infrastructure, such as new staff or IT systems –  Advanced payments would be recovered from any future shared savings achieved by the Accountable Care Organization.
  5. 5. ACOs  -­‐  Primary  Care  Responsibility  in  Flux   •  Current –  Emphasis on referral source Represents a shifting –  Extension of care responsibilities definition of market •  Evolving roles –  Care coordination Movement from –  Chronic care management downstream referrals –  Access expansion to increased panel size •  Future roles under ACO Model –  Population health management –  Patient activation Enabled by health IT
  6. 6. ACOs  -­‐  Performance  and  U@liza@on  Risk   •  Performance Risk –  Cost of care becomes paramount as bundled pricing comes under spotlight –  Focus on episodic efficiency –  Re-admission reduction –  ….and Care Standardization •  Utilization risk –  Potential volume of care increasing –  Chronic care management and care substitution –  Disease prevention remains the imperative •  At the intersection…Quality of Care –  Pay-for-performance – metrics, metrics, metrics –  Process reliability –  Clinical quality –  Patient experience
  7. 7. Infrastructure  Impact   •  Requirements require team approach with organizational support –  “Office of CIO will be overwhelmed under traditional structure” •  Near-term milestones already loading up operational timelines –  Stage 2 MU –  ICD-10 conversion –  Medicaid capitation –  National Episodic Bundling Pilot –  HIPAA 5010 –  Hospital valued based purchasing (II) –  Stage 3 MU –  Payment adjustments –  Existing demonstration and pilot projects
  8. 8. ACOs  –  Technological  Infrastructure   •  EMR •  Risk modeling – financial –  CCD •  BI – predictive and descriptive •  HIE •  Care management prediction •  Reporting Capabilities •  Pop. Health mgmt. tools •  Clinical Documentation •  Performance monitoring tools •  Interoperability •  Data Analytics infrastructure •  Closed-loop medication •  RCM capabilities administration •  Compliance •  ICD-10 •  Cost analytics •  PHR •  These are just the ones we know about •  mHealth •  No proto-typical model emerging…yet
  9. 9. 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.
  10. 10. Current  Context  for  Health  IT  Innova@on   •  Health IT Market Sizes – new opportunities •  Accountable Care Organization (ACO) pure-plays – transition to accountable care – early startups targeting mid-sized hospital systems •  Dashboards and existing data assets – e.g. patient scheduling, cardiology, surveillance systems, and access management •  ACO Roadmap and milestones •  Supporting performance risk management and identifying challenges under utilization risk •  Developing patient attribution within accountable care organization
  11. 11. Health  Reform,  Accountable  Care  Models  (ACOs)  and  Health  IT  -­‐    Organiza@onal  Impact        Wil  Yu,  Innova@ons  Dept.  of  Health  and  Human  Services  Wil.Yu@HHS.gov  

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