Dr Ashish Jha, Harvard School of Public Health, presenting at the Nuffield Trust Health Policy Summit, explores how change happens, drawing on examples from Accountable Care Organisations in the USA.
From High Hopes to HITECH: Money and Meaningful Use. Centricity Healthcare User Group. This presentation covers meaningful use, IT Adoption, interoperability, network effects, transparency and better outcomes from the use of Health Information Technology.
From High Hopes to HITECH: Money and Meaningful Use. Centricity Healthcare User Group. This presentation covers meaningful use, IT Adoption, interoperability, network effects, transparency and better outcomes from the use of Health Information Technology.
Navigating Oceans of Data - Being Part of and Competing in the ACO & Bundled ...jfsheridan
Bundled Payment BPCI and Accountable Care Organizations are changing the paradigm for payment and delivery of post acute care. This change creates episode of care programs. The presentation reviews how New Jersey is affected by BPCI and ACOs.
Cashing in on Value Based Reimbursementathenahealth
Stay on top of changing governmental regulations and don't leave money on the table. Value based reimbursements can be tricky to navigate while managing a medical practice but not with athenahealth.
The Latest Self-Pay Trends: New Burdens and Opportunitiesathenahealth
Let athenahealth guide you through the burdens of navigating through revenue collections from your patients to make sure your practice has access to all monetary opportunities to ensure financial success.
Population Health in 2016: Know How to Move Forwardathenahealth
Accountable care organizations (ACOs) present a significant opportunity to reduce health care expenditures and ensure quality care. Successfully managing the transition to an ACO is one of the most difficult challenges facing health organizations today. The key is to focus on the risk contract and approach population health management in a staged, incremental way.
Mobile Health at Ochsner: The Apple HealthKit and Epic EMR IntegrationRahlyn Gossen
These slides are from the April 2, 2015 meeting of Health 2.0 New Orleans with special guest Jonathan Wilt, the Assistant Vice President of the Center for Innovation at Ochsner Health System. Jonathan spoke about Ochsner's Health System's integration of Apple HealthKit with the Epic EMR.
Audio is here: http://www.youtube.com/watch?v=UsSKui7m4VY
Drivers of Remote Patient Monitoring (RPM)CRF Health
Adoption of Remote Patient Monitoring technology is growing increasingly amongst healthcare providers for its ability to save time, money, and lives.
Download the "Drivers of Remote Patient Monitoring (RPM)" infographic to see real-life examples of how RPM is gaining traction for so many in the industry.
Keeping Community Hospitals Thriving and Independentathenahealth
Research showing hospitals how to best maintain their independence while conducting a thriving business model in changing times of governmental regulation.
Electronic health record (EHR) is a computerized patient-centric history of an individual’s health
care record that includes data from the multiple sources of care that the patient has used.
It's no secret that any EHR takes away essential time with the patient and doctoring in general. See what athenahealth is doing to help remedy these frustrations and to make the best out of a bad situation.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The Top 7 Outcomes Measures and 3 Measurement EssentialsHealth Catalyst
Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement:
Transparency
Integrated care
Interoperability
CDS Innovations for Chronic Disease Managementdpugrad01
This is a presentation I gave at the 2007 AMIA Spring Congress. The presentation focuses on innovative projects in the AHRQ Health IT Portfolio focused on improving health care through the use of clinical decision support. In particular, these projects targeted chronically ill patients.
Penalties are coming. Are you prepared? Widely recognized as one of healthcare's most knowledgeable speakers on healthcare policy, Brian Ahier will provide an in-depth look at current healthcare reform and more specifically the implications of the HITECH Act from 2009 as well as the Patient Protection and Affordable Care Act.
In this webinar, Brian covers: 1) The most important details defining the Affordable Care Act regulation, 2) Future implications of this body of reform legislation, 3) Paths healthcare executives can take to prepare,4) The importance of analytics to navigate healthcare reform, 5) The fundamental issues pertaining to Meaningful Use.
Zero Sepsis Deaths: A Dialogue of Passion and Practical Wisdom on Sepsis Prev...Health Catalyst
Each year 1.7 million Americans are diagnosed with sepsis, resulting in 270,000 deaths, according to the Centers for Disease Control and Prevention. That’s one death every two minutes, making sepsis the leading cause of death in U.S. hospitals. The financial toll is also high, with the average cost per sepsis stay over $18,000. Sepsis is the number one cause of both initial hospitalizations and readmissions.
Nearly all sepsis deaths are preventable. Community outreach, focused attention on the emergency department, and effective technology and processes to monitor patients already admitted can reduce sepsis mortality. Making a goal of “zero sepsis deaths” a reality is a personal and professional passion of Armando Nahum, a patient activist and co-founder and President of the Safe Care Campaign, and Kathleen Merkley, DNP, ANP, FNP, Senior Vice President of Professional Services at Health Catalyst.
Nahum and Merkley share stories and practical steps to drastically reduce the sepsis toll. Michael L. Millenson, Senior Advisor to Health Catalyst, patient safety expert, and long-time advocate of safer, higher-quality, more patient-centered care, facilitates the dialogue.
What You’ll Learn
- How to implement community outreach to facilitate timely sepsis recognition and seeking of care.
- How to organize emergency department processes for prompt sepsis recognition and treatment.
- How to ensure prompt sepsis recognition and treatment in the inpatient environment.
- How to avoid sepsis readmissions.
The term ashtakam (Sanskrit: अष्टकम् aṣṭakam), also often written astakam, is derived from the Sanskrit word aṣṭā, meaning "eight". In context of poetic compositions, 'ashtakam' refers to a particular form of poetry, written in eight stanzas.
Ardhanareeshvara stotram sanscrit with english transliterationRavi Ramakrishnan
Ardhanarishvara (Sanskrit: अर्धनारीश्वर, Ardhanārīśvara),(Tamil:அர்தனாரீஸ்வரர்) is a composite androgynous form of the Hindu god Shiva and his consort Parvati (also known as Devi, Shakti and Uma in this icon). Ardhanarishvara is depicted as half male and half female, split down the middle. The right half is usually the male Shiva, illustrating his traditional attributes.
The earliest Ardhanarishvara images are dated to the Kushan period, starting from the first century CE. Its iconography evolved and was perfected in the Gupta era. The Puranas and various iconographic treatises write about the mythology and iconography of Ardhanarishvara. While Ardhanarishvara remains a popular iconographic form found in most Shiva temples throughout India, very few temples are dedicated to this deity.
Ardhanarishvara represents the synthesis of masculine and feminine energies of the universe (Purusha and Prakriti) and illustrates how Shakti, the female principle of God, is inseparable from (or the same as, according to some interpretations) Shiva, the male principle of God. The union of these principles is exalted as the root and womb of all creation. Another view is that Ardhanarishvara is a symbol of Shiva's all-pervasive nature.
Navigating Oceans of Data - Being Part of and Competing in the ACO & Bundled ...jfsheridan
Bundled Payment BPCI and Accountable Care Organizations are changing the paradigm for payment and delivery of post acute care. This change creates episode of care programs. The presentation reviews how New Jersey is affected by BPCI and ACOs.
Cashing in on Value Based Reimbursementathenahealth
Stay on top of changing governmental regulations and don't leave money on the table. Value based reimbursements can be tricky to navigate while managing a medical practice but not with athenahealth.
The Latest Self-Pay Trends: New Burdens and Opportunitiesathenahealth
Let athenahealth guide you through the burdens of navigating through revenue collections from your patients to make sure your practice has access to all monetary opportunities to ensure financial success.
Population Health in 2016: Know How to Move Forwardathenahealth
Accountable care organizations (ACOs) present a significant opportunity to reduce health care expenditures and ensure quality care. Successfully managing the transition to an ACO is one of the most difficult challenges facing health organizations today. The key is to focus on the risk contract and approach population health management in a staged, incremental way.
Mobile Health at Ochsner: The Apple HealthKit and Epic EMR IntegrationRahlyn Gossen
These slides are from the April 2, 2015 meeting of Health 2.0 New Orleans with special guest Jonathan Wilt, the Assistant Vice President of the Center for Innovation at Ochsner Health System. Jonathan spoke about Ochsner's Health System's integration of Apple HealthKit with the Epic EMR.
Audio is here: http://www.youtube.com/watch?v=UsSKui7m4VY
Drivers of Remote Patient Monitoring (RPM)CRF Health
Adoption of Remote Patient Monitoring technology is growing increasingly amongst healthcare providers for its ability to save time, money, and lives.
Download the "Drivers of Remote Patient Monitoring (RPM)" infographic to see real-life examples of how RPM is gaining traction for so many in the industry.
Keeping Community Hospitals Thriving and Independentathenahealth
Research showing hospitals how to best maintain their independence while conducting a thriving business model in changing times of governmental regulation.
Electronic health record (EHR) is a computerized patient-centric history of an individual’s health
care record that includes data from the multiple sources of care that the patient has used.
It's no secret that any EHR takes away essential time with the patient and doctoring in general. See what athenahealth is doing to help remedy these frustrations and to make the best out of a bad situation.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The Top 7 Outcomes Measures and 3 Measurement EssentialsHealth Catalyst
Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement:
Transparency
Integrated care
Interoperability
CDS Innovations for Chronic Disease Managementdpugrad01
This is a presentation I gave at the 2007 AMIA Spring Congress. The presentation focuses on innovative projects in the AHRQ Health IT Portfolio focused on improving health care through the use of clinical decision support. In particular, these projects targeted chronically ill patients.
Penalties are coming. Are you prepared? Widely recognized as one of healthcare's most knowledgeable speakers on healthcare policy, Brian Ahier will provide an in-depth look at current healthcare reform and more specifically the implications of the HITECH Act from 2009 as well as the Patient Protection and Affordable Care Act.
In this webinar, Brian covers: 1) The most important details defining the Affordable Care Act regulation, 2) Future implications of this body of reform legislation, 3) Paths healthcare executives can take to prepare,4) The importance of analytics to navigate healthcare reform, 5) The fundamental issues pertaining to Meaningful Use.
Zero Sepsis Deaths: A Dialogue of Passion and Practical Wisdom on Sepsis Prev...Health Catalyst
Each year 1.7 million Americans are diagnosed with sepsis, resulting in 270,000 deaths, according to the Centers for Disease Control and Prevention. That’s one death every two minutes, making sepsis the leading cause of death in U.S. hospitals. The financial toll is also high, with the average cost per sepsis stay over $18,000. Sepsis is the number one cause of both initial hospitalizations and readmissions.
Nearly all sepsis deaths are preventable. Community outreach, focused attention on the emergency department, and effective technology and processes to monitor patients already admitted can reduce sepsis mortality. Making a goal of “zero sepsis deaths” a reality is a personal and professional passion of Armando Nahum, a patient activist and co-founder and President of the Safe Care Campaign, and Kathleen Merkley, DNP, ANP, FNP, Senior Vice President of Professional Services at Health Catalyst.
Nahum and Merkley share stories and practical steps to drastically reduce the sepsis toll. Michael L. Millenson, Senior Advisor to Health Catalyst, patient safety expert, and long-time advocate of safer, higher-quality, more patient-centered care, facilitates the dialogue.
What You’ll Learn
- How to implement community outreach to facilitate timely sepsis recognition and seeking of care.
- How to organize emergency department processes for prompt sepsis recognition and treatment.
- How to ensure prompt sepsis recognition and treatment in the inpatient environment.
- How to avoid sepsis readmissions.
The term ashtakam (Sanskrit: अष्टकम् aṣṭakam), also often written astakam, is derived from the Sanskrit word aṣṭā, meaning "eight". In context of poetic compositions, 'ashtakam' refers to a particular form of poetry, written in eight stanzas.
Ardhanareeshvara stotram sanscrit with english transliterationRavi Ramakrishnan
Ardhanarishvara (Sanskrit: अर्धनारीश्वर, Ardhanārīśvara),(Tamil:அர்தனாரீஸ்வரர்) is a composite androgynous form of the Hindu god Shiva and his consort Parvati (also known as Devi, Shakti and Uma in this icon). Ardhanarishvara is depicted as half male and half female, split down the middle. The right half is usually the male Shiva, illustrating his traditional attributes.
The earliest Ardhanarishvara images are dated to the Kushan period, starting from the first century CE. Its iconography evolved and was perfected in the Gupta era. The Puranas and various iconographic treatises write about the mythology and iconography of Ardhanarishvara. While Ardhanarishvara remains a popular iconographic form found in most Shiva temples throughout India, very few temples are dedicated to this deity.
Ardhanarishvara represents the synthesis of masculine and feminine energies of the universe (Purusha and Prakriti) and illustrates how Shakti, the female principle of God, is inseparable from (or the same as, according to some interpretations) Shiva, the male principle of God. The union of these principles is exalted as the root and womb of all creation. Another view is that Ardhanarishvara is a symbol of Shiva's all-pervasive nature.
Presentation on infertility and fertility treatments. Things yo wanted to ask a fertility doctor, but did not want to pay $399 for the consultation. Definition and prevalence in the society. Information on affordable IVF clinics abroad.
Mit dem Umbau der Uhlandschule in Stuttgart-Zuffenhausen zur Plusenergieschule zeigt die Landeshauptstadt Stuttgart gemeinsam mit ihren Partnern das technisch Machbare bei der energetischen Gebäudesanierung. Der
gesamte Energiebedarf soll durch Nutzung lokal verfügbarer erneuerbarer Energiequellen gedeckt werden. Das Projekt soll 2013 fertig sein.
Adam Steventon: Evaluating the Whole System Demonstrator trialNuffield Trust
In this audio slideshow, Adam Steventon, Senior Research Analyst at the Nuffield Trust, provides an introduction to the Department of Health’s Whole System Demonstrator trial – to date, the largest and most complex evaluation of telehealth in the world.
The Nuffield Trust led on one of five strands of analysis to examine the impact of telehealth on trial participants’ use of hospital care and on their mortality. Here, Adam summarises the key findings from this study.
The full findings have been published in the British Medical Journal (BMJ) and are summarised in the Nuffield Trust report: 'The impact of telehealth on use of hospital care and mortality' (June 2012), by Adam Steventon and Martin Bardsley.
An industry-wide survey of the health ecosystem. By looking at leading operating models that are representative of the future health ecosystem, the viewer can get a handle on how the future will look.
Managing National Health: An Overview of Metrics & OptionsDale Sanders
This is a presentation that I gave at the annual international healthcare conference hosted by the Cayman Islands government. It summarizes the international standards and frameworks for planning and managing the health of a nation. One of the most fun parts of a very fun career was the time that I spent working and living in the Cayman Islands and serving as the CIO of the national health system. The Cayman Islands national health system sat at the intersection of three very influential healthcare ecosystems-- the United States, United Kingdom, and the Pan-American Healthcare Organization. As a result, I was fortunate enough to learn from these international settings and contrast that to the US healthcare system. Other healthcare systems tend to benchmark themselves internationally more so than the United States, where we tend to benchmark ourselves internally. Unfortunately, those internal US benchmarks are the lowest in the developed world by almost every measure of national health.
The clinical case study of a patient with advanced COPD who has multiple comorbid conditions and develops sepsis provides the backdrop for two potential clinical pathways—sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis in both conditions.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
Using the Perioperative Surgical Home as a Model to Implement CJRWellbe
Watch the webinar on youtube: https://youtu.be/rNaU_P2mHXE
The transition to value-based care models has increased pressure to deliver high quality and cost effective care. The medical home concept has gained traction in the primary care setting, and now, the perioperative surgical home has the potential to improve patient satisfaction, outcomes, and cost-effectiveness in the acute setting.
Dr. Zeev Kain, Chancellor’s Professor of Anesthesiology and former Associate Dean of Clinical Operations at University of California at Irvine Health, will share challenges and lessons learned implementing their Joint Replacement Surgical Home to provide more coordinated, standardized care.
What you’ll learn:
– An overview of the Perioperative Surgical Home model, and how it can improve outcomes while reducing cost
– Lessons learned from UC Irvine’s implementation of a Joint Replacement Surgical Home
– Considerations for implementing a Perioperative Surgical Home in your organization
About the Speaker:
Zeev N. Kain is a Chancellor’s Professor of Anesthesiology & Pediatrics & Psychiatry and the Chair of the Department of Anesthesiology & Perioperative Care at UC Irvine Health. Dr. Kain completed residency training in Pediatrics and Anesthesiology, a fellowship in Pediatric Anesthesia and was received an MBA from Columbia University. After 19 years at Yale University he joined UC Irvine Health in 2008. Dr. Kain has had continuous NIH funding since 1996 and had published over 200 publications in the peer-reviewed literature. His main research focus was stress in children undergoing surgery and invasive procedures.
Dr. Kain established the annual summit on the Perioperative Surgical Home and is a member of the steering committee of a 43 hospital collaborative on this topic. His training in Lean Six Sigma and his MBA and his management background have enabled him to embark on the quest to make the Perioperative Surgical Home ubiquitous at UC Irvine Health and to help bring this care model to institutions nationally.
Learn more about the next stage in Meaningful Use and how that affects today's health care providers.Will there be changes in the measures required to receive Medicare or Medicaid Incentive funds? Will there be any changes to data capturing? Find out in this informative presentation.
The drivers of public health spending: integrating policies and institutionsOECD Governance
This presentation was made by Joaquim Oliveira Martins at the 5th Meeting of the joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems, held on 4-5 February 2016 at the OECD Conference Centre in Paris.
Similar to Dr Ashish Jha: lessons from organisational change (20)
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
4. + Total U.S. healthcare spending, 2013:
$2.9 trillion
Source: Centers for Medicare & Medicaid Services
$4,881
$5,243
$5,694
$6,129
$6,508
$6,887
$7,265
$7,652
$7,944
$8,175
$8,428
$8,698
$8,996
$9,255
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
Per Capita National Health Expenditures
5. +
-22% -31%
-12%
-14% -13% -51%
+37%
$0
$2
$4
$6
$8
$10
$12
$14
$16 2001 2010
What’s the cost of high costs?
Changes in MA state spending, 2001-2010 (in billions)
6. + Quality is suboptimal
1 in 4 seniors injured during hospitalization*
Each year:
1.8 million hospital-acquired infections
4th leading cause of death
1.5 million preventable injuries due to medications
A top10 cause of death
Large variations in use of effective services
Patient experience often suboptimal
*Source: OIG, HHS, Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries
8. + Multiple theories
Fragmentation
How we pay for care (FFS, lack of incentives)
Inadequate transparency
Inadequate competition
Inadequate patient “skin in the game”
9. + The ACA & Delivery Reform
Change how we pay for things
Hospital readmissions reduction program
Value-based purchasing
Hold providers accountable
Patient-centered medical home
Accountable Care Organizations
Centrally manage innovation
CMMI
14. + Readmissions Reduction Program
Up to 3% penalty for high readmission rate
2/3 of hospitals penalized each of the 3 years
Penalty seems to be making a difference
15. + Good News: Readmissions are down
19.0%
17.8%
15.0%
16.0%
17.0%
18.0%
19.0%
20.0%
21.0%
22.0%
2007 2008 2009 2010 2011 2012 2013
Medicare 30-day all-cause readmission rate
Source: Centers for Medicare & Medicaid Services
ACA
16. + HITECH Act: Incentives for EHRs
Signed into law in 2009 by President Obama
Incentives for “meaningful use” of Health IT
Through 2013: Incentives seem to be working
17. + Use of EHRs among U.S. hospitals
9.1%
11.9%
15.2%
26.6%
44.6%
59.8%
0%
10%
20%
30%
40%
50%
60%
70%
2008 2009 2010 2011 2012 2013
Basic or Comprehensive EHR
Incentives
Start
18. + Value-based purchasing aka P4P
Up to 2% of Medicare payments tied to:
Broad set of quality measures:
Processes
Outcomes
Patient Experience
Efficiency
Impact underwhelming
23. +
ACOs: What are they?
CMS Definition: “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”
Simple Definition:
Group of providers that take responsibility
for a population
24. +
ACOs come in 2 main flavors:
Pioneers
Big
Risk-sharing, moving towards capitation
Many of the premier organizations (Partners, etc.)
Shared-savings program
Smaller
Less risk-sharing
25. + Good News: Number of ACOs up
146
252
366
455
0
50
100
150
200
250
300
350
400
450
500
2012 2013 2014 2015
Source: Health Affairs Blog; Centers for Medicare & Medicaid Services
15-20% of Medicare Beneficiaries in an ACO
27. + Pioneer ACOs by Year 2
32 Pioneers initially signed up
13 dropped out or switched to SSP
Of the 19 remaining:
4 generated shared losses
2 broke even
13 generated shared savings
36. +
%
Primary care
incentive
payments for
performance
on:
%
Primary care
incentive
payments for
performance
on:
Quality
None 25
<10% 44
>10% 31
%
Primary care
incentive
payments for
performance
on:
Efficiency
None 46
<10% 29
>10% 25
%
Primary care
incentive
payments for
performance
on:
Patient
Satisfaction
None 35
<10% 46
>10% 19
Incentives for primary care docs
37. + Major programmatic efforts
%
Currently in use
by majority of
ACO
participants:
%
Currently in use
by ACOs:
Electronic Health
Record
96
%
Currently in use
by ACOs:
Electronic Health
Record
96
Targeted Disease
Management
Programs
76
%
Currently in use
by ACOs:
Electronic Health
Record
96
Targeted Disease
Management
Programs
76
Programs to Reduce
Preventable
Readmissions
84
%
Currently in use
by ACOs:
Electronic Health
Record
96
Targeted Disease
Management
Programs
76
Programs to Reduce
Preventable
Readmissions
84
Case Management
for High Cost
Patients
80
38. + What are ACOs doing less?
%
Currently in use
by ACOs:
%
Currently in use
by ACOs:
Messaging Between
Providers and
Patients
37
%
Currently in use
by ACOs:
Messaging Between
Providers and
Patients
37
Electronic Alerting of
PCPs when their
Patients use ER
43
%
Currently in use
by ACOs:
Messaging Between
Providers and
Patients
37
Electronic Alerting of
PCPs when their
Patients use ER
43
Programs to Reduce
Hospital Acquired
Infections
47
%
Currently in use
by ACOs:
Messaging Between
Providers and
Patients
37
Electronic Alerting of
PCPs when their
Patients use ER
43
Programs to Reduce
Hospital Acquired
Infections
47
Patient Decision Aids
for Discretionary
Procedures
22
40. + Challenges to implementing ACOs
% Reporting Somewhat or Very
Challenging
% Reporting Somewhat or Very
Challenging
Shifting Mindset from FFS to Integrated Care 91
% Reporting Somewhat or Very
Challenging
Shifting Mindset from FFS to Integrated Care 91
Facilitating Data Exchange 91
% Reporting Somewhat or Very
Challenging
Shifting Mindset from FFS to Integrated Care 91
Facilitating Data Exchange 91
Building EHR for Population Health Management 88
% Reporting Somewhat or Very
Challenging
Shifting Mindset of doctors from FFS to
Integrated Care
91
Facilitating Data Exchange 91
Building EHR for Population Health Management 88
Controlling Use When Patients Can Receive
Care Outside of ACO
97
41. +
%
Do you
believe that
most
ACOs:
Will Improve
Quality
Yes 86
No 11
No response 3
ACOs are optimistic
%
Do you
believe that
most
ACOs:
Will Improve
Quality
Yes 86
No 11
No response 3
Will Reduce
Costs
Yes 64
No 34
No response 3
42. +
Final thoughts
U.S. on a major effort to fix the delivery system
Mix of centralized and market-based
Initial glimpse: some early successes
ACOs represent a most promising approach
Some will figure it out
What are the lessons for improvement?
Will we know how to spread and scale it?
Long journey to healthcare delivery reform
We are still just getting started