Tony rogers presentation 2011 Utah Health IT Conference
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Transcript of Tony rogers presentation 2011 Utah Health IT Conference
2011 ConferenceUtah Promontory HIE/Technology
CMS Strategic Direction
Anthony RodgersDeputy Administrator
Center for Strategic PlanningJune 2011
The Role of the Center for Strategic Planning
• Policy: Provide policy research, formulation, translation, and evaluation.
• Delivery System and Market Analysis: Provide management decision support, insights, and long range analysis.
• Information: Public Medicare and Medicaid data resources and reports for comparative effectiveness research, community health indicators, Beacon communities and others.
• Knowledge Discovery: Research, evaluate and gather intelligence and develop new data sources to increase organizational knowledge about key performance outcomes and delivery system effectiveness.
• Enterprise Management Performance Reporting: Provide management with delivery system, health plan, program, and operational performance data for the purpose of managing strategic goals.
• CMS Strategic Planning: Monitor goal achievement, and internal consultation.
• Enterprise Strategic Business Planning: Plan, design, develop, and modernize, CMS business processes and information systems.
CMS Three Part Aims for Healthcare Delivery System Improvement
• Better care for individuals through seamless coordinated health care.
• Reduced costs through continuous improvement.
• Better health for populations.
2008 Data Table for High-Cost HRRsRatios of 2008 HRR Standardized Cost to National Average for Selected HCC Groupings
FL - MiamiLA -Monroe
TX -McAllen
LA -Alexandria
LA -Shreveport
FL - Fort Lauderdale
FL -Bradenton
FL - Fort Myers TX - Tyler
LA -Metairie
LA - Baton Rouge
LA -Lafayette
Diabetes W/O Complication 1.66 1.34 1.46 1.19 1.27 1.20 1.24 1.19 1.10 1.06 1.19 1.09Chronic Obstructive Pulmonary Disease (COPD) 1.42 1.29 1.33 1.23 1.27 1.10 1.05 1.05 1.24 1.10 1.28 1.21Vascular Disease 1.24 1.06 1.23 1.07 1.33 1.19 1.09 1.07 1.26 1.20 1.11 1.08Breast, Prostate, Colorectal & Other Cancers and Tumors 1.17 1.20 1.43 1.19 1.15 1.25 1.32 1.28 1.12 1.04 1.07 1.05Specified Heart Arrhythmias 1.24 1.23 1.13 1.26 1.29 1.24 1.13 1.14 1.17 1.06 1.06 1.12Specified Heart Arrhythmias & Congestive Heart Failure (CHF) 1.10 1.20 1.45 1.43 1.35 1.29 1.10 1.04 1.20 1.20 1.21 1.13Metastatic Cancer & Acute Leukemia 1.15 0.80 1.22 1.26 0.96 1.14 1.33 1.28 1.08 1.01 1.34 1.05Rheumatoid Arthritis & Inflammatory
Connective Tissue Disease 1.24 1.30 1.32 1.29 1.29 1.26 1.14 1.11 1.15 1.21 1.25 1.21CHF & COPD 1.28 1.27 1.21 1.23 1.31 1.33 0.88 1.02 1.26 0.77 1.41 1.18Diabetes W/O Complication & CHF 1.38 1.39 1.23 1.55 1.17 1.02 0.99 1.20 1.10 1.33 1.14 1.34Lymphatic, Head and Neck, Brain & Other Major Cancers 1.22 1.18 1.36 1.53 0.91 1.22 1.22 1.24 1.26 1.00 1.18 0.94Vascular Disease & COPD 1.42 1.59 0.94 0.93 1.13 1.05 1.03 1.09 1.21 1.21 1.20 1.37Diabetes W/ Renal or Peripheral Circulatory Manifestation 1.68 1.63 1.57 1.33 0.92 1.25 1.01 1.05 1.29 0.83 1.44 1.70COPD & Diabetes W/O Complication 2.27 1.19 1.38 1.59 1.02 1.26 1.06 1.03 1.13 1.29 0.92 1.19Vascular Disease & Diabetes W/O Complication 1.76 1.12 1.58 1.38 1.24 1.09 1.61 0.89 1.17 1.07 1.02 1.19Major Depressive, Bipolar, & Paranoid Disorders 1.76 2.20 1.32 1.99 1.51 1.31 1.47 1.09 1.11 1.29 1.52 1.47Diabetes W/ Neurologic or Other Specified Manifestation 2.17 1.34 1.62 0.85 1.42 1.21 1.34 1.17 1.56 0.96 1.36 1.23Lung, Upper Digestive Tract, & Other Severe Cancers 1.14 1.21 1.22 0.95 0.96 1.13 1.25 1.06 1.26 0.56 1.03 1.06Renal Failure 1.42 1.63 1.64 1.27 1.20 1.18 1.03 0.98 1.11 1.32 1.37 1.36
CHF & COPD & Specified Heart Arrhythmias 1.24 1.63 1.56 1.41 1.47 1.20 1.04 1.01 1.03 1.52 1.52 1.14Diabetes W/O Complication & CHF & Specified Heart Arrhythmias 1.15 1.40 1.25 1.62 1.47 1.07 0.96 0.99 1.15 0.93 1.45 1.18Ischemia or Unspecified Stroke 1.24 1.16 1.59 1.38 1.32 1.29 0.98 1.08 1.16 1.41 1.38 1.08CHF 1.14 1.37 1.27 1.57 1.38 1.14 1.08 1.08 1.14 1.23 1.34 1.28Study Cohort minus beneficairies in above HCC Groupings 1.91 1.37 1.72 1.31 1.29 1.24 1.10 1.03 1.14 1.27 1.28 1.27
2008 Data Table for Low-Cost HRRsRatios of 2008 HRR Standardized Cost to National Average for Selected HCC Groupings
NM -Albuquerque OR - Eugene
CA -Sacramento
VT -Burlington
CA - San Mateo County
NY -Rochester
CA -Alameda County
OR -Medford
AK -Anchorage
CA - San Jose
CA - San Francisco
HI -Honolulu
Diabetes W/O Complication 0.77 0.80 0.82 0.83 0.74 0.85 0.77 0.80 0.87 0.79 0.76 0.62Chronic Obstructive Pulmonary Disease (COPD) 0.88 0.86 0.79 0.86 0.93 0.84 0.84 0.76 0.74 0.92 0.71 0.56Vascular Disease 0.92 0.93 0.83 0.74 0.89 0.86 1.09 0.85 0.82 0.92 0.85 0.68Breast, Prostate, Colorectal & Other Cancers and Tumors 0.86 0.88 0.89 0.84 0.88 0.94 0.95 0.82 0.93 0.92 0.82 0.73Specified Heart Arrhythmias 0.94 0.76 0.86 0.91 0.85 0.89 0.86 0.83 0.86 0.91 0.93 0.73Specified Heart Arrhythmias & Congestive Heart Failure (CHF) 0.82 0.80 0.78 0.96 0.94 0.92 1.02 0.77 0.91 0.83 1.12 0.79Metastatic Cancer & Acute Leukemia 0.98 0.95 0.89 0.77 0.85 0.88 0.85 0.75 0.94 0.86 0.85 0.64Rheumatoid Arthritis &
Inflammatory Connective Tissue Disease 0.78 0.86 0.81 0.84 0.85 0.84 0.67 0.98 0.73 0.86 0.86 0.68CHF & COPD 0.75 0.66 0.81 0.85 0.72 0.92 0.90 0.75 0.64 0.74 0.79 0.73Diabetes W/O Complication & CHF 0.97 0.69 0.79 0.80 1.08 0.97 0.71 0.93 0.95 0.58 0.76 0.68Lymphatic, Head and Neck, Brain & Other Major Cancers 0.91 0.84 0.78 0.77 0.92 0.93 0.97 1.06 0.81 0.81 0.80 0.66Vascular Disease & COPD 1.08 0.81 0.79 0.68 0.62 0.76 0.95 1.20 0.73 0.83 0.76 0.71Diabetes W/ Renal or Peripheral Circulatory Manifestation 0.77 0.87 0.67 0.65 0.77 1.00 0.70 0.87 0.95 0.79 0.76 0.70COPD & Diabetes W/O Complication 0.77 0.76 0.79 0.75 0.72 0.67 0.95 0.71 0.78 0.69 0.59 0.63Vascular Disease & Diabetes W/O Complication 0.85 0.91 0.82 0.92 0.67 0.59 0.69 0.82 0.73 0.73 0.89 0.68Major Depressive, Bipolar, & Paranoid Disorders 0.79 0.68 0.80 0.82 0.73 0.77 0.97 0.86 0.79 0.67 0.79 0.58Diabetes W/ Neurologic or Other Specified Manifestation 0.92 0.79 0.70 0.68 0.77 0.83 0.79 0.64 0.64 0.78 0.75 0.67Lung, Upper Digestive Tract, & Other Severe Cancers 0.85 0.66 0.73 0.74 1.21 0.78 0.67 0.64 1.13 0.91 0.93 0.60Renal Failure 0.94 0.70 0.89 0.82 0.73 0.77 0.89 0.72 0.73 0.87 0.99 0.71CHF & COPD & Specified Heart Arrhythmias 0.81 0.69 0.74 0.82 0.90 0.75 0.98 0.81 0.88 1.00 0.88 0.79Diabetes W/O Complication & CHF & Specified Heart Arrhythmias 0.87 0.59 0.73 0.76 1.03 0.72 1.14 0.67 1.05 1.05 0.76 0.73Ischemia or Unspecified Stroke 0.83 0.83 0.81 0.83 0.74 0.69 0.81 0.75 0.53 0.76 0.94 0.69CHF 0.87 0.85 0.69 0.82 0.86 0.82 0.85 0.75 0.93 0.70 0.88 0.63Study Cohort minus beneficairies in above HCC Groupings 0.75 0.72 0.77 0.76 0.77 0.84 0.92 0.71 0.71 0.79 0.81 0.63
Managing the Cost and Quality Factors
Value Performance
Quality of Care
Cost
of C
are
Making Transparent the
Factors that Contribute to
Cost and Quality Variation in
EpisodesOf Care
CMS’ goal is to align the health care delivery systemto better manage all of the factors that impact
the cost and quality of care
Tools to steer healthcare delivery system to target aims:1. Innovation Center Initiatives2. Payment Reforms 3. ACO and Medical Home Initiatives4. Quality Incentives and Penalties 5. Special Emphasis on Dual Eligible Individuals, Health Disparities, and Chronically Ill Populations6. Public Reporting of Performance Information7. Patient Safety and Delivery System Initiatives8. Beacon Community Initiatives
Steering the Healthcare Delivery System to the CMS Targeted Aims
Accountable Care
Healthcare Delivery System 2.0
• Transparent Cost and Quality Performance
– Results oriented– Access and coverage
• Accountable Provider Networks Designed Around the patient
• Focus on care management and preventive care
– Primary Care Medical Homes– Utilization management– Medical Management
IntegratedHealth
• Patient/Person Care Centered– Patient/Person centered Health Care– Productive and informed interactions
between Family and Provider– Cost and Quality Transparency – Accessible Health Care Choices
– Aligned Incentives for wellness
• Integrated networks with community resources wrap around
• Aligned reimbursement/cost Rapid deployment of best practices
• Patient and provider interaction– Aligned care management– E-health capable– E-Learning resources– Public Access to Cost and Quality Data
• Episodic Health Care– Sick care focus– Uncoordinated care– High Use of Emergency Care– Multiple clinical records– Fragmentation of care
• Lack integrated care networks
• Lack quality & cost performance transparency and public information
• Poorly Coordinate Chronic Care Management
Healthcare Delivery System 1.0
Driving Health Care System Transformation Healthcare Delivery System
3.0
Episodic Non Integrated Care
Barriers to Health Care Delivery System Transformation
Episodic/Uncoordinated
Accountable Care
Integrated Care
InfrastructureBarrier
Clinical Care Knowledge
Barrier
Transformation Barrier
Adoption of Health
Information Technology
EnhancingHealth System Performance
Competencies
Personalized Patient-Centered
Health Care Management
CMS Tools For Overcoming Barriers to Healthcare System Transformation
HealthCare Delivery System Transformation
Electronic Health
Records and HIE
Payment Reform
Quality and Cost
Transparency
Service Delivery Redesign
Investments
ACOs and Medical Homes
Shared Savings, Episode- based
Bundled Payments, Value-base
payments, and Partial Capitation
Essential Elements of The Patient Centered Care of a Transformed Healthcare System
Informed,Activated
Patient
ProductiveInteractions
PreparedClinical Team
Requires new web based Health E-Learning, Electronic Care
Planning, and Self Care Management Tools
Requires Meaningful Use Electronic Health Records and
Exchange of Health InformationCommon
Set of Patient Health Information
Seamless & Coordinated Care
Focus on Beneficiary
/Patient Quality and Cost Impact
Accountable for Continuum of
Care improvements
Transformative Clinical
Leadership and Governance
Structure
Organized Care Management
Process, Including
Prevention
Alignment Around
Performance and Outcome
Measurements
Effective Use of Health
Information Technologies
Ability to Manage Clinical Knowledge and
Skills for Effective Teams
Learning Organization
Able to Adapt to Change
Accountable Care Design Elements
Results In
An Accountable System for Beneficiary-Centered Care
Improved Care Coordination and
Integrated Delivery of Care
Increased Provision of Evidence-Based Care
Patient Activation and Increased Health Literacy
Efficient Delivery of Care and Elimination of Waste
Reduced, Contained, and Sustained Cost of Care
Population Health Improvement
Expected Outcomes
Advanced Medical Home
13
Medical Home
3.0
Fully E-Health Capable
Advanced Care
ManagementCapable
Community Practice
TranslationalResearch
Site
Connected to Community ResourceDatabases
Patient E-Learning
Center
Psycho/SocialEvaluation
AndIntervention
CommunityHealth
SurveillanceInterfaces
HorizontallyIntegrated
WithInteroperable
HIT
Remote Bio-metricMonitoring
Capable
Rethinking the CMS Business Architecture to Support Health Delivery System
Transformation
Rethinking the CMS Business Operations Information Technology Framework
Data Processing
Data Management
Layer
Data Standards
Integrated Data
Repository
BusinessServices
Technical Services
Technology Solutions
Technical Functionality
ApplicationArchitecture
Technology Standards
Service Oriented Technical Architecture
Business Operations
B2B ProcessCapacity
SharedBusiness
Applications
Business Intelligence
Tools
Business Architecture
Information Architecture
16
CMS Business Intelligence and Knowledge Management
Population SurveyPerformance Benchmarks
Claims/Encounter
Health Data
Population
Prescription Drug
Premiums / Cap
Provider & ACO Quality & Cost Data
Public & SpecializedData Sets
Beneficiary Data
External Data / Profiles
CMS Program Data
Analytics Tool Suite•Predictive Modeling Tools•Episodes of Care Grouper• Business Intelligence Tools•Geospatial/Simulation Tools
IntegratedData
Repository
Care ManagementAnalysis
Fraud Detection
Medical/Drug U/R& Cost
Performance Analysis
Quality Analysis
ChronicDisease
Sub-databasesRegistries
Business IntelligenceAnalytical
Support System
Eligibility Data
Data Management
Profiles
TranslationStandards
MEGA DATA
Policy and ProgramDevelopment andPublic Reporting
KnowledgeRepository
State Level Electronic Health Record
Deployment and Health Information Exchange
Impact of HIT Better Outcomes , Lower Cost , Improve
Population Health
Improving Health Care Quality, Cost Performance, Population Health
BetterOutcomes
• Improved Patient Safety
• Reduced Complications Rates
• Reduced Cost per Patient Episode of Care
• Enhanced cost & quality performance accountability
• Improved Quality Performance
• Improve Community Health Surveillance
ROI of EHI at Point of Care:
LowerCosts
Population Health
Building Blocks of Next Phase of the Health Information Exchange Platform
Radiology
Health Data Publication Layer
Clinical Lab
DataSources
Health Data Management Layer
Health Data Integration and Translation Layer
Data Analysis Applications
Web Services Application
Collaborative Knowledge Management
PlatformServices
ValueAddedWebServices
Secu
rity
and
Con
sent
Pol
icy
Admin/Claims EHRRx History
The Expanding Role of State Level Health Information Exchange Organizations
Information
Contributor
•Patient Registries•Accountable Care
Organization•Medical Home•Multi-payer
Initiatives
Application
Service
Provider
• Electronic Health Record
• Personal Health Record
Quality and Cost
Reporting
•Qualified Entity Provider Profile
•Public Reporting•Support the Work
of QIO’s
Community Health
Information
•Beacon Community•Community Transformation
PatientsBetter Care
Better HealthLower Cost
Evolving Health System Properties and Influences- - How the Pieces Align & Fit Together - -
PROVIDERS
Medical Homes
Community Care
Transitions Programs
Accountable Care Organizations
SAFE, SEAMLESS COORDINATED CARE
Quality
Reporting
Incentives Bundled
Payment
Maintenance &
Certification
Incentives
Value Based
Purchasing
Multiple
Sites
HAC
PenaltyPhysician
Value
Modifier
Meaningful
Use
Incentives
Readmission
Penalty
Shared
Savings
NursingFacilities
Hospice
OtherProviders
PsychiatricFacilities
Long Term Care
IRFs
HealthCenters
Physicians
Collaborative Improvement Projects & Networks Tool Foundation Transparency and Reporting
Electronic Health Records Demonstrations Conditions of Participation
QIO Technical Assistance Data Sharing Consumer Health Plan Labeling
"Instead of payment that asks "How much did you do?" The new system clearly moves us toward payment that asks "How well did the patient do?"
-- Don Berwick, CMS Administrator
PAYORS
Medicare Advantage
Plans
Exchanges
MedicaidPrivateInsurance
Plans
Medicare
Questions?
Thank you!