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Beacons and the Health 2.0 Community



 Office of the National Coordinator for Health
 Information Technology
 July 21, 2010
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
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
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
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
“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
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
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
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
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
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
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
Round 1 Beacon Communities




                             14
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
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
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
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?

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Beacons and the Health 2 0 community

  • 1. Beacons and the Health 2.0 Community Office of the National Coordinator for Health Information Technology July 21, 2010
  • 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. 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. 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. 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
  • 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. 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. 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. 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. 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. 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. 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. Round 1 Beacon Communities 14
  • 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. 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. 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. 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?