Kate Ryan, National Women's Health Network. This is Part 2. For the beginning of the Workshop, please see Sloan - Workshop C - Part 1.

1. Kate Ryan National Women‘s Health Network August 12, 2011 Promoting Evidence-based Health Care in ACOs

2. Goals of the ACO model ACOs will have dual measures of success improving the quality of care lowering the cost of care How can these goals be achieved through increased use of evidence-based health care (EBHC)?

3. Evidence in ACOs The ACA requires an ACO to "define processes to promote evidence-based medicine” and the HHS regulation allows for flexibility within the ACO model Each proposed ACO must provide documentation in its application describing its plans to promote evidence-based medicine

4. ACO definition of EBHC In the regulation, evidence-based health care: seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests based on the best available scientific evidence applies this evidence to the processes of medical decision-making and treatment

5. General Plan to Promote EBHC To demonstrate incorporation of EBHC, ACOs should: Describe the evidence-based guidelines it will follow or establish Describe how it will implement these guidelines Describe how it will demonstrate it is following these guidelines

6. ACOs & Chronic Conditions ACO population is more likely to have chronic conditions, and women are disproportionately impacted 90% of older adults have at least one chronic health condition 77% have multiple chronic conditions. 96% of Medicare dollars is spent on patients with multiple chronic conditions.

7. Chronic Conditions & Evidence Older adults with multiple chronic health conditions report duplicate tests and procedures conflicting diagnoses for the same set of symptoms contradictory medical information not receiving adequate information about potential drug interactions when they fill prescriptions. How could evidence-based guidelines address these problems?

8. Evidence in Practice Evidence-based practices to lower readmission rates greater attention to follow-up care during hospital discharge results in lower readmission rates 1 female stroke survivors are less likely than males to receive complete stoke prevention information including medication and outpatient follow-up 2 Helfand, Duke. “Health care partnership pays big dividends.” Los Angeles Times. August 1, 2011. http://articles.latimes.com/2011/aug/01/business/la-fi-healthcare-savings-20110802 Agency for Healthcare Research and Quality (AHRQ), Health Care for Minority Women: Recent Findings (Pub. No. 11P005). Rockville MD: AHRQ, 2010. Available online at: http://www.ahrq.gov/research/minority.htm

9. Women’s Health in ACOs Because women live longer, older women are more likely than men to have multiple chronic conditions that require care coordination Socio-economically disadvantaged and minority women experience the highest burden of chronic illness, disability, and co-morbidity 1 Bierman AS and CM Clancy, “Health disparities among older women: identifying opportunities to improve quality of care and functional health outcomes”, Journal of the American Medical Women’s Association 2001; 56(4): 155-159, 188.

10. Communication & Patient Engagement Reduce unnecessary treatment by improving communication Improve patient understanding of follow up care Reduce the potential for dangerous drug interactions  Reduce hospital readmission rates

11. Communication & Patient Engagement Ensure patients understand their treatment options Communicate the evidence of risks and benefits for all available treatments Hot flashes Osteoporosis Talk to patients about their values and priorities

12. The Impact of EBHC Improved communication and patient engagement can reduce unnecessary hospitalizations, tests and treatments and indirectly lower costs Health care providers could also lower costs by promoting use of generic drugs when they are available

13. Conclusion Widespread use of evidence-based health care in ACOs can: Improve communication with patients Engage patients in decisions making Reduce unnecessary hospitalizations, tests and treatments Reduce costs to the health care system

14. Questions? How could ACO's be a useful tool for promoting evidence-based care? What are the current evidence-based practices for coordinating care that ACOs could model?

15. Questions? How should we recommend that ACOs measure their success in promoting evidence-based health care? Quantitative/qualitative metrics?

16. Thank you Kate Ryan National Women’s Health Network 202-682-2640 kryan@nwhn.org