Our HealthCare is Broken

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Our HealthCare is Broken Because of the way we pay for it It’s going to get worse Boomer Bulge is here Chronic disease is >75% of costs Country cannot sustain current path Medicare/Medicaid Cuts will happen Technology is just a tool, but it can help enable the needed process and payment changes

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Our HealthCare is Broken . Because of the way we pay for it It’s going to get worse Boomer Bulge is here Chronic disease is >75% of costs Country cannot sustain current path Medicare/Medicaid Cuts will happen - PowerPoint PPT Presentation

Transcript of Our HealthCare is Broken

Page 1: Our HealthCare is Broken

Our HealthCare is Broken

Because of the way we pay for itIt’s going to get worse– Boomer Bulge is here– Chronic disease is >75% of costs

Country cannot sustain current pathMedicare/Medicaid Cuts will happen

Technology is just a tool, but it can help enable the needed process and payment changes– ACOs, EMRs, CDS, VBP, HIEs, etc.

Page 2: Our HealthCare is Broken

Where should we focus first?

Click icon to add picture

Page 3: Our HealthCare is Broken

What is Meaningful Use?Menu set: Select 5 of 10– Drug-formulary checks (one report)– Structured lab results (40%)– Patients by conditions (one report)– Send patient-specific education (10%)– Medication reconciliation (50%)– Summary care record at transitions (50%)– Feed immunization registries (one test)– Hospital Advance medical directives

• (50% > 65yrs.)– Send reminders to patients for preventative

and follow-up care (20% > 65yrs. < 5yrs.)– Patient electronic access to labs, problems,

meds and allergies (10% in 4 days)

Core set: All 15 Measures Required– Demographics (50%)– Vitals: BP and BMI (50%)– Problem list:

ICD-9-CM or SNOMED (80%)– Active medication list (80%)– Medication allergies (80%)– Smoking status (50%)– Patient clinical visit summary (50% in 3 days)– Hospital discharge instructions (50%)

- or -Patient with electronic copy (50% in 3 days)

– e-Prescribing (40%)– CPOE (30% including a med)– Drug-drug and drug-allergy interactions– Exchange critical information (perform test)– Clinical decision support (one rule)– Security risk analysis– Report clinical quality (BP, BMI, Smoke, 3

others)

20 things you must do to get money from the government and avoid penalties in the future

Stuff we should have been doing

Page 4: Our HealthCare is Broken

What is an Accountable Care Organization?

• A defined team of caregivers responsible for a defined population’s health– Shared Savings (& risk)

• Improve overall health and thus lower costs• Incentive Alignment

– Better, consistent communications• Outcome measures • EMRs/Web• Medical Home models

– Access– Population management– Care plans & management– Self Care– Track care & referrals– Measured performance

Stuff we should have been doing

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Why should Docs Care?

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Foundations for the Next Decade

Providers must generate population-level reports and analytics.

To effectively decrease costs and keep patients well, clinical data must be fluid, usable, and have consumer accountability.

Population Management

Coordinate Care and Engage Patients

1

2

3

4

To measure and achieve quality targets, providers need the ability to integrate EBM, document processes, monitor & report on quality markers.

Monitor & Improve Quality

Providers must be able to understand how each provider is delivering care and manage the payment distribution to incent the correct outcomes.

Manage the Organization

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Current Situation

• To Manage, you must Measure– Viable Input method, Analysis, and Display at low Cost– Growth in # of Measures and complexity strains resources

• Manual processes aren’t scalable for Data management– Data Warehouses and Interfaces are essential

• Computer Systems must understand context and situation– Problems, Meds, Labs, Procedures, Allergies, Orders

• Processes are Part of the Problem– Capture data in the same way every time– Right Data, place, time, person, method

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Heartland Health Technology

Patient-Entered

dataEDIS

Physician Documentation

Pathologyimaging

Clinical/financialAnalytics EDW

RFID

Innovators 1

Early Adopters 2

ConsensusAdopters

3

CautiousAdopters 4

Late Adopters 5

IntegratedIP/OP EMR

RemoteICU

Inpatient EMR

Clinical datarepository

AmbulatoryEMRSmartphones

Mobile Systems

Point of CareCDS

CriticalCare IS

Device Mgmt

Laboratory IS

Radiology ISPACS

Pharmacy IS

Master patientindex

Surgical IS

CVIS

Bedsidecomputers

Purple = DoingGold = considering

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Bar Code Meds Mgmt

Inpt CPOE

E visits /Pt portal

ACO/MU workflows

Home Monitoring

Remote Presence Telemedicine

New partnerships

LACIE HIE

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IncentivesProcesses

& Standards

Outcomes&

Quality Measures

Commun.systems

Providers and Patients

Current

Pay for procedures- Short visits- Illness care

Provider vs insurance vs patient

Fraud, poor quality and inefficiency rarely penalized

Ad hoc processes

Revolve around $

Silos rewarded

Whatever the user remembers from long ago

Manual extraction

Non specific

Retrospective weeks later

Small data sets

PaperFaxPhoneFace to Face or Repeat test orDo without

Long wait times

Decisions based on minimal data

Page 10: Our HealthCare is Broken

IncentivesProcesses

& Standards

Outcomes&

Quality Measures

Commun.systems

Providers and Patients

Current

Pay for procedures- Short visits- Illness care

Provider vs insurance vs patient

Fraud, poor quality and inefficiency rarely penalized

Ad hoc processes

Revolve around $

Silos rewarded

Whatever the user remembers from long ago

Manual extraction

Non specific

Retrospective weeks later

Small data sets

PaperFaxPhoneFace to Face or Repeat test orDo without

Long wait times

Decisions based on minimal data

New

Pay for Health

Shared Savings

Efficiency rewarded

Payer, patient and provider aligned

Lean/Evidence based

Determined prior to care = fair

Available and updated

Real time Point of Care in EMR

Measures support competition

Population based but patient specific

Transparency required

EMR essential

Mobile

Team based

Can see alerts across complete data

Patient choice in treatment based on data

Maximize licenses

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If we have that….

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It’s more than just dashboards

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Preventive and Health Maintenance Measures

User customizable components for

various workflows

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What Needs to be Done?

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Physician ScorecardsdPopulation in need with one

click

“Drill Down” Physician Quality Measure

comparisons

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LACIE Provider View: Integrated with EMR

dSource of information

Linked reports

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Give it to someone else

Actionable orders at

POC

Exclusions

Risk Calculation

Associated lab with meds

Clinical Decision Support at Point of Care

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Population Summary for Qual Measures

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Customizable Filters

Individual Quality Measures and management

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Who is at Risk?

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Why, Again? • Example lifeline with poor diet, activity

level

• Lifeline with Health promotion – Prevention, exercise, diet– Best evidence based care

0 20 30 40 50 60 70 80 90

Vita

lity

Source: Extremely Scientific Guesswork, inc.

For CFOs – Lost productivity,

lower claims

For Patients – Happier, healthier

lives