The Long Game: Advancing the Health IT Agenda to Improve ... · The Long Game: Advancing the Health...

The Long Game: Advancing the Health IT Agenda to Improve Care Delivery

John Glaser, Ph.D. CEO, Siemens Health Services January 29, 2015

Objective of the Long Game

•  In golf

–  To get to the green in one shot

or

–  To minimize the number of shots needed to get to the green

•  In healthcare information technology

–  To position your organization and its information systems for an uncertain future

or

–  To minimize the number of information systems detours to get to that future

The Majority of an Average Provider’s Revenue Will Likely Be Risk-Based in 10 Years

Source: The Advisory Board Company, Jan. 2014

On Jan. 26, 2015 HHS Set Goals for Expanding New Medicare Payment Models

•  Set goals to move from volume to value for all Medicare payments

  First goal is make payments tied to using alternative payment models

  30% by 2016

  50% by 2018

  Second goal is all fee-for-service payments be tied to quality and value

  85% in 2016

  90% in 2018

•  Announced Health Care Payment Learning & Action Network to facilitate public-private sector partnership

Reimbursement Changes are Leading to a Greater Emphasis on Population Management, Consolidation/ New Organizational Models and a Focus on Improving Quality

Oliver Wyman, The Volume-to-Value Ratio, 2012

amednews.com, ACOs, already surging, poised for even more growth, Dec. 2012

The Commonwealth Fund, Rehospitalizations among Patients in the Medicare Fee-for-Service

Program, April 2009

Barton Associates, Number of retail clinics will double in 3 years, July 2013

CMS, Readmissions Reduction Program, April 2013

Centers for Disease Control, Chronic Disease Prevention and Health Promotion, July 2013

Over 25% of the US Population Will Be Covered by an ACO by 2018

Source: Leavitt Partners – Providers & the New World of Accountable Care (Feb, 2014)

Source: Best Care at Lower Cost, September 2012 Institute of Medicine; Smith, M Study Chair

Less than 50% of elderly patients are up to date on clinical preventive services Elderly patients with

co-morbidities require up to 19 medication doses daily

Every year, the average elderly patient sees 7 doctors across 4 practices

Specialties

Primary Care

Average surgery patient is seen by 27 different health care providers

RNs

MDs

Allied Health Less than half of non-

surgical patients follow-up with their primary care provider after discharge

1 out of 5 elderly patients are readmitted within 30 days

Preventive Self Management Outpatient Care Hospital Follow-up

Providers Will Need to Manage and Improve Multiple Disease-Invariant Care Processes

Today's Providers Are Addressing These Challenges By Adopting a Foundation of Sophisticated IT

Today’s providers are taking on risk arrangements and need to proactively manage the care and wellness of their patient population by:

•  Managing care over a continuum

•  Managing the health of populations and individuals

•  Supporting care teams with evidence-based processes and advanced analytics

•  Engaging patients (and their families) to take the necessary steps to improve their health

•  Improving the efficiency and effectiveness of core operations

And providers must accomplish all of this across an ecosystem with multiple IT systems.

Percent of Office-Based Physicians with EHR systems: U.S., 2001-2013

Physician Adoption of EHRs Has Increased Steadily

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001–2013.

SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement

Electronic Health Information Exchange Among Hospitals and Outside Providers Increased 51% from 2008 to 2013

Hospital Health Information Exchange Has Increased Since 2008

HIT Venture Investments Show Strong Growth

Year! Dollars! Deals!2010 $1.1B" 142

2011 $1.6B" 242

2012 $2.2B" 447

2013 $2.8B" 580

2014" $6.5B 459

Source: StartUp Health, 2014

Continue laying the HIT foundation

What’s next… in 2015 and beyond?

EH and EP Meaningful Use Adoption Appears to be Progressing

•  Historically, eligible hospitals and professionals attest after their reporting year closes

–  Most hospitals attested after FY2014 closed

–  Eligible professionals have until February 2015 to attest

•  Not all Eps and EHs are eligible for Stage 2

–  56% of EHs are eligible

–  42% of Eps are eligible

•  Among providers eligible for Stage 2 in 2014:

–  More than 8 in 10 hospitals have attested; among those, 77% attested to Stage 2

–  13% of professionals have attested; of those, almost 6 in 10 attested to Stage 2

Source: CMS, 2014

Major Improvements Needed in IT Adoption Among Long Term/Post-Acute Care Providers

•  Long-term care providers have not yet adopted health IT and EHRs on a “broad scale,” according to a March 2013 ONC report.

•  Not Eligible for Medicare and Medicaid EHR Incentive Programs

•  No national data on HIT adoption available

•  Low level of HIE participation

•  According to a 2014 Black Book survey, two-thirds (63%) of all post-acute care providers report that they either don’t have—or aren’t fully using—information systems, technology and patient data exchanges.

•  Black Book also reports that a sizable portion (89%) of single or standalone nursing homes and SNFs reported having no money budgeted for 2014 technology projects. But most (84%) large SNF and post-acute care providers had funds allocated in 2014 for technology improvements.

While Improving, HIE Still Has A Ways to Go

Source: Circle Square, HIT Trends, 2014


Adjusting the Federal focus


Federal Role Will Focus Less on MU Feature/Function and More on Quality Measures, Interoperability and Program Linkages

The Federal Health IT Strategic Plan 2015-2020 describes the government’s strategies to achieve five goals:

Attempting to Accelerate Interoperability


Adjusting the Federal focus Continuing to move to full HIT support of new care models


Core Technology Components Will Be Required

  An electronic health record that spans the continuum of care

  A revenue cycle application that spans the continuum of care

  Sophisticated business intelligence and analytics

  Applications that support the management of populations and the coordination of care

  Systems that enable interoperability between closely affiliated providers

  Technologies that support the engagement of patients

  Services that enable maximum leverage of healthcare IT investment

The key is managing the care plan of the individual and stepping back and looking at the population in aggregate. Populations will include those that are a readmission risk,

are undergoing a procedure bundle or have a chronic disease.

IT Support of Care and Population Management Represents a Big Shift from the EHR

IS Support of New Care Models is in its Early Stages

Source: Square Circle, HIT Trends, 2014



Adjusting the Federal focus Continuing to move to full HIT support of new care models Harnessing the power of data

Greater Intelligence in Systems and Increased Use of Big Data Has the Potential to Transform Healthcare

  Post market surveillance of medication and device safety

  Comparative effectiveness research

  Assignment of risk (e.g. readmissions)

  Novel diagnostic and therapeutic algorithms in areas such as oncology

  Real time status/process surveillance (e.g. patient compliance with treatment regimens)

  Identification of patterns in the data using structured and unstructured data (e.g. determining if a patient is following their treatment regime by looking at medication compliance, grocery purchases, sensor and activity data)

  Machine correction of data quality problems

Leveraging Increases in Data Velocity to Enable Concurrent Monitoring of Clinical Performance

Tracking the Discovery of Vioxx’s Adverse Effects Through EHR Data

Source: Brownstein, PLoS ONE, 2007

Figure 1

Cumulative sum chart of monthly incidence of hospitalizations due to myocardial infarction from January 1, 1997 to March 30, 2006

Monitoring Social Media for Patient Discussion of Medication Use and Effectiveness


Adjusting the Federal focus Continuing to move to full HIT support of new care models Harnessing the power of data

Engaging the patient


Efforts to Increase Patient Engagement and Better Manage Chronic Disease Will Deepen

The Reach of the Specialist/Care Giver Will Be Extended

The Degree to Which IT Will Strengthen Engagement is Unclear

Source: Square Circle, HIT Trends, 2014

•  Business Process Management •  Industry Analyst, Derek Miers

But, it’s not just about the implementation of specific applications…

Material Changes in Business Models, Technologies and/or Environment Lead to Significant Changes in an Industry’s Core IT Platforms

Retail World Wide Web Web-based product review, comparison and ordering

Banking Deregulation Funds Management

Content Distribution World Wide Web

Music ecosystems; Free news; Craigslist

Shipping GPS; Bar codes; Handheld devices

Real time package tracking

Digital Intensity vs. Transformation Ability: The Impact on Profitability

Source: The Digital Advantage, Cap Gemini & MIT, 2012

Gross Margin Impact of Savvy IT Investments

Source: McAfee and Brynjolfsson, 2008

Spread between the gross margins of companies in the top 25% and companies in the bottom 25% of an IT-intense industry

Summary

• The long game will be a time of extraordinary change for healthcare and healthcare information technology.

• We have the opportunity to truly improve the care that we deliver.

• It will take our collective efforts.

Questions ?

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