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!