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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.

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Presentation on theme: "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."— Presentation transcript:

1 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 –ACOs, EMRs, CDS, VBP, HIEs, etc.

2 Where should we focus first?

3 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

4 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

5 Why should Docs Care? 5

6 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 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

7 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

8 Heartland Health Technology Patient- Entered data EDIS Physician Documentation Pathology imaging Clinical/financial Analytics EDW RFID Innovators 1 Early Adopters 2 Consensus Adopters 3 Cautious Adopters 4 Late Adopters 5 Integrated IP/OP EMR Remote ICU Inpatient EMR Clinical data repository Ambulatory EMR Smartphones Mobile Systems Point of Care CDS Critical Care IS Device Mgmt Laboratory IS Radiology IS PACS Pharmacy IS Master patient index Surgical IS CVIS Bedside computers Purple = Doing Gold = considering 8 Bar Code Meds Mgmt Inpt CPOE E visits /Pt portal ACO/MU workflows Home Monitoring Remote Presence Telemedicine New partnerships LACIE HIE

9 Incentives Processes & 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 Paper Fax Phone Face to Face or Repeat test or Do without Long wait times Decisions based on minimal data

10 Incentives Processes & 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 Paper Fax Phone Face to Face or Repeat test or Do 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

11 If we have that….

12 It’s more than just dashboards

13 Preventive and Health Maintenance Measures User customizable components for various workflows

14 What Needs to be Done?

15 Physician Scorecards dPopulation in need with one click “Drill Down” Physician Quality Measure comparisons

16 LACIE Provider View: Integrated with EMR dSource of information Linked reports

17 Give it to someone else Actionable orders at POC Exclusions Risk Calculation Associated lab with meds Clinical Decision Support at Point of Care

18 Population Summary for Qual Measures 18 Customizable Filters Individual Quality Measures and management

19 Who is at Risk?

20 Why, Again? Example lifeline with poor diet, activity level Lifeline with Health promotion –Prevention, exercise, diet –Best evidence based care Vitality Source: Extremely Scientific Guesswork, inc. For CFOs – Lost productivity, lower claims For Patients – Happier, healthier lives


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