1. 2011 Douglas T. Miller Symposium Dennis Wagner, Acting Director, Office of Clinical Standards and Quality Centers for Medicare & Medicaid Services April 29, 2011

2. Plan for This Segment “Gestalt” Overview of CMS, Health Reform and Quality Improvement Quality Improvement Lessons from the Organ Donation Breakthrough Collaborative – A Story of Abundance

3. Questions to Run On What is happening with healthcare reform nationally and at CMS? What can we learn and apply from the success of the national organ donation quality improvement work? What is my advice for CMS? 3

4. CMS is Changing 4

5. CMS Vision CMS is a major force and a trustworthy partner for the continual improvement of health and health care for all Americans. 5

6. Operating Values How we shall work together and with others? Boundarilessness Speed and Agility Unconditional Teamwork Valuing Innovation Customer Focus 6

7. Better Health for the Population Better Care for Individuals Lower Cost Through Improvement The “Three-Part Aim” Generating Abundance for Patients 7

8. Affordable Care Act Some Key CMS Accountabilities Major, Ongoing Demonstration & Testing Authority & Resources (Center for Innovation) Accountable Care Organizations Value Based Purchasing Programs Health Insurance Exchanges Expanded Medicaid Programs Care Transitions to Reduce Readmissions Expanded Quality Reporting Programs Expanded Preventative Services ….and Much More

9. What Will the Affordable Care Act Look Like on the Front Lines? Increasing measurement of quality, efficiency & value Public reporting and sharing of data Reimbursement linked to quality, efficient service delivery, and cost reduction thru improvement Increasing integration of delivery systems and coordination of care across settings Greater role in addressing public health issues Greater use of health information technology Creation of a learning environment in healthcare 9

10. New Tools, New Incentives, New Penalties, New Organizations What does it all mean? 10

11. Value-Based Purchasing and Linking Payment to Quality “ A major, overarching theme in the Affordable Care Act is one of measurement, transparency, and altering payment to reinforce, not simply volume of services, but the quality of the effects of those services. Instead of payment that asks, “How much did you do,” the Affordable Care Act clearly moves us toward payment that asks, “How well did you do?” and, more important, “How well did the patient do?” That idea is at the heart of Value-Based Purchasing. It is not just a CMS idea; it is one increasingly pervading the agenda of all payers.” Don Berwick, CMS Administrator, April 4, 2011 11

12. New Tools, New Incentives, New Disincentives, New Organizations What does it all mean? Doing the right things for patients will become easier and doing the wrong things will become more difficult. 12

13. Questions for Quick Reaction and Discussion What do you like about what you see in this high level summary? What do all of us need to do more of, better, differently? 13

14. 14 The Healthcare Quality/Value Challenge U.S. spends more per capita on healthcare than any other country in the world Quality is often inferior to that of other nations Significant variation in quality and cost by geographic location Serious disparities in the quality of health care by race, and socioeconomic status

15. How do we make quality better? 15

16. How do we make quality better? -- Stages of Personal Accountability -- Stage 1. “The data are wrong” Stage 2. “The data are right, but it’s not a problem” Stage 3. “The data are right; it is a problem; but it is not my problem.” Stage 4. “I accept the burden of improvement”

17. How do we make quality better? Clear Intent – Will Proven Practices – Ideas Focused, Constant Action -- Execution 17

18. How do we make quality better? Clear Intent – Will Proven Practices – Ideas Focused, Constant Action – Execution Your work on organ donation is an extraordinary national example of what is possible. 18

19.  50% of eligible donors are found in 206 hospitals  75% of eligible donors are found in 483 hospitals  90% of eligible donors are found in 846 hospitals Concentration of Potential Donors In Nation’s Largest Hospitals

20. Tremendous Variation in Donation Rates in 300 Largest Hospitals

21. Collaborative Engine Select Topic Planning Group Identify Change Concepts Enroll Participants Prework LS 1 LS3 LS 2 Support System ListServe Site Visits & Filming Conference Calls Rapid Sharing Data Reporting Website S AD P S AD P

22. Measures of Success

24. UWHC OPO Performance Rates by Year OPO Conversion Rate: (Eligible Donors/Eligible Deaths) OPO Adjusted Conversion Rate: (Eligible Donors + Other Donors/Eligible Deaths + Other Donors)

25. What generated this abundance of life saving results?  Including the Customer: Donor Families and Recipients  Clear, Ambitious, Achievable Aims  Transparent About Data and Practice  Model for Improvement and Collaborative Methodology  Teaming Nationally to Work Smarter, Faster  Creating Bolder, Thoughtful Agendas for Action  Rapid Testing & Change  Using Proven Practices  Doing More Of What Works  Relentless Pursuit of Improvement, Never Settling for the Status Quo

26. Questions for Discussion and Action What are your key insights about the organ donation improvement work? How can each of us take this further? What can we learn and apply to our current challenges and opportunities with healthcare reform? 26

27. “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” –Margaret Mead

28. Contact Information Dennis Wagner Acting Director, Office of Clinical Standards and Quality Centers for Medicare and Medicaid Services Office of Clinical Standards and Quality 7500 Security Blvd., MSC: S3-02-01 Baltimore, MD 21244-1850 Phone Number: 410-786-6841 E-mail Address: dennis.wagner2@cms.hhs.gov 28

29. Question for Reflection and Action What is it about this work that makes my heart sing? 29