1. Collocated Congress on the Un- and Under-insured
Fixing Health Care from the Inside Out: The Physician’s Role in Health System Reform
Collocated Congress on the Un- and Under-insured
and National Congress on Health Reform
Sept. 23, 2008
Jack Lewin, M.D.
CEO

2. Reform is Necessary 47 million are uninsured
50 million are underinsured
79 million struggle with medical debt
Lack of coordinated care
High cost, low value for the dollar
Inconsistent quality
Inefficient use of resources
Care is not patient-centered
Professional judgment challenged

3. Distribution of Fee-for-Service Medicare Spending Among Beneficiaries, 2001
Percent
Fee-for-Service
Beneficiaries
Total Fee-for Service
Spending
Source: Congressional Budget Office

4. Cardiologist-Reported Challenges to Quality
% Often
Patient had trouble affording out-of-pocket costs
51%
Medical records, results, or other clinical information were not available at scheduled visit
29%
Care compromised because of conflicting information from different doctors
19%
Tests or procedures had to be repeated because findings were unavailable or inadequate
17%
Q. In the past 12 months, how often have you directly observed the following?
CV professionals are most likely to observe payment difficulties among patients. Lack of availability of medical records, compromises in patient care, repeating tests/procedures and inappropriate follow-up also occur in practice but less often.
Positive test result without appropriate follow-up
14%

5. Responsibility Comparison
CV Specialists strongly differ from policy makers regarding who should shoulder the responsibility for setting quality standards. Over half of healthcare policy makers felt that a new public/private national entity should be responsible for setting standards for quality measurement and performance while cardiologists target provider professional societies for this role.

6. Policymakers Say …
Almost two-thirds of respondents say that Professional Societies such as the A.C.C. should be responsible for setting standards for quality measurement and reporting

7. CV Professionals Say …
Almost two-thirds of respondents say that Professional Societies such as the A.C.C. should be responsible for setting standards for quality measurement and reporting

8. A Fork in the Road

9. They will fail again. (Think disparities!)
Policies centered around cost and volume controls have failed in the past.
They will fail again.
(Think disparities!)

10. PROACTIVE
rather than
REACTIVE

11. What about the patient?

12. Patient in the Center O.O.P.s Informed (CardioSmart™) Choices
Responsibility for lifestyle and adherence
Boomers …

13. We must transform health care …
… from the inside out.

14. Events to Date BOT Visioning Session, 8.07 Blue Ribbon Panel
Key Issues Debated, Vetted
Draft Document Developed
Presented at Health System Reform Summit, Feb 1 – 2
Stakeholder Meetings
Legislative Proposals

15. Principles of Health Care Reform
Universal access to necessary care
Public/private financing
A focus on high-quality, patient-centered care
Patient, physician, medical team at the center
Payment incentives for quality care and value
Coordination across sources and sites of care

16. How Important Are these Principles?
Top 2
Increase patient value through the delivery of evidence-based, high quality care
95%
Involve patients as partners in their own care
91%
Provide universal access through an expansion of public/private financing
86%
Implement a payment system that rewards quality, value and coordinated care management
86%
Manage care by disease state and across sources and sites of care
89%

17. Quality First Web Site

18. QCARE

19. QCARE in Action

20. Field Base Consultant potential partnership with AHA
NCDR At a Glance Today…
Guidelines Develop.
Educational Needs Assess.
Market Intelligence
Analytic
Reporting Services
Registries
United PA
ACC
CathPCI
IMPACT MI
BCBSA
WellPoint WV
Research &
Publication Services
ICD
IC3
CMS
HCA
Tenet
CARE
Yale
40+ Studies on the docket
DCRI
MAHI
ACTION-GWTG
Certainly this slide is not intended for a detailed review!!!
A lot of group. Tipping point for other stakeholders seeking NCDR for data quality.
Focus on new initiatives for NCDR
How ACTION and ML are working together going forward
How IC3 is organized.
20 million operating budget with 2.5m net return in 2009
Talking points
As you can see the NCDR has grown to represent a suite of services that supports Analytic Reporting Services, QI and Research.
We have:
6 registries,
a couple registry studies, and
Several payors and states who subscribe to receive analytic reports from consenting participants.
We also started to respond to a flurry of internal analytic requests to support guideline development, educational needs assessment, and market intelligence
We’ve continued to fast track our research pipeline and have more than 40 potential studies either in process or being considered.
Lastly, we continue to put more and more emphasis on quality improvement. For 10 years our registry reports have been a primary QI tool for 1,000s of hospitals, but now we’re developing more QI tools and exploring a partnership with AHA for field based consulting.
Quality Improvement
Registry Studies
More Registry QI Tools
(ACTION, IC3, etc)
SPECT MPI
Field Base Consultant potential partnership with AHA
ICD Longitudinal 20

21. Appropriate Use Criteria
Echo CT MR
SPECT-MPI
Stress testing
Multi-modality
Stents vs. CABG vs. Meds

22. CQI and Transparency

23. New patient-centered, quality and value–based payment concepts.
We Have …
Perverse Incentives.
We need …
New patient-centered, quality and value–based payment concepts.

24. New patient-centered, quality and value–based payment concepts.
We Need …
New patient-centered, quality and value–based payment concepts.

25. The Greatest Threat to Physician Autonomy

26. Autonomy vs.
Systems of Care

27. Learning Systems
rather than
Cookbooks

28. Nothing About You
Without You

29. Who will save us?