Presentation on theme: "American Association of Colleges of Pharmacy"— Presentation transcript:
1 American Association of Colleges of Pharmacy Anthony D. RodgersDeputy AdministratorFebruary 2011
2 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.
3 Strategic Aims and Priorities CMS Business Environments Achieving CMS Three Part Aims and Priorities Through Improvements to CMS Business EnvironmentsStrategic Aims and PrioritiesCMS Business EnvironmentsCMS Strategic AimsBetter careLower per capita costBetter health for populationsStrategic Priority AreasExcellence in operationsImproved care deliveryIntegrated carePrevention and community healthCMS Business OperationsEnterprise ManagementStrategic Enterprise PlanningPolicy and regulatory leversACA implementationCost containment strategiesPublic Information and Customer ServiceInnovationIt will be unclear to the audience what the difference is between Strategic Aims and Strategic Priority Areas
4 Sample Data Table for High-Cost HRRs (2007 Data) A ratio for each HRRxHCC
5 Sample Data Table for Low-Cost HRRs (2007 Data) A ratio for each HRRxHCC
6 Driving Health Care System Transformation Healthcare Delivery System 3.0IntegratedHealthPatient/Person Care CenteredPatient/Person centered Health CareProductive and informed interactions between Family and ProviderCost and Quality TransparencyAccessible Health Care ChoicesAligned Incentives for wellnessIntegrated networks with community resources wrap aroundAligned reimbursement/cost Rapid deployment of best practicesPatient and provider interactionAligned care managementE-health capableE-Learning resourcesHealthcare Delivery System 2.0Healthcare Delivery System 1.0Accountable CareEpisodicNon IntegratedCareTransparent Cost and Quality PerformanceResults orientedAccess and coverageAccountable Provider Networks Designed Around the patientFocus on care managementand preventive carePrimary Care Medical HomesUtilization managementMedical ManagementEpisodic Health CareSick care focusUncoordinated careHigh Use of Emergency CareMultiple clinical recordsFragmentation of careLack integrated care networksLack quality & cost performance transparencyPoorly Coordinate Chronic Care Management
7 CMS AIMSCMS aims to: 1. Measurably improve care provided to all patients in all settings while reducing cost by continuous improvement, 2. That every Medicare, Medicaid, and insured beneficiary receive seamless coordinated care, 3. That population health status is improved by organizing the delivery system and raising community health capacity.
8 CMS 2011 Focus Delivery System Transformation Patient Safety ACO DiffusionMedical/Health Home DiffusionPatient SafetyHospital Readmission RatesHospital Acquired Conditions RatesImprove Care TransitionsCost and QualityValue Base PurchasingAligned Performance Incentives
9 CMS Tools for Transforming the Delivery System Shared Savings, Episode- based Bundled Payments, Value-base payments, and Partial CapitationACO’s and Medical HomesHealthCare Delivery System TransformationElectronic Health Records and HIEPayment ReformQuality and Cost TransparencyService Delivery Redesign Investments
10 Essential Elements of The Patient Centered Care of a Transformed Healthcare System Seamless & Coordinated CareInformed,ActivatedPatientProductiveInteractionsPreparedClinicalTeamThe advisory committee told us that good outcomes are the result of productive interactions between an informed, activated patient (and their family or caregivers) and a prepared, proactive practice team. This is what the chasm report calls continuous healing relationship.Wagner EH, Davis C, Schaefer J, Von Korff M, Austin B. A survey of leading chronic disease management programs: Are they consistent with the literature? Managed Care Quarterly. 1999;7(3):56-66CommonSet of PatientHealth InformationRequires Electronic Health Records and Exchange of Health InformationRequires new web basedHealth E-Learning, Electronic Care Planning andSelf Care Management Tools
11 An Accountable System for Beneficiary-Centered Care Accountable Care Design ElementsExpected OutcomesFocus on Beneficiary /Patient Quality and Cost ImpactAccountable for Continuum of Care improvementsTransformative Clinical Leadership and Governance StructureOrganized Care Management Process, Including PreventionAlignment Around Performance and Outcome MeasurementsEffective Use of Health Information TechnologiesAbility to Manage Clinical Knowledge and Skills for Effective TeamsLearning Organization Able to Adapt to ChangeImproved Care Coordination and Integrated Delivery of CareIncreased Provision of Evidence-Based CarePatient Activation and Increased Health LiteracyResults InEfficient Delivery of Care and Elimination of WasteReduced, Contained, and Sustained Cost of CarePopulation Health Improvement