Transcript Heartland Health - University of Missouri School of Medicine

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.
Where should we focus first?
What
is
Meaningful
Use?
20 things you must do to get money from the government and
avoid penalties in the future
Core set: All 15 Measures Required
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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)
Menu set: Select 5 of 10
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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.)
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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)
Stuff we should
have been doing
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
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Access
Population management
Care plans & management
Self Care
Track care & referrals
Measured performance
Stuff we should
have been doing
Why should Docs Care?
5
Foundations for the Next Decade
1
Monitor & Improve Quality
To measure and achieve quality targets, providers need the ability
to integrate EBM, document processes, monitor & report on
quality markers.
2
Coordinate Care and Engage Patients
To effectively decrease costs and keep patients
well, clinical data must be fluid, usable, and have
consumer accountability.
3
Manage the Organization
Providers must be able to understand how each
provider is delivering care and manage the payment
distribution to incent the correct outcomes.
4
Population Management
Providers must generate population-level reports and
analytics.
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
Heartland Health Technology
Purple = Doing
Gold = considering
Remote Presence
Telemedicine
Bedside
computers
Home Monitoring
E visits /Pt portal
Smartphones
Mobile Systems
Ambulatory
EMR
CVIS
Clinical/financial
Analytics EDW
Device
Mgmt
Point of Care
CDS
Bar Code
Meds Mgmt
ACO/MU workflows
LACIE HIE
New partnerships
Physician
Documentation
PatientEntered
data
Pathology
imaging
Innovators
1
Critical
Care IS
RFID
Clinical data
repository
Laboratory IS
Inpt CPOE
Master patient
index
Radiology IS
PACS
EDIS
Remote
ICU
Integrated
IP/OP EMR
Early
Adopters
2
Inpatient EMR
Consensus
Adopters
Surgical IS
Cautious
Adopters
4
Pharmacy IS
Late Adopters
5
8
Incentives
Pay for procedures
- Short visits
- Illness care
Processes
&
Standards
Ad hoc processes
Outcomes
&
Quality
Measures
Manual
extraction
Revolve around $
Current
Non specific
Provider vs
insurance vs
patient
Fraud, poor quality
and inefficiency
rarely penalized
Silos rewarded
Whatever the user
remembers from
long ago
Retrospective
weeks later
Small data sets
Commun.
systems
Paper
Fax
Phone
Face to Face
or
Repeat test
or
Do without
Providers
and
Patients
Long wait times
Decisions based
on minimal data
Incentives
Pay for procedures
- Short visits
- Illness care
Processes
&
Standards
Ad hoc processes
Outcomes
&
Quality
Measures
Manual
extraction
Revolve around $
Current
Non specific
Provider vs
insurance vs
patient
Fraud, poor quality
and inefficiency
rarely penalized
Pay for Health
Silos rewarded
Whatever the user
remembers from
long ago
Retrospective
weeks later
Commun.
systems
Paper
Fax
Phone
Face to Face
or
Repeat test
or
Do without
Long wait times
Can see alerts
across complete
data
Lean/Evidence
based
Real time Point
of Care in EMR
Transparency
required
Determined prior to
care = fair
Measures
support
competition
EMR essential
New
Payer, patient and
provider aligned
Population
based but
patient specific
Team based
Available and
updated
Decisions based
on minimal data
Small data sets
Shared Savings
Efficiency
rewarded
Providers
and
Patients
Mobile
Patient choice in
treatment based
on data
Maximize
licenses
If we have that….
It’s more than just dashboards
Preventive and Health
Maintenance
Measures
User customizable
components for
various workflows
What Needs to be Done?
Physician Scorecards
“Drill Down” Physician
Quality Measure
comparisons
dPopulation in
need with one
click
LACIE Provider View: Integrated with EMR
dSource of
information
Linked reports
Clinical Decision Support at Point of Care
Risk
Calculation
Actionable
orders at
POC
Exclusions
Give it to
Associated lab
someone else
with meds
Population Summary for Qual Measures
Customizable
Filters
Individual Quality Measures
and management
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Who is at Risk?
Why, Again?
Vitality
• Example lifeline with poor diet, activity
level
For CFOs –
Lost productivity,
lower claims
0
20
30
40
50
60
70
• Lifeline with Health promotion
– Prevention, exercise, diet
– Best evidence based care
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90
For Patients –
Happier, healthier
lives
Source: Extremely Scientific Guesswork, inc.