Using technology to improve quality
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Using technology can improve healthcare quality by addressing rising costs and moving to a value-based system. Key assumptions include unsustainable cost growth, payers prioritizing value over volume, and electronic health records (EHRs) and quality becoming standard. One health system improved diabetes care through EHR-enabled care management, standardized workflows, and enhanced patient engagement, achieving significant quality gains. EHRs alone are not sufficient and health systems must address fragmentation through coordinated, team-based care leveraging analytics across the healthcare ecosystem.
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Using technology to improve quality
- 1. Using Technology to Improve QualityCharles DeShazer, MDVP, Quality, Medical Informatics & TransformationDean Health SystemMadison, WI
- 2. Key Industry AssumptionsCurrent cost inflation curve is unsustainablePayers are moving towards paying for value rather than volumeEHR will become a standard tool Quality will become not only the “ticket to play” but also one basis of competition (value = quality/cost)Primary care will be the engine for quality
- 3. Overall Rank Ordering of Health System Characteristics 2010Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
- 4. ACO model represents a shift of COST RISK to Providers through payment mechanisms…
- 5. Complex Case Management1000 Lives25%Disease/Demand Management14,000 Lives50%15,000 Lives15%HealthMgmt70,000 Lives10%Population vs. Costs vs. InterventionsExample of 100,000 People in a Population % of Cost% ofPopulation1%14%15%70%
- 6. 24 hours in the life of a PCP“The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care,” a report from the American College of Physicians, 2006Yarnall KS, et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93:635 Ostbye T, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005; 3:209
- 7. Therefore, managing costs (risk) means managing chronic and complex conditions (especially in the short term)Quality initially will be the ticket to play and later become a key competitive measure
- 8. You will have to fix the PCP’s day in the processKaiser Permanente Diabetes CareOhio region 2006Large population of diabetic patientsRecently implemented EHRNo infrastructure for care managementPoor quality scores on HEDIS diabetic care
- 9. Creation of Diabetic Care ModelPrimary care restructuring as medical homeAdded care management resourcesOutsourced health coaching and outreachLeveraged EHR for process management and communicationCreated quality measurement dashboard with actionable drill-down, filtering and sorting capabilitiesDeveloped standardized workflows aligned with Clinical Decision SupportBetter leveraged non-physician staffEnhanced patient engagement via education, PHR, email, behavioral health integration and outreach
- 10. ResultsStatistically significant improvement in 6 of 9 commercial and all Medicare HEDIS metrics within 1 yearBecame one on the top performing regions in Diabetic care3 years after implementation beginning to see decreased cost secondary to decreased strokes, heart attacks and amputations consistent with modeling (Achimedes)
- 11. Does Use of EHRs Help Improve Quality?“For patients with diabetes, 51 percent of those receiving care in an EHR practice received all the recommended care, as compared with 7 percent of those who received care in a paper-based practice.”Source: http://www.rwjf.org/files/research/72480af4qehr201106.pdf(Accessed 7/8/2011)Better Health Greater Cleveland: http://www.betterhealthcleveland.org/
- 12. Leverage Meaningful Use as a Springboard
- 13. Key System Challenge is to address FRAGMENTATION Poor Coordination of Care Is Common,Especially If Multiple Doctors Are InvolvedSource: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2011.** On average, Medicare beneficiaries see 6.4 MDs and fill 20 prescriptions annually. Beneficiaries with 5+ chronic conditions see 14 MDs and fill 57 prescriptions annually (Source: N Engl J Med 2007;356:1130-9)
- 14. Key Technical Functions for Next Level Quality ManagementEHR is necessary but not sufficient. The next level of quality management will require a Health Information Technology (HIT) “ecosystem” especially a robust analytic infrastructure. Standalone EHR may not be able to provide all of these functions.
- 15. Provider Organizational Cultural ShiftsCritical Success Factors for TransformationNowFutureVolume Focus Value FocusPhysician Autonomy Organizational StandardsIndependenceInterdependencePhysician Captain Physician Coach & MgrAccountability External Accountability InternalHIT optionalHIT Core to StrategyMy data is my dataTRANSPARENCY!!
- 16. Looking Ahead…MU Stage 2 & 3ICD-10ACO development (success or flop?)Evolution of Value-Based Reimbursement Genomics
- 17. QUESTIONS?