Axel Arroyo, MD MPH
Learning Objectives
Which are the reasons behind these changes?
Past
• To review the reasons of this transformation.
• To review Legislative initiatives (ARRA, PPACA and HITECH)
What is happening right now?
Present
• To learn about the EHR and Meaningful use concepts.
• To discuss the Medicare/Medicaid incentive program.
Why we are doing all these changes?
Future
• To mention the new health care and financial models
• Population Health ManagementProgram Targets
Learning Healthcare System
Health Care System Transformation
Health Information Exchange
Volume vs Value Based System
Low financial accountability for
cost of care.
Defines population as patients
who present at doctor’s office.
Minimal infrastructure to
manage more than the
sickest/most complex patients.
Culture rewards volume and
operational efficiency.
Volume
Based
2012
High financial accountability
for cost care.
Defines population as every patient in the provider organizations panel,
regardless of whether they present
at the doctor’s office.
Must have infrastructure to
manage the entire population.
Culture rewards optimization
of cost and quality.
Value
POPULATION HEALTH MANAGEMENT
Population Health Management
To address health needs at all points along the continuum
of health and well being through participation,
engagement and targeted interventions for the population
to improve clinical and financial outcomes.
Conceptual PHM Framework
Population monitoring/Identification Health Assessment
Risk Stratification
No or Low risk Moderate risk High risk
Care Continuum
Health Management Interventions
Health Promotion,
Wellness Management Health Risk Coordination/Advocacy Care Management Disease/Case
Community Resources Organizational Interventions
(Culture/Environment) Tailored Interventions
Person
Operational Measures
Psychosocial
Outcomes Behavior Change Health Status Clinical and
Productivity, Satisfaction,
QOL
Health Care System Transformation
Population Health Management
Health Information Exchange
PATIENT CENTER MEDICAL HOMES
Patient-Center Medical Home (PCMH)
A personal physician who is the first
contact for his/her
patients and who provides continuous
and comprehensive care.
A physician-led care
team that takes
collective responsibility for
care.
The personal physician will provide for all of a
patient’s health needs and arrange
referrals to other health professionals
as needed.
Care coordination
across all care settings, facilitated by information technology and health information exchange. An emphasis on delivering
high-quality, safe care in
partnership with patients and their
families.
Enhanced access to care through open
scheduling, expanded hours, and
improved communication among physicians, staff, and patients via secure e-mail and
other modes.
PCMH Recognition
(National Committee for Quality Assurance-NCQA)
Standard categories (9)
• Access and Communication
• Patient Tracking and Registry Functions
• Care Management
• Patient Self-Management and Support
• Electronic Prescribing
• Test Tracking
• Referral Tracking
Health Care System Transformation
Patient-Center Medical Home
Population Health Management
Health Information Exchange
ACCOUNTABLE CARE ORGANIZATIONS
Accountable Care Organizations (ACO)
An organization of healthcare providers that can receive additional
funds from Medicare if it can demonstrate that it provides
higher-quality care at reduced costs to a defined group of patients.
An ACO must measure (using sophisticated IT infrastructure)
• Quality
• Outcomes
Accountable Care Organizations (ACO)
Shared-saving Programs
Legal structure that allows for receiving/distributing payments.
Governance must include representation from clinical, administrative participants & patients.
Participation- is a 3-year commitment, requires a minimum of 5,000 beneficiaries.
There are 65 measures (Patient/Caregiver assessment, Care Coordination, Patient Safety, Preventive Health).
Health Care System Transformation
Accountable Care Organizations
Patient-Center Medical Home
Population Health Management
Health Information Exchange
Value Based-Purchasing
• Buyers should hold providers of health care accountable for both cost and
quality of care.
• Brings together information on the quality of health care, including patient
outcomes and health status, with data on the dollar outlays going towards
health.
• Focuses on managing the use of the health care system to reduce
inappropriate care and to identify and reward the best-performing providers.
• This strategy can be contrasted with more limited efforts to negotiate price
discounts, which reduce costs but do little to ensure that quality of care is
Health Care System Transformation Summary
Value based Purchasing
Employers Employees
Accountable Care Organizations
Patient-Center Medical Home
Population Health Management
Health Information Exchange
For more information
http://healthit.hhs.gov http://www.cms.gov/EHRIncentivePrograms/
