Beacons and the Health 2.0 Community

Office of the National Coordinator for Health Information Technology

July 21, 2010

The HITECH Act Vision

• A major transformation in American health care

• Each patient receives optimal care through

nationwide health information exchange

• Programs and regulations to help overcome

obstacles to adoption and Meaningful Use of

electronic health records (EHRs) and to enable

breakthrough advances in health and health

care

The HITECH Act

• Part of American Recovery and

Reinvestment Act of 2009 (ARRA)

• Goal: Every American to have an

EHR by 2014

• Systematically addresses major

barriers to adoption and Meaningful

Use:

– Money/market reform

– Technical assistance, support, and

better information

– Health information exchange

– Privacy and security

How HITECH Addresses Barriers to Adoption

Obstacle Intervention Funds Allocated

Market Failure, Need for

Financial Resources

• Medicare and Medicaid EHR

Incentive Programs for “Meaningful

Use”

• $27.3 B*

Addressing Adoption

Difficulties

• Regional Extension Centers

• Health IT Research/Resource Center

• $643 M

• $50 M

Workforce Training • Workforce Training Programs • $84 M

Addressing Technology

Challenges and Providing

Breakthrough Examples

• Strategic Health Information

Technology Advanced Research

Projects

• Beacon Communities Programs

• $60 M

• $250 M

Privacy and Security• Policy Framework

• New Privacy and Security Policies

Addressed

across all

Programs

Need for Platform for Health

Information Exchange

• NHIN, Standards and Certification

• State Cooperative Agreement

Program

• $64.3 M

• $548 M

*$27.3 B is high scenario

Unprecedented Moment for Health

System Performance Improvement

• HITECH Act

• Affordable Care Act

• Action at Local, Regional, and National Levels

– Shared urgency to seize opportunities and address gaps

– New communications and technology tools

– Growing body of evidence about effective approaches

– Strong and growing local leadership and collaboration

6

“Tribes” of Health System Improvement:

Different Interpretations, Strategies, and Tools

1. Quality Improvement Crusaders

2. Payment Reformers

3. Consumer Energizers

4. Health IT Champions

7

Tribe 1: Quality Improvement Crusaders

Scientific evaluation methods and management techniques to achieve

better patient outcomes

• Data analysis and performance measurement

- Provider feedback processes, evidence-informed guidelines

• Management techniques

- Lean manufacturing, continuous quality improvement

• Learning and “best practices”

- e.g., avoiding complications in the ICU, reducing hospital

readmissions, improving care transitions, reducing infection

and surgical-complication rates, etc.

8

Tribe 2: Payment Reformers

Alternatives to volume-based payments to support systematic

improvements in care and opportunities for slower spending growth

• Fee-for-service payments drive toward more, not better care

• Misalignment of primary care and technology-intensive services

• Underdevelopment of value-increasing quality improvement and care

coordination improvements

9

Tribe 3: Consumer Energizers

Better information and appropriate incentives to help consumers

improve their own health, save money, and achieve better outcomes

• Providing better information to make better informed consumers

• Consumer responsiveness to out-of-pocket costs

• New value-based insurance design

• Shared decision making/informed patient choice

10

Tribe 4: Health IT Champions

Electronic infrastructure to support administrative simplification, error

avoidance, and improved outcomes

• Widespread adoption of electronic health records

• Tools to support physicians in achieving high-value care

- e.g., clinical decision support tools

• Tools to help consumers make optimal health care decisions

– e.g., personal health records

11

Tribal Approaches to Health System Reform

• Quality improvement activities may be unsustainable due to

volume-based payment methods

• Payment reforms ineffective if unaccompanied by changes in

provider practices and consumer behavior

• Uncoordinated care subjecting even highly engaged and

informed patients to fragmented care

• Higher spending on technology with uncertain benefits

Yet…tribal approaches to health system reform are common

12

The Beacon Community Program

• Goal: Demonstrate specific ways that communities

can achieve sustainable health improvement and cost

savings through complex health IT-enabled reforms

• 15* demonstration communities that will:

– Build and strengthen their HIT infrastructure and

exchange capabilities and showcase the Meaningful Use

of EHRs

– Provide valuable lessons to guide other communities to

achieve measurable improvement in the quality and

efficiency of health services or public health outcomes

*Two additional communities to be funded in Summer 2010

Round 1 Beacon Communities

14

Round 1 Beacon Communities

15

Lead Organization Location

Community Services Council of Tulsa Tulsa, Oklahoma

Delta Health Alliance Stoneville, Mississippi

Eastern Maine Healthcare System Brewer, Maine

Geisinger Clinic Danville, Pennsylvania

HealthInsight Salt Lake City, Utah

Indiana Health Information Exchange Indianapolis, Indiana

Inland Northwest Health Services Spokane, Washington

Louisiana Public Health Institute New Orleans, Louisiana

Mayo Clinic College of Medicine Rochester, Minnesota

The Regents of the University of California, San Diego San Diego, California

Rhode Island Quality Institute Providence, Rhode Island

Rocky Mountain Health Maintenance Organization Grand Junction, Colorado

Southern Piedmont Community Care Plan, Inc. Concord, North Carolina

University of Hawaii at Hilo Hilo, Hawaii

Western New York Clinical Information Exchange Buffalo, New York

Beacon Community 90-Day Workplan

COCommunity

Objectives

MO

CO

Activities

Resources

MO MOMO

A A A A AA

R R R R R R R R R R R

Measured

Outcomes

R

Sustainability plan outlining provider reimbursement,

program revenue, and other strategies

Outputs O O O O O O

Well-defined measurable improvement goals

Beacon “Community Objectives” encompassing

cost, quality, and population health

Operational and process results of core activities

Defining risks and barriers and establishing plans to prevent or mitigate them

Resources needed to support activities and meet

stated outcome goals

Tasks/interventions leading to outputs

Program Goals

16

Geisinger Clinic (Keystone Beacon Program)

Community

Objectives

MO

CO

Activities

Resources

MO

A A A A

R R R R R R R R

Measured

Outcomes

Sustainability plan: integration of accountable care payment model

aligned with health IT-enabled performance improvement goals

Outputs O O O O

Reductions in hospital admissions, avoidable 30-day hospital

readmissions, and ED visits among target patients; increased access

to/utilization of primary care services among same patients

Improve quality and efficiency among targeted patients with Chronic

Obstructive Pulmonary Disease (COPD) and Heart Failure (HF)

Medication reconciliation outputs, hospital discharge counseling,

targeted case management contact, web-based portals, others

Specific plans to prevent or mitigate implementation risks and barriers

Specific funding allotments to core activities phased in over new areas

and over time; dedicated administrative, IT, and clinical teams

Comprehensive HIT-enabled care model includes care process redesign

and teaming; integration across all systems of care, care protocols;

performance feedback to patients and clinicians, and reminder systems

Program GoalsSummary of 1 out of 10 Beacon/Geisinger Community

Objectives (Logic Models)

17

Conclusion and Discussion Questions

• What are new innovative tools and applications

that can help “unite the tribes” in these and other

communities?– Real-time data interfaces (providers and consumers)

– Prizes, challenges

– Data visualizations

• How do we ensure that the lessons learned from

communities participating in Beacon

Communities are shared in a broader and

dynamic learning network environment?