Health Care Reform: Where are the Pharmacist? Opportunities and Challenges for Pharmacist in Health Care Reform

Health Care Reform: Where are the Pharmacists?

Opportunities and Challenges for Pharmacists in Health Care Reform

Anthony D. RodgersCMS Deputy Administrator Center for Strategic PlanningJune 2011

The US healthcare system produces significant level of unjustified variance in patient safety, healthcare cost, quality performance and health outcomes.Rationale for CMS Strategic DirectionTo Transform the US Healthcare Delivery SystemThe Three Part Aims of CMS

Better care, better health, and lower costs through continuous improvement for all Americans

What is the end of the game with Health Reform?The Essential Elements of a Transformed Healthcare SystemInformed andActivatedPatientProductiveInteractions

PreparedClinical TeamWeb based health e-learning,Electronic Care PlanningSelf Care Management Tools

Electronic Health Records Exchange of Health InformationMulti-disciplinary teamCoordinated Care Management CommonSet of Patient Health Information5The 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):56-66

Patient Centered Care Informed andActivatedPatientProductiveInteractions

PreparedClinical TeamElectronic Health Record & HIEClinical and Value Based Integrated Care Management Decision Making

Supported by ACO or Integrated Care SystemSupported By E-Health and Learning Tools

6The 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):56-66

Accountable Care

Healthcare Delivery System 2.0Transparent Cost and Quality PerformanceResults orientedAccess and coverageAccountable Provider Networks Designed Around the patientFocus on care management and preventive carePrimary Care Medical HomesUtilization managementMedical ManagementIntegratedHealth

Patient/Person Care CenteredPatient/Person centered Health CareProductive and informed interactions between Family and ProviderCost and Quality Transparency Accessible Health Care ChoicesAligned Incentives for wellnessIntegrated networks with community resources wrap aroundAligned reimbursement/cost Rapid deployment of best practices Patient and provider interactionAligned care managementE-health capableE-Learning resourcesEpisodic Health CareSick care focusUncoordinated careHigh Use of Emergency CareMultiple clinical recordsFragmentation of care Lack integrated care networksLack quality & cost performance transparency Poorly Coordinate Chronic Care ManagementHealthcare Delivery System 1.0Driving Health Care System Transformation Healthcare Delivery System 3.0Episodic Non Integrated Care 7CMS Strategic Plan FocusDelivery System TransformationACO and Integrated Care Management Delivery System Models DiffusionMedical/Health Home DiffusionElectronic Health Record and HIE InfrastructurePatient Safety Reduce Hospital Readmission RatesReduce Hospital Acquired Conditions Rates and Patient HarmImprove Care TransitionsImproved Medication ManagementCost and QualityValue Base PurchasingAligned Performance Incentives and PenaltiesNew payment models Quality and Cost Public Transparency and AccountabilityCoverage and AccessHealthcare manpower capacity development (e.g. use of mid-levels, telemedicine) Medicaid/CHIP expansionHealth Insurance ExchangesSpecial PopulationsDual Eligible IndividualComplex Chronic DiseaseSpecial Need ChildrenFrail Elderly and Disabled

Case Study # 1Health Delivery System Performance: Geographic Variation in Cost and Quality OutcomesHospital Referral Region Per Capita Spending Varies Dramatically Medicare per capita spending in Miami, FL is more than 2 times Medicare per capita spending in Honolulu, HI !HRRs with Low Per Capita SpendingPer Capita SpendingRatio to NationalHI - Honolulu$4,9590.66CA - San Francisco$5,8220.78CA - San Jose$5,9420.79HRRs with High Per Capita SpendingPer Capita SpendingRatio to NationalFL - Miami$10,1451.35LA - Monroe$9,4681.26TX - McAllen$9,3701.251011

Sample Data Table for High-Cost Hospital Referral Region (HRR)A ratio for each HRRxHCCI definitely understand the point youre trying to make with this slide, and the slide that follows, but they are very hard to read. Would it be possible to pull out a couple of lines from each table and expand them so they are easier to read? I think the point is an important one to make, but this risks people being turned off by the busy-ness of the slide and not looking at the data. Also, is HCC in this instance an acronym for Hierarchical Condition Category? If so, you should state that, and then be prepared to give a brief explanation of HCCs.1112Sample Data Table for Low-Cost Hospital Referral RegionA ratio for each HRRxHCC

Geographic Variation In Potentially Avoidable Hospitalizations

Potentially Avoidable Hospitalizations

Patient Settings : Variation in Results by Setting Case Study #2Dual Eligible Beneficiary Population: Potentially Avoidable HospitalizationsCurrent Dual Eligible Population Hospitalization Rates

Health Reform: Dual Eligible with Complex Chronic Disease Population5,569,903Percentage of Hospitalizations That Were Potentially Avoidable 26%Percentage of Fully Dual Eligible individuals With at Least One PAH9%Percentage of All Medicare Hospital Costs from Fully Dual Eligible PAHs3%2011 Projected Costs Attributable to Fully Dual Eligible PAHs$7-$8 BillionPotentially avoidable hospitalizations699,818Total costs (in billions)$5.6 Potentially avoidable hospitalization rate (per 1,000 person-years)151Average length of stay days6.1Average Medicare cost for potentially avoidable hospitalizations$7,665 Average Medicaid cost for potentially avoidable hospitalizations$333 The CMS Strategic Plan

Systematically guiding the Health Care System to achieve targeted measurable improvements in care management, cost reduction, and population health.

CMS Tools for Transforming the Delivery System20CMS Levers and Initiatives to Improve Care, Reduce Cost, & Impact Population HealthPolicy Levers and InitiativesAlign the Healthcare Industry to CMS Strategic Aims and DirectionInitiate and Lead Major National Campaigns and Initiatives10th Scope of Work for QIOsProgram Policy AlignmentPayment Reform and IncentivesCMS Public Reporting, Public Access DatabasesGraduate Medical Education policy and fundingProvide or Sponsor Learning CollaborativeInnovation Center Initiatives and Investments Public-Private Partnering on strategic aimsBuilding Knowledge Resources - Health Information Databases, Collaborative Insight and Knowledge DiscoveryDeploying Integrated Care Delivery System ModelsAccountable Care Design ElementsResults InAn Accountable System for Beneficiary/Patient-Centered CareImproved Care Coordination and Integrated Delivery of CareIncreased Provision of Evidence-Based CarePatient Activation and Increased Health LiteracyEfficient Delivery of Care and Elimination of WasteReduce and Contain Cost of CarePopulation Health ImprovementExpected OutcomesAdvanced Primary Care Medical Home2424Clinical Pharmacist Role in Health Care Reform Patient Compliance Comparative Effectiveness25Questions?

Thank you!26Sheet1Percentage of Hospitalizations That Were Potentially Avoidable 26%Percentage of Fully Dual Eligibles With at Least One PAH9%Percentage of All Medicare Hospital Costs from Fully Dual Eligible PAHs3%2011 Projected Costs Attributable to Fully Dual Eligible PAHs$7.5 Billion

Population5,569,903Percentage With at Least One Hospitalization27%Total hospitalizations2,691,276 Total costs (in billions)$27.5 Hospitalization rate (per 1,000 person years)574 Average length of stay (days)7.1 Average Medicare cost$9,815 Average Medicaid cost$411

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