Virginia HIMSS Conference10-06-05
Presentation Overview
• Why is health improvement a priority for our Central Appalachian region?
• What strategies are we undertaking?
• What progress has been made?
• What have we learned?
Innovative Regional Cooperation To Improve Health
• Active, representative membership, including• Eastman Chemical Company, AFG, General Shale,
Kingsport Foundry, BAE Systems• Blue Cross Blue Shield, John Deere Health• Mountain States Health Alliance,
Wellmont Health System, Frontier Health• Holston Medical Group, Cardiovascular
Associates, Brookside Medical Group•East TN State University, School of Medicine,
College of Nursing, College of Public and Allied Health
• Sullivan County and Northeast TN Regional Health Departments• Kingsport Tomorrow• American Heart Association, American Cancer Society, American Lung Association
Health Care Spending Per Capita
1970 1980 1985 1990 1995 1996 1997 1998 1999 2000e 2001e 2002e
High Cost of Health Care
Source: Health, United States, 2002; HealthAlliant analysisFive Countries: Luxembourg, Canada, Germany, Norway, SwitzerlandG-7 Countries: Canada, France, Germany, Italy, Japan, United Kingdom
US $5,473
5 Countries$2,876
G-7 $2,191
6.9%
3.1%
4.8%
Rising Costs
Health Care Costs are rising:
10% in 2004
9% projected in 2005
2004 2005 2006 2007 2008 2009 2010 2011 2012 20132004 2005 2006 2007 2008 2009 2010 2011 2012 2013
> $500 Billion in Waste Annually
Source: U.S. Department of Health and Human Services, Gordian Project analysis
$3.3 T
$1.7 T
Unnecessary Cost
$515 B
$1 T
Aggregate Waste$7.4 Trillion
JWR3JWR4
Poor Results
Life Expectancy at Birth - Females70 75 80 85
JapanFrance
SwitzerlandSpain
SwedenCanada
AustraliaItaly
NorwayGreeceAustriaBelgiumFinland
NetherlandsGermany
New ZealandUnited Kingdom
Costa RicaUnited States
Puerto RicoPortugalIreland
DenmarkCzech Republic
PolandSlovakiaHungaryBulgariaRomaniaRussian
Infant Mortality0 2 4 6 8 10
Hong KongSweden
JapanNorwayFinland
SingaporeFrance
GermanyDenmark
SwitzerlandAustria
AustraliaCzech Republic
NetherlandsCanada
ItalyNew Zealand
ScotlandBelgium
Northern IrelandEngland and Wales
GreeceIsraelSpain
PortugalIreland
CubaUnited States
SlovakiaKuwait 28th
19th
Source: Health, United States, 2002, National Center for Health Statistics, U.S. Department of Health and Human Services
Tri-Cities TN / VARegional Medical Service Area
Medical Service
AreaStatistics:
705, 000 patients
1200 MDs 16
Hospitals
Regional Health Status
All Cancer Mortality TrendsAge Adjusted Rates
150
160
170
180
190
200
210
220
230
1969-1971
1972-1974
1975-1977
1978-1980
1981-1983
1984-1986
1987-1989
1990-1992
1993-1995
1996-1998
1999-2001
Years
Mor
talit
y R
ates
/100
,000
USTennesseeVirginiaOur Region
Diabetes Mortality TrendsAge Adjusted Rates
12
14
16
18
20
22
24
26
28
1969-1971
1972-1974
1975-1977
1978-1980
1981-1983
1984-1986
1987-1989
1990-1992
1993-1995
1996-1998
1999-2001
Years
Mor
talit
y R
ates
/100
,000
USTennesseeVirginiaOur Region
Regional Health Disparities
ETSU Rural Cancer Demonstration Project, 2004
Regional Health Problems
Diabetes Mortality Trends% of National Levels
75%
80%
85%
90%
95%
100%
105%
110%
115%
1969-1971
1972-1974
1975-1977
1978-1980
1981-1983
1984-1986
1987-1989
1990-1992
1993-1995
1996-1998
1999-2001
Years
Rat
e as
% o
f US
Rat
e
USOur Region
All Cancer Mortality Trends% of National Levels
75%
80%
85%
90%
95%
100%
105%
110%
115%
1969-1971
1972-1974
1975-1977
1978-1980
1981-1983
1984-1986
1987-1989
1990-1992
1993-1995
1996-1998
1999-2001
Years
Rat
e as
% o
f US
Rat
e
USOur Region
ETSU Rural Cancer Demonstration Project, 2004
Regional Health Disparities
1 9 9 6 -2 0 0 1 M o rta lity R e la tive to U S R a teb y S u b g ro u p s
-30%
-20%
-10%
0%
10%
20%
30%
H eart D isease C an cer D iab etes
% o
f US
Rat
e
W om enM enA ges 40 -64A ges 65+B lackW h ite
ETSU Rural Cancer Demonstration Project, 2004
Poor Health Status means$2,400 More Per Capita Annually
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Projected Cost and Waste in Tri-Cities TN / VA Region
Source: U.S. Department of Health and Human Services, Gordian Project analysis
$5.5 B
$2.8 B
Unnecessary Cost
$800 M
$1.7 B
Aggregate Waste$12.5 Billion
Conclusion
To become and remain economically viable
Our region must use our resources more efficientlyto improve health outcomes and cost
Barriers to be Addressed
• Fragmented system for Health Care Delivery
• Little Financial Incentive for Providers to perform Preventive Medicine / Disease Management
• Patient Education / Personal Responsibility
• 10-15% Uninsured with limited access
Tactical plan
To address health issues, we propose to provide technical capability and encourage clinical process improvement in the following areas:
1.Prescription Medication 2.Diagnostic (lab, imaging) Services3.Preventive Medicine (immunizations /
screenings)4.Chronic disease management
VisionTo be a world-class, quality-driven, clinically integrated, efficient
health and wellness system for the people of our region
MissionTo improve the health of people in Northeast
Tennessee and Southwest Virginia through the collaborative use of health information
Goals
Improve clinical practiceCoordinate clinical care
Personalize careImprove population health
Create an efficient health system
Values
Regional CooperationCommunity Accountability
PrivacyIntegrity
Continuous ImprovementInclusiveness
Stakeholder Parity
Building Consensus
Source: SBCCDE, CITL, Gordian Project analysis
Redundancy
Treatment
Errors
Diagnostic
Electronic Medical Record
Clinical Data Sharing
Decision Support
Benefits Arise from Better Medical Decisions
Patient Data
Quality Measures For
VA
Compared With Best
Practices
0
20
40
60
80
100
120
Tob Cou
nsel
B-block
p M
I
Mammogram
PAP Smea
rCho
l Scre
enCho
l p M
I
LDLC <130
p M
I
Colore
ctal S
creen
HgbA1c a
nnually
HgbA1c <
9.5DM C
hol
DM Chol <
130
DM eye ex
am
HTN contro
lled
Flu vacc
ine, >65yo
Pneumova
x, >65
yoMH f/
u p D/C
Perc
ent G
oals
Met
VABest Other
2002 Data
17 Measures
BW1
Slide 21
BW1 dramtaic improvement is acheivableBen Wilson, 11/1/2004
1. 1. Provide patient information on demand at 2. the point of care3. 2. Provide decision support information
available at point of care3. Empower Patients to make healthy
choices and informed decisions1. 4. Provide selected aggregate data for 2. population health improvement
Core Strategies
Office of the National Coordinator for Health Information Technology (ONCHIT)
•Appointed of first National Health Information Technology Coordinator
on May 6, 2004
•Framework for National Health Information Infrastructure issued July 2004
•Alignment with four components of national framework:
1. Inform clinical practice
2. Interconnect clinicians
3. Personalize care
4. Improve population health
The Decade of Health Information Technology
David J. Brailer, M.D., Ph.D.
National effort to remove barriers
• “Harmonization” of state / federal / organization policies and regulations
• Move to establish data standards that support interoperability, certification for electronic medical records
• Pilots for financial incentives to encourage adoption and spur private investment
• Coordination through policy-making body: American Health Information Community
National Visibility
• Community-Based initiative
• Multi-state effort
• Focus on improved health outcomes
• Broad collaboration and commitment
• Extensive planning process
• Comprehensive strategy (long-term, broad participation)
• Sustainable business plan
Strategic Planning Process
MissionVisionValuesGoalsPrinciples
CoreStrategies
Core Tactics
Strategic Plan Implement
Continuous Improvement Cycle
Work GroupsClinical Finance Legal &Technology Communications Governance
Interim Board
Targeted health issues
We are targeting the health issues of greatest impact on quality of life and cost:
1.Diabetes2.Hypertension / stroke3.Cardiovascular disease4.Lung disease / asthma5.Preventive immunizations / screenings
Hospital A ILS
Hospital B ILS
Information Locator
Access, Authorization, Relationship
MPI
ILS =Information locator server
Health Information Exchange
References & DSS WWW
EMRASP
EMRLocal
OfficePayor ILS
Dx Service ILS
ILS
Small Providers
Use Centralized
Server
ILS
PublicHealth
Analysis
89% Physicians
PurchasersPayers
CommunityHealth
FoundationPhysicians
Gain Sharing
Enrollment Fee
Community Pool
Participation Fee
Aligning Community Interests & Resources
Savings
Local Governance
Financing
DecisionSupport
IncentivesQuality Improvement
PatientData
MedicalKnowledge
Implementation
HIE
Regional Health Information Exchange
Medication and Diagnostic Services Improvement Savings Model Projections*
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
$35,000,000
$40,000,000
$45,000,000
$50,000,000
Year 1 Year 2 Year 3
Generic Substitution Rad Utilization Lab UtilizationAdverse Drug Events MD Admin Cost Callbacks
17.2% of Possible Savings
* Data sources: BlueCross BlueShield and John Deere
Cost-Benefit Projections*
-10
0
10
20
30
40
50
2005 2006 2007
$ Millions Gross Savings Costs Net Savings
Positive Cash Flow in Year 2
* Includes medication and diagnostic services improvement only
Progress to Date
• Technical inventory and feasibility study completed
• Strategic business plan developed
• Non-profit organization formed, board of directors, committees and staff in place
• Funding commitments of $725,000 to date
Next Steps
• Secure $4.5M in funding for development and execution through June 2006
$600K by July 2005 $2.5M by Oct. 2005
$2M by Jan. 2006
• Secure staffing for development and operations
• Define technical specifications, conduct vendor selection process (Oct - Dec 2005)
• Finalize partnership agreements (by Jan 2006)
Opportunities for Our Region
National Visibility for our Initiatives
Coordination / Collaboration betweenNorth Carolina · Tennessee · Virginia
· Kentucky · West Virginia
Local Investment Leverages Other Funding (federal / state / private)
Small Business Expansion / Creation of High-Wage Jobs (Health Care, Technology)
Better Health for Central Appalachia
www.carespark.comLiesa Jenkins, Executive Director