healthcare reform, hitech & the view from 2015meaningful use pressure will “snowball”...
TRANSCRIPT
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Healthcare Reform, HITECH & The View from 2015
John Glaser, PhDCEO, Siemens Health ServicesSeptember 1, 2010
Page 2 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Increasing Growth in Healthcare Costs
Chronic Disease Under Control: Managed Care Plan Distribution, 2006
70 73
49
81
88
68
6056
30
0
25
50
75
100
Private Medicare Medicaid
Mean 90th %ile 10th %ile
Note: Diabetes includes ages 18–75; hypertension includes ages 18–85.Data: Healthcare Effectiveness Data and Information Set (NCQA 2007).
Percent of adults with diagnosed diabetes whose HbA1c level <9.0%
Uneven Care Quality
Source: Commonwealth Fund National Scorecard on U.S . Health System Performance, 2008 3
6057
53
68 67 66
4946
39
0
25
50
75
100
Private Medicare Medicaid
Mean 90th %ile 10th %ile
Percent of adults with hypertension whose blood pressure <140/90 mmHg
Diabetes Hypertension
Page 4 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Factors Contributing to Heightened Pressure on Healthcare – Particularly Costs
� Relentless increases in care costs to individuals and purchasers of care
� Cost increases occurring against an adverse economic backdrop� Federal government deficits
� State government revenue shortages� Lingering economic recession for businesses
� Slow job growth, underwater mortgages and evaporated retirement plans for consumers
� Suspicion that cost increases reflect monopolistic behavior rather than the true costs of care
� Lack of comparable increases in care quality and safety � Problematic data on care quality
� Too much care variation
� Data that distinguishes no one
� Overall poor performance on global measures of health
Page 5 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Techniques for Limiting Growth InHealth Spending and Likely Impact
� Very Limited Impact� Encourage Greater Use of
Preventive Services (Short-term)
� • Limited Impact� Provide Better Price and
Quality Information� Require Patients To Pay
More� Restrict Use of Harmful
Care� Reduce Expense and Waste
of Medical Mal-Practice System
� Reduce Administrative Costs of Insurance
� Develop and Use Government Supported “Comparative Effectiveness Studies”
� Greater Impact� Restructure Payment System -- (Bundled
Payment and Value Based Pricing)� Restructure Delivery System (Integrated
Care)� Restrict Use of Marginally Useful Care� Limit Supply of Expensive Services� Incentives to Use Preventive Services
(Long-Term)� Expand and Restructure Primary Care ---
Create Effective “Medical Homes” for Patients
� Create a Governmental “High Cost Reinsurance System” with Effective Disease Management
� Systems for Chronic Conditions� Greatest Potential Impact
� Gov. Regulation of Payments To Providers� Establish Global Budgets
Source: Discussion at The Cash Catalyst Meeting, Stuart H. Altman, 7/15/10
Page 6 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Health IT as a Critical Enabler for Healthcare Transformation
TIMETIME
Transformational Change in Health Care Delivery and Population Health - ACA
Technology Adoption and Use - HITECH
20042004 2012?2012?
Page 7 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Examples of Meaningful Use
Perform at least one test of capacity to provide su ch data
Capability to provide electronic syndromic surveillance data to public health agencies (M)
Summary provided for at least 50% of all transition s of care or referrals
Provide summary of care record for each transition of care or referral (M)
At least 50% of patients who request an electronic copy are provided it within 3 business days
Provide patients with an electronic copy of their health information
Reminders sent to 20% of all patients seen that are over 65 years old
Send reminders to patients per patient preference for preventive/follow-up care (M)
At least 50% of patients seen or admitted have “smoking status” recorded
Record smoking status for patients 13 and older
At least 80% of patients seen or admitted have at l east one entry
Maintain an up-to-date problem list of current and active diagnoses
Page 8 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
CMS Estimates of the Number of Providers who will be Meaningful Users in 2011
73%58%43%High
46%35%30%LowHospitals
44%40%36%High
15%13%10%LowEligible Professionals
201320122011Scenario
Baselines considerations (2008):
29% of hospitals have some level of medication CPOE (AHA)
4% of eligible professionals have a full function electronic health record
Page 9 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
32 million now covered
Closes Medicare donut hole
32 million now covered
Closes Medicare donut hole
The Healthcare Reform Legislation Focused on Access but has Significant Payment Reform Provision s
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
$940 billion over ten years
Page 10 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Changing Perspective
SpecialtyHospitals &
Clinics
Provider-centric ���� Person-centric
Implications• Data/information/knowledge focus (not function/UI focus) • EHR focus shifts to coordination and collaboration • Open, standards-based data exchange• Move towards person controlled data access
RetailClinics
GeneralHospitals
Employers
NetworksThat Profit
From Health
FacilitatedPatient
Networks
IndependentPhysicians’Practices
AcademicMedicalCenters
Provider
Provider
Provider
Provider
ProviderProvider
Provider
Provider
Provider
Page 11 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Horizon 1 - Exchange
Horizon 2 - Orchestrate
Horizon 3 - Guide
HIT Market Evolution
2009 2013 2015 2017Low
High
Market Evolution
Exchange•Non-disruptive secure sharing of normalized patient data
•Respects privacy boundaries•Directed push dominatesDrivers•MU stages 2, 3•Physician recruitment•Federal/state grants
Orchestrate•Builds on Exchange•Actionable, supports care coordination across settings
•Driven by care guidelines, care-giver arrangements
Drivers•Payment reform, bundled payments
•ACOs, medical homes
Guide•Builds on Orchestrate•Provides care-givers with contextual knowledge at PoC
•Supports translational researchDrivers•Heightened reimbursement pressures
•Comparative effectiveness implementation
Stakeholder Value
Page 12 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Lower Altitude but Still High Altitude Ramifications
� From now on Medicare/Medicaid payments will be mate rially based on effective use of EHRs� Beginning with meaningful use
� And moving to payment reform� Meaningful use pressure will “snowball”
� Payment reform and increased care accountability assume meaningful use� Commercial health plan incentives may be based on an assumption that
meaningful use has been achieved
� Maintenance of certification may have meaningful use requirements� Will licensure and/or accreditation consider meaningful use status?
� Industry EHR development agenda will be increasingl y dominated by certification, interoperability, meaningful use and ACA requirements� The Federal agenda will define the EHR
Page 13 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Lower Altitude but Still High Altitude Ramifications
� The presence of a broadly adopted EHR will cease to be a competitive differentiator. Differentiation could occur in seve ral areas:
� EHR-leveraged care improvement within the organization and with other providers
� Care analyses and secondary use of data
� Superior utilization of clinical decision support
� Engagement of the patient in their care
� The growth of exchange infrastructure will bring in creased interdependence between the information systems age nda of provider and other stakeholder organizations
� A wide variety of new “species” will enter the healt hcare information technology market
� They will focus on secondary use of data and delivering “intelligence” to the care process extending into the EHR
Page 14 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Health Plans (and others) are Making Moves
Page 15 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Health Plans (and others) are Making Moves
Page 16 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Near Term Ramifications for Information Technology
� Electronic health record� Core EHR capabilities, e.g., manage a problem list and eprescribing, remain very
relevant
� Other functions increase in importance� Ability to identify and track a patient across multiple organizations
� Clinical decision support to deliver evidence-based guidelines, reminders, order sets and alerts
� Disease registries to provide analyses of care processes and outcomes for a population
� Care documentation
� Some functions are new� Technologies to support care coordination and care team collaboration, e.g., discussion rooms and event
messaging
� Health Information Exchange� Enable tight interoperability with clinical affiliates
� Enable exchange of “directed push” transactions
� Support messaging of patient events, e.g., missed radiology procedure appointment
� Initial HIE efforts will be focused on a well defined set of clinical relationships
Page 17 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Near Term Ramifications for Information Technology
� Data Management
� Business intelligence tools to support
� Assessment of care quality and costs for cohorts of patients (episodes and bundles)
� Analyses of practice variations
� Examination of care delivery alternatives
� Predictive modeling to identify high risk patients
� Personal Health Records
� Provide patients with access to their EHR data
� Support communication with care team
� Enable direct entry of data
� Provide access to health information and self management tools
Page 18 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Impact on Care Documentation
� Because of the change in reimbursement care documen tation will:� Support a more extensive diversity of needs
� Require greater thoroughness
� Be shared by multiple care providers
� Face increased time pressures
� This will require efforts to:� “Compile” necessary data from multiple sources; claims, processing of text,
other providers and patients
� Enable the provider to focus on context-specific data
� Develop means to ease the documentation challenges of time and thoroughness
Page 19 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Identifying a CMP Patient
Page 20 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Email and Page Alerts –Admissions and Discharges
From: Care Management Program Admit Notification [mailto:[email protected]] Sent: Thu 01/01/2008 12:00 PM To: Neagle, Mary Subject: ABC Patient MRN 123456 Has Been Admitted to the ED at approx 17:26 on 07/10/2008 (AMN)
Neagle, Mary, your patient ABC Patient MRN: 123456 Has Been Admitted to the ED at approx 12:00 on 01/01/2008 (AMN) With a Chief Complaint of: CP/ SOB
*** This alert is generated when a patient is REGISTERED in the ED *** *** Clinical information may not be immediately available ***
Page 21 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Inpatient Census – Real Time
Page 22 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Blurring of Information Technology Boundaries
� There has been a progressive erosion in the boundaries between the organization’s IT infrastructure, staff and applications and the rest of the world� Minicomputers� Personal computers� Remote computing services� Outsourcing
� This erosion is accelerating� Mobile devices� Cloud computing� Web 2.0 collaboration tools
� The mature form of this erosion is unclear. It is clear that the provider IT response will involve a collection of “owned” and “sourced” infrastructure, staff and applications
Consider…� 71% of doctors consider a smart phone
essential to their practice
� More than 500,000 Wi-Fi networks will be implemented in the US healthcare market in 2010, a 50% increase from 2009. Expected to double the 2010 figure to more than 1 million by 2015
� 73% of Siemens software sold this year is hosted or “in the cloud” – up significantly over prior years
� Siemens has nearly 900 customers with over half a million healthcare professionals using its hosted systems on any given day
Source: Manhattan Research, 3/2010, ABI Research, 7/2010 & Siemens Healthcare 8/2010
Page 23 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
We are in for a Tumultuous but Exciting Period of Time
� Payment change is THE “disruptive innovation” in care delivery
� The Federal agenda “defines” several aspects of the healthcare information technology industry:
� Conceptual models of healthcare information technology
� Definition of the electronic health record
� Interoperability and exchanges
� Standards
� Adoption and implementation support (RECs)
� A wide range of new entrants with innovative ideas and diverse interests will enter the market
� Along the way we will see major advances in the technology and its delivery
� Cloud computing
� Mobile devices
� Web 2.0 collaboration tools
Page 24 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Early ACO Results
� Community Care of North Carolina
� Formed in 1998; enhanced medical home supported by the state’s Medicaid program
� Results: Saved roughly $3.3 million in the treatment of asthma patients and $2.1 million in the treatment of diabetes patients between 2000 and 2002, while reducing hospitalizations for both patient groups.
� In 2006, the program saved the state roughly $150 to $170 million
� Physician Group Practice (PGP) Demonstration
� Formed in 2005 and developed by Medicare; group of 10 provider organizations and physician networks to test shared savings.
� Performance payments are designed to reward both cost efficiency and performance on 32 quality measures
� Results: Through year three of the program, all ten participating sites achieved success on most quality measures, and five collectively received over $25 million in bonuses as a share of $32 million in Medicare cost reductions
� Pathways to Health, Battle Creek, Michigan
� Formed in 2006, Integrated Health Partners participated in a chronic disease initiative with Blue Cross Blue Shield of Michigan (BCBSM).
� Later restructured into Pathways to Health
� Results: BCBSM reports that hospitalizations for conditions that can be prevented via better ambulatory care have dropped 40 percent over the three-year life of the program
Source: AHA, 6/2010
Page 25 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
There are two ways this could go…
Page 26 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Page 27 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Or…
Page 28 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
We’re Facing a Serious Horror Show
Page 29 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Comparing US Utilization to Other Countries
10.4%1.23514.12456.1UK
15.2%0.977N/A2018.6Germany
12.4%1.261230.988N/ACanada
13.3%0.842302.61585.7Australia
12.4%1.8114424.81215.6US
% of Total HC Spend on Pharma.
Liver Transplant*
(2002)
Renal Dialysis*
(2005)
Cardiac Catherization*
(2003)
Dis-charge Rate*
(2005)
Avg.
LOS (2005)
* Per 100,000 pop.
Source: OBCD Health Data
Page 30 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
A Comparative Look at Costs
$22,092N/A$2,200$300$72USA -
Medicare
$56,472-$116,798
$125-$334$3,181-$12,708
$950-$1,800$59-$151USA
$12,868$40N/A$179N/AUK
$15,761$32$579$161$15Spain
N/A$63$502$258$32Netherlands
N/A$48$550$319$22Germany
$11,916$53$1050$212$31France
$14,111$33$837$41-$530$30Canada
Bypass Surgery
Lipitor (Rx)
Avg. Cost Per Hosp.
Day
Head CT Scan
Phys. Fees Office Visit
Page 31 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Techniques for Limiting Growth InHealth Spending and Likely Impact
� Very Limited Impact� Encourage Greater Use of
Preventive Services (Short-term)
� • Limited Impact� Provide Better Price and
Quality Information� Require Patients To Pay
More� Restrict Use of Harmful
Care� Reduce Expense and Waste
of Medical Mal-Practice System
� Reduce Administrative Costs of Insurance
� Develop and Use Government Supported “Comparative Effectiveness Studies”
� Greater Impact� Restructure Payment System -- (Bundled
Payment and Value Based Pricing)� Restructure Delivery System (Integrated
Care)� Restrict Use of Marginally Useful Care� Limit Supply of Expensive Services� Incentives to Use Preventive Services
(Long-Term)� Expand and Restructure Primary Care ---
Create Effective “Medical Homes” for Patients
� Create a Governmental “High Cost Reinsurance System” with Effective Disease Management
� Systems for Chronic Conditions� Greatest Potential Impact
� Gov. Regulation of Payments To Providers� Establish Global Budgets
Source: Discussion at The Cash Catalyst Meeting, Stuart H. Altman, 7/15/10
Page 32 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
The Cost of Healthcare Reform Failure
� The number of uninsured Americans would increase from 49.4 million in 2010 to 59.7 million in 2015 and 67.6 million in 2020.
� A larger share of the uninsured would come from middle- and higher-income families.
� Premiums would become increasingly expensive for employers and their workers.
� Offers of coverage would fall significantly for workers in small and medium firms. Even in the best case, the rate of employer sponsored insurance coverage would fall to 53 percent in 2020.
� Medicaid and Children's Health Insurance Program (CHIP) enrollment and costs would increase substantially.
� Employers would see large increases in premium costs.
� Uncompensated care costs would more than double.
� Health care costs paid directly by families would increase significantly.
Source: Robert Wood Johnson Foundation, 3/2010
Page 33 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Questions