One Union StationProvidence, RI

02903(401) 274-4564www.riqi.org

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The RI Quality Institute

A collaboration among hospitals, health care providers, insurers,

business, academe and government for the purpose

of improving health care quality, safety and efficiency.

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Our MissionOur Mission

To improve the quality, safety To improve the quality, safety and efficiency of health care in and efficiency of health care in

Rhode Island and serve as a Rhode Island and serve as a learning laboratory for the learning laboratory for the

nation. nation.

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Guiding PrinciplesGuiding Principles

Collaboration—first and foremostCollaboration—first and foremost Real improvement is requiredReal improvement is required Win-win for all participantsWin-win for all participants Focus on system improvements Focus on system improvements

that none of us can achieve that none of us can achieve alonealone

Senior Leaders requiredSenior Leaders required

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Electronic Prescribing with Electronic Prescribing with SureScripts as the First SureScripts as the First InitiativeInitiative True electronic prescribing offers a strong True electronic prescribing offers a strong

value proposition for all involvedvalue proposition for all involved We knew we could build on the IT We knew we could build on the IT

infrastructure and the experience gainedinfrastructure and the experience gained Built physician confidence in our Built physician confidence in our

organization and our motivesorganization and our motives Beta testing began in June, 2003 and by Beta testing began in June, 2003 and by

the end of 2004, if all goes as planned, we the end of 2004, if all goes as planned, we will have 75% of RI pharmacies connected will have 75% of RI pharmacies connected and more than 45% of active RI and more than 45% of active RI prescribersprescribers

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The Cost and Quality The Cost and Quality OpportunityOpportunity

30%Unnecessary

Cost

Practice Variation

Fisher, Wennberg, et al, Annals of Internal Medicine, 2003

“…“…30% of direct health care outlays are the 30% of direct health care outlays are the result of poor-quality care…”result of poor-quality care…”

MBGH, Juran, etal 2002MBGH, Juran, etal 2002

“…“…20 to 30 percent of the acute and chronic 20 to 30 percent of the acute and chronic care that is provided today is not care that is provided today is not clinically necessary.” clinically necessary.”

Becher, Chassin 2001Becher, Chassin 2001

“…“…cost of poor quality was … nearly 30% of cost of poor quality was … nearly 30% of the expense base…The biggest the expense base…The biggest opportunities were in the core medical opportunities were in the core medical processes that comprise the majority processes that comprise the majority of what we do.”of what we do.”

Mayo ClinicMayo Clinic

““Costs associated with poor health care Costs associated with poor health care account for 30% of the premiums account for 30% of the premiums people pay.”people pay.”

David Lawrence, MDDavid Lawrence, MD

““The cost of poor quality in health care is as The cost of poor quality in health care is as much as 60% of costs”much as 60% of costs”

Brent James, MD, IHCBrent James, MD, IHC

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2004 2005 2006 2007 2008 2009 2010 2011 2012 20132004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Projected U.S. HealthProjected U.S. HealthExpenditures and Expenditures and WasteWaste

Source: U.S. Department of Health and Human Services, Gordian Project analysis

$3.3 T

$1.7 T

Unnecessary Cost

$515 B

$990 B

Aggregate Waste$7.4 Trillion

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Misaligned Incentives Drives Lack of Capital

% of Savings Captured

11%89% PhysiciansOthers

Source: Center for Information Technology Leadership, 2003

Ambulatory Computer-based Physician Order Entry

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The “Others” (89%)

10%

26%

22%21%

17%

Source: Health, United States, 2002

Medicaid

Medicare

Households

Employers

State/Local

Other Federal

Purchasers of Health Care

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The Rhode Island Health The Rhode Island Health Improvement Initiative Improvement Initiative (RIHII)(RIHII)

Give physicians the tools they needGive physicians the tools they need Information technologyInformation technology Connectivity to the entire community Connectivity to the entire community Best Practices (Evidence-Based Medicine, Chronic Best Practices (Evidence-Based Medicine, Chronic

Care Model, Person-Centered Care, etc.)Care Model, Person-Centered Care, etc.) Heavy implementation/process redesign supportHeavy implementation/process redesign support

Reward physicians’ use of best practices Reward physicians’ use of best practices Fund it through a stakeholder coalitionFund it through a stakeholder coalitionShare the gains with physicians Share the gains with physicians Provide community governanceProvide community governance

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RIHII OverviewRIHII Overview

What to do?What to do? Where to start?Where to start? Cost?Cost? Benefit?Benefit? ROI?ROI?

Who to finance it?Who to finance it? Why to finance it?Why to finance it?

Comprehensive approachComprehensive approach

Manageable place—100K Manageable place—100K peoplepeople

$9 M per year $9 M per year

> $100 M per year > $100 M per year

77% (10 year compound annual 77% (10 year compound annual return)return)

Public/Private PartnershipPublic/Private Partnership

Safer, higher quality care at a Safer, higher quality care at a lowerlower

cost cost (1) per 100k people

1

1

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2004 2005 2006 2007 2008 2009 2010 2011 2012 20132004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Projected Community HealthExpenditures per 100,000 People

Source: U.S. Department of Health and Human Services, Gordian Project analysis

$1.1 B

$615 M

Unnecessary Cost

$185 M

$320 M

Aggregate Waste$2.5 Billion

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Meanwhile…Meanwhile…

Statewide connectivity/Master Statewide connectivity/Master Patient Index developmentPatient Index development

Effort to promote state-wide Effort to promote state-wide adoption of Electronic Health adoption of Electronic Health Records (EHRs)Records (EHRs)

Further expansion of e-Further expansion of e-prescribingprescribing

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The Role RIQI is The Role RIQI is Considering for the Future:Considering for the Future: Market Institution (as described in the Market Institution (as described in the

Thompson/Brailer 10-year plan) – Regional Thompson/Brailer 10-year plan) – Regional Health Information Organization (RHIO)Health Information Organization (RHIO)– Center for regional collaborationCenter for regional collaboration– Certifying organizationCertifying organization– Connection centerConnection center– Keeper of the Master Patient IndexKeeper of the Master Patient Index– Provider of access/authentication/securityProvider of access/authentication/security– Provider of data/document storageProvider of data/document storage