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

423-963-4970ljenkins@carespark.com