1 reforming health care in america union delegates conference george c. halvorson chairman and ceo,...

1

Reforming Health Care in America

Union Delegates Conference

George C. Halvorson

Chairman and CEO, Kaiser PermanenteMarch 26, 2011

2

Care Delivery Requirements and Agendas from the

Affordable Care Act

3

Health Care Reform Bill –

Over a Thousand “Shalls”

4

75 % of the “Shalls”

Deal with Care

(Less than 25 % deal with insurance)

5

Focus on

-- Chronic Care

-- Team Care

-- Connected Care

-- Safer Care

-- Continuously Improving Care

-- Becoming a Culture of Learning For Care

6

The new law requires a

first time ever

care improvement plan

for America.

77

National Strategy for Quality Improvement in

Health Care

March 2011

http://www.healthcare.gov/center/reports

88

Making Care Safer


Agenda One --

99

Ensuring Person and

Family Centered Care


Agenda Two --

1010

Promoting Effective Communication

and Coordination of Care


Agenda Three --

1111

Promoting the Most Effective Prevention and

Treatment

of the Leading Causes

of Mortality Starting with Cardiovascular Disease


Agenda Four --

1212

Working with Communities to

Promote Wide Use of Best

Practices to Enable Healthy Living

Agenda Five --

1313

Making Quality Care

More Affordable


Agenda Six --

14

The bill is rich in care

improvement provisions.

(most invisible to the general public)

15

ACA PROVISION REGARDING CARE

Requires HHS Secretary to develop a National Strategy to

Improve Health Care Quality to improve health outcomes

and efficiency, identify areas for improvement, address

gaps in comparative effectiveness information and data

gathering, and improve research and dissemination of best

practices. National strategy must be updated annually.

16


Requires AHRQ, and CMS to develop quality

measures conforming to National Strategy; requires HHS

Secretary to develop, periodically update provider-level

outcome measures for hospitals and physicians, including

10 outcome measurements for acute and chronic diseases

by March 2012 and 10 outcome measurements for primary

and preventive care by March 2013.

17


Establishes Medicaid Quality Measurement Program,

requiring state Medicaid plans to report on state-specific

health quality measures, as determined by the HHS

Secretary; requires HHS Secretary to test, validate, and

develop the quality measures.

18


Creates a quality measures reporting system for long-term

care hospitals, inpatient rehabilitation facilities, cancer

hospitals, and hospice programs.

19


Creates an Interagency Working Group on Health Care

Quality to coordinate quality activities across 23 federal

departments.

20


Care Continuity

Establishes the Community-Based Care Transitions Program

to improve home-based chronic care management for

Medicare beneficiaries with multiple chronic conditions.

21


Establishes interdisciplinary community health teams,

created by grants and contracts to eligible organizations

from the HHS Secretary, to facilitate collaboration between

primary care providers and community-based prevention,

patient education, and other resources.

22


Condition-Specific Care Improvement

Creates a National Congenital Heart Disease Surveillance

System to track epidemiological data on heart disease and

identify areas for prevention and outreach.

23


Establishes Centers of Excellence for Depression - a

network of organizations developing, implementing

evidence-based treatment and prevention standards; foster

communication with stakeholders; leverage community

resources; and promote use of electronic health records to

coordinate and manage treatment of depressive disorders.

24


Creates National Diabetes Report Card: biennial, publically-

available report of aggregate prevention, quality of care, risk

factors, and outcomes data for diabetic patients.

25


Modifies the Medicare physician fee schedule to incorporate

payments that vary based on the quality of care provided.

The modifier will be applicable to specific physicians and

physician groups, as determined by HHS, beginning January

1, 2015, and will apply to all physicians and physician

groups starting January 1, 2017.

26


Modifies the Medicare physician fee schedule to incorporate

payments that vary based on the quality of care provided.

The modifier will be applicable to specific physicians and

physician groups, as determined by HHS, beginning January

1, 2015, and will apply to all physicians and physician

groups starting January 1, 2017.

27


Rating System - The Secretary shall develop a rating

system that would rate qualified health plans offered through

an Exchange in each benefits level on the basis of the relative

quality and price. The Exchange shall include the quality rating

in the information provided to individuals and employers

through a required Internet portal.

28

Medicare Advantage Quality Stars

CMS rates Medicare Advantage plans on a scale of one to five stars. Health plans achieving four or more stars receive additional quality payments.

Five Stars = Excellent Performance Four Stars = Above Average Performance Three Stars = Average Performance Two Stars = Below Average Performance One Star = Poor Performance

29

Medicare Advantage Quality Requirements

Quality scores for Medicare Advantage plans are based on 36

standard performance measures that are derived from four

sources:

Healthcare Effectiveness Data and Information Set (HEDIS)

Consumer Assessment of Healthcare Providers and Systems

(CAHPS)

Health Outcomes Survey (HOS)

CMS administrative data, including information about

member satisfaction, plans’ appeals processes, audit results,

and customer service

30

Hospital Value-Based Purchasing Program

Designed to provide incentive payments to hospitals that

meet set performance standards for certain quality measures.

Program will reward hospitals for improving patients’

experiences of care, while making care safer by reducing

medical mistakes.

Significant departure from current system, which rewards

hospitals for reporting quality data through the Hospital

Inpatient Quality Reporting Program.

31


Safe hospitals are a priority – ACA reduces Medicare

payments to hospitals for hospital-acquired conditions and

preventable readmissions; imposes monetary penalty on

hospitals with the worst rates of hospital-acquired

conditions.

32


Allows Accountable Care Organizations (ACOs), groups of

Medicare providers that voluntarily meet quality thresholds,

to share in cost savings; ACO regulations are being

developed now.

33


Establishes an Office of Women’s Health

34


Establishes an Office of Minority Health

35


Awards grants to states for programs that incentivize

Medicaid beneficiary participation in tobacco cessation,

weight control, and other health promotion programs to

help prevent or manage chronic disease.

36


Creates a Medicaid demonstration program requiring states

to reimburse qualified mental health care institutions for

services to stabilize Medicaid beneficiaries experiencing an

emergency psychiatric condition.

37


Promotes employer-based wellness programs through

assessment, technical support on implementation, and

grants to small employers.

38


Increases funding for the National Health Service Corps,

community health centers, school-based health centers, and

nurse-managed clinics.

39


Creates an evidence-based national education campaign to

increase awareness about breast cancer.

40


Cross-Cutting - Innovation

Creates a new Center for Medicare and Medicaid Innovation

(CMMI) within CMS to test and evaluate payment and service

delivery models that reduce costs and maintain or improve

quality of care.

41

Aligned Elements of the

Recovery Package

42

Health Care ITTo promote adoption and improve the performance of

the health care system, the HITECH Act was signed

into law in 2009.

The Act addresses obstacles to the adoption of EHRs

and provides substantial financial incentives for the

adoption and meaningful use of certified EHR

technology.

43

Meaningful Use

Meaningful use criteria include quality measurements

that will be built on over the next several years.

The goal is to build a system that supports clinical

practice, research, public health, and the health of

individual patients.

44

The entire agenda includes

Seventeen Billion Dollars to fund

Health Care IT.

(with meaningful use requirements

needed to receive the money)

45

So What About Kaiser Permanente?

How do we fit the new

care agenda?

46

-- Team Care

-- Data Supported Care

-- Focus on Patients with Chronic Care Needs

-- Connected Care

-- Consistently Improving Care

-- Safe Care

47

-- Sepsis

-- Pressure Ulcers

-- Central Line Infections

-- HAI’s

48

We are the proof point

that care can be much

safer.

49

Sepsis

-- #1 cause of death in California hospitals

-- 24% of seniors who die in hospitals die

of sepsis

-- Triple the percentage who die in

hospitals from cancer

Sources: California Office of Statewide Health Planning and Development (OSHPD)

50

Up to a third of sepsis

patients die from the

disease.


51

We are on a path of

continuous improvement

and team care for sepsis

52

30%

0%

5%

10%

15%

20%

25%

30%

35%

Sepsis Death Rate


53

Sepsis Death Rate

30%

24%

0%

5%

10%

15%

20%

25%

30%

35%


54

Sepsis Death Rate

30%

24%

18%

0%

5%

10%

15%

20%

25%

30%

35%


55

Sepsis Death Rate

30%

24%

18%

12%

0%

5%

10%

15%

20%

25%

30%

35%


56

Sepsis Death Rate

30%

24%

18%

12%10%

0%

5%

10%

15%

20%

25%

30%

35%


57

Why?

-- Team Care

-- Rapid Reponse Times and Teams

58

Kaiser Permanente Value Compass

59

Team care gives us

21 HEDIS First Place Scores

60

Our data base supports

Team Care.

61

Our data base

also supports

great research.

62

Other Research (without EMR)

-- A few hundred patients

-- A couple of years

-- Truncated research with no follow up

-- hugely expensive

( We have electronic data for ten million patients.)

63

We can sort through data

and learn important things

64

Alzheimer's

High cholesterol in 30’s –

360% higher Alzheimer’s in 60’s

Source: KP Division of Research Study

65

Special Data Combinations

66

Question --

When mothers have an amniotic

fluid infection during pregnancy,

are their kids more likely to have

asthma?

67

The Answer?

We used our database to find

mothers with that infection and

then track their kids for a couple of

years after they were born

-- YES

68

African-American kids: 98% higher rate of childhood asthma

What did we learn?

69


Hispanic kids:70% higher rate of childhood asthma

What did we learn?

70

What did we learn?



Caucasian kids: 60% higher rate of childhood asthma

71

What did we learn?



Caucasian kids: 60% higher rate of childhood Asthma

-- What about Asian-American kids?

72

What did we learn?

Asian-American kids – zero

(There was no increase in the childhood asthma rate for

Asian-American kids whose mothers had that very same

infection)

73

Zero and 90 are very

different numbers

-- Same caregivers-- Same care settings-- Same care-- Different results

74

Next step –

500,000 DNA samples

(being collected now)

DNA will open doors that will save many lives – and it will be

particularly useful at Kaiser Permanente because we are a total care

team with accountability for each patient’s total care needs and we

have the ability to make data use real.

75

We are on the edge of a

Golden Age of

Medical Research that only

Kaiser Permanente can do.

76

People’s lives will be better

everywhere because of the care

improvement we model and the

medical research we do.

7777

Acute

Care

25%

Chronic Care

Chronic Care vs. Acute Care

75%

78

Population health is the

next big challenge.

79

-- We can make care better.

-- We also need to help

people stay healthier.

80

HEAL is our total package

Healthy Eating Active Living

81

Multiple Eating Programs

-- Farmers Market

-- Live Well Be Well

-- Locally sourced food in Kaiser Permanente

hospitals

82

Multiple eating programs

83

New Focus --

WALKING

84

Walking Works

85

Walking improves health

86

Walking 30 minutes a day five days a

week cuts the likelihood of becoming

diabetic by half – and the likelihood of

stroke, heart disease and a couple of

cancers by over a third.

87

-- Dieting is hard

(people don’t get addicted to diets)

-- Walking can be extremely pleasant

(people do become “addicted” to walking)

88

The Best News Is --

The thirty minutes a day can be

done in two fifteen minute chunks.

89

Two fifteens are a lot easier to

accommodate and schedule

then one thirty.

90

Diabetes is a

Disease of Urbanization.

91

The United Nations is

holding a world summit this

Fall on Chronic Conditions.

92

World Epidemic of

Chronic Disease

93

Walking needs to be

part of the answer

everywhere.

94

WHO cited the

Kaiser Permanente Walking Campaign

in Davos as a direction the world

needs to study.

95

We Need

-- Patient focused care

-- Best Care

-- Safest Care

-- Active and useful programs to support

health

96

-- We can model the right

direction for the world.

-- We need to do it all together.

97

Be Well

1 reforming health care in america union delegates conference george c. halvorson chairman and ceo,...

Documents

care slide

care care continuity

quality care

safer care

connected care

team care

preventive care

care es