Shifting to Fee for Value: The Information Mandate

Transcription

1 Shifting to Fee for Value: The Information Mandate Randy L. Thomas, FHIMSS Service Line Executive Bryan Eckert Strategic Advisor CSOHIMSS 2013 Spring Conference May 17, 2013 CSOHIMSS 2013 Slide 0 May 17 th, 2013

2 Discussion Topics What is the information mandate and why do it? How does it work? What will it take to be successful? Case study the journey of one organization CSOHIMSS 2013 Slide 1 May 17 th, 2013

3 New Models Require New Capabilities 2 CSOHIMSS 2013 Slide 2 May 17 th, 2013

4 Hardwiring Performance to Payment Delivery Models Quality & Performanc e Payment Models Coordinate and Collaborate Accountable Care Organizations Clinically Integrated Networks Patient Centered Medical Home Contracting Bundled payments Shared Savings Readmission penalties Incentive based payments 3 CSOHIMSS 2013 Slide 3 May 17 th, 2013

5 Transforming How Quality and Performance Will be Measured MMA Core Measures GAO recommends HIT for Quality ONC HITECH Performance based payment (HVBP, ACOs, PCMH) CMS contracts with NQF to retool Core Measures for electronic specifications (emeasures) ACA ACA rule making and implementation CMS EHR Incentive Program Stage 1,2,3 Eligible Hospitals and Providers 2014 IPPS 4 Measures manually abstracted and reported Payment annually updated CSOHIMSS 2013 Slide 4 May 17 th, 2013

6 Measuring 5 CSOHIMSS 2013 Slide 5 May 17 th, 2013

7 Federal (and Commercial) Contracts are Driving Requirements CSOHIMSS 2013 Slide 6 May 17 th,

8 emeasures: Based on Evidencebased Guidelines and Programs Get with the Guidelines: Stroke 7 CSOHIMSS 2013 Slide 7 May 17 th, 2013

9 Measure Process Performance 8 CSOHIMSS 2013 Slide 8 May 17 th, 2013

10 emeasures & Analytics Start in the EHR: Getting the Data Right STROKE 2 Build for computerization using standards set by the NQF and CMS 9 CSOHIMSS 2013 Slide 9 May 17 th, 2013

11 Workflows & Data Needs are Interdependent 10 CSOHIMSS 2013 Slide 10 May 17 th, 2013

12 Technology & Tools 11 CSOHIMSS 2013 Slide 11 May 17 th, 2013

13 Knowledge & Insights 12 CSOHIMSS 2013 Slide 12 May 17 th, 2013

14 Information-based Performance Improvement 13 CSOHIMSS 2013 Slide 13 May 17 th, 2013

15 Leads to 14 CSOHIMSS 2013 Slide 14 May 17 th, 2013

16 Clinical and business process optimization Health Analytics Maturity Model Quality and safety reporting Performance management Operational reporting Basics Value-based purchasing Risk-based contracts Foundational Competitive Metrics Data marts Segmented data governance MS Office Out-of-the-box transaction reports Population health management Comparative effectiveness research Dashboards/ Scorecards Data warehouse (enterprise view) Enterprise data governance Differentiating Personalized medicine Text analytics Data mining (what is not known) Transforming Predict and personalize Managing and learning from information 2013 Encore Health Resources CSOHIMSS 2013 Slide 15 May 17 th, 2013

17 Implementation Information Capability Analytics The Journey from Volume to Value Operational reporting Basics Quality and safety; performance metrics Fundamentals Risk-based contracts; FFC Competitive Comparative effectiveness; population health Differentiating Personalized medicine; predictive analytics Transforming Analytics Platform Acquire clinical, administrative, & financial data Implement & optimize certified enterprise EHRs Integrated Data Identify data sources workflows data mapping Value 2013 Encore Health Resources CSOHIMSS 2013 Slide 16 May 17 th, 2013

18 Anatomy of a Data Element From Source to Re-purpose Medicare Shared Savings Pilot Partnership for Patients THAT SUPPORT FOCUSED INITIATIVES THAT ARE RE-PURPOSED Pop Health Quality Metrics Cost & Margin Payer Analysi s IN ANALYTIC APPS GENERATE INDIVIDUAL DATA ELEMENTS SOURCE SYSTEMS ED Practic e Mgmt EHR Patient Billing ADT Other Encore Health Resources CSOHIMSS 2013 Slide 17 May 17 th, 2013

19 Role of Data Governance to here consistently and accurately. 18 Data governance makes sure data gets from 2013 Encore Health Resources CSOHIMSS 2013 Slide 18 May 17 th, 2013

20 Multi-dimensional Assessment and Plan Dimensions 1) Organizational Alignment Enterprise-level strategy Alignment of Business / IT strategic goals 2) Information Culture Medical Group Sample Health System Acute Care Division Other (IPAs, LTC, etc.) Data Governance, Shared Ownership/Accountability 3) Clinical Integration Enterprise-level workflow optimization Cross-continuum care coordination External community linkages Patient-Centric Care Patient ID Patient Handoff Member Engagement Care Coordination Patient Access Patient ID Patient Handoff Member Engagement Care Coordination Patient Access Patient ID Patient Handoff Member Engagement Care Coordination Patient Access 4) Front-End Integration 5) Health Information Exchange 6) BI / Analytics 4) Data Access, Context-Sharing, Identity Management 5) Data Sharing, Exchange, Standardization 6) Data Acquisition, Aggregation, Analysis, 7) Core Systems Environment 19 Clinicals Inpatient EMR ED Pharmacy Ambulatory EMR Revenue Cycle OP Reg. OP Sched. IP ADT Hosp. Billing Prof. Billing CSOHIMSS 2013 Slide 19 May 17 th, 2013

21 A CASE STUDY 20 CSOHIMSS 2013 Slide 20 May 17 th, 2013

22 Program Governance CSOHIMSS 2013 Slide 21 May 17 th, 2013

23 Based on an emeasure foundation CSOHIMSS 2013 Slide 22 May 17 th, 2013

24 Driving performance improvement: A Meaningful Use Dashboard 23 CSOHIMSS 2013 Slide 23 May 17 th, 2013

25 What s Next CSOHIMSS 2013 Slide 24 May 17 th, 2013

26 The New Fundamentals CSOHIMSS 2013 Slide 25 May 17 th, 2013

27 CSOHIMSS 2013 Slide 26 May 17 th, 2013 References: White Paper: A World Evolving Toward Value Video: emeasures THANK YOU Randy L. Thomas, FHIMSS Health Analytics Service Line Executive Phone: rthomas@encorehealthresources.com Bryan J Eckert, BS, MBA Strategic Advisor Mobile: Office: beckert@encorehealthresources.com

28 MU is the foundation for clinical emeasures CSOHIMSS 2013 Slide 27 May 17 th, 2013 MU standards are the foundation Increased clinical granularity Reimbursement & regulatory-driven and using EHR data for reporting

29 Agenda CSOHIMSS 2013 Slide 28 May 17 th, 2013