Improving Healthcare Safety, Quality and Value

Transcription

1 Improving Healthcare Safety, Quality and Value Jeneen Iwugo, MPA Deputy Director, Quality Improvement and Innovation Group Center for Clinical Standards and Quality

2 Weaknesses of Fee for Service Payment Excessive use of low-value services Insufficient incentives to improve quality of care Poor coordination of care 2

3 Affordable Care Act Impact Expansion of Health Insurance Coverage -> Decreased Uninsured Rates Slower Growth in Health Care Costs Improved Quality of Care Source: Furman J, Fiedler M Continuing the Affordable Care Act s Progress on Delivery System Reform is an Economic Imperative. 3

4 Results: Higher Value, Lower Costs CBO Projections of Federal Spending on Major Health Programs Percent of GDP August 2010 CBO Projections March 2015 CBO Projections (incl. actuals through FY14) Source: Congressional Budget Office; CEA calculations. Note: The August 2010 GDP estimates have been adjusted for major NIPA revisions in the summer of Without these revisions, the decline since August 2010 would be larger. According to the Congressional Budget Office, federal spending on major health care programs in 2020 will be $200 Billion lower than predicted in 2010.

5 Using Information to Make Better Decisions Quality comparison websites for nursing facilities, hospitals, physicians/clinicians and ultimately all major provider types Data releases on spending, quality, charges, and other consumer-relevant information Quality rating system for qualified health plans Electronic Heath Record adoption

6 Better Care, Smarter Spending, Healthier People Focus Areas Incentives Description Promote value-based payment systems Test new alternative payment models Increase linkage of Medicaid, Medicare FFS, and other payments to value Bring proven payment models to scale Care Delivery Encourage the integration and coordination of services Improve population health Promote patient engagement through shared decision making Information Create transparency on cost and quality information Bring electronic health information to the point of care for meaningful use Source: Burwell SM. Setting Value-Based Payment Goals HHS Efforts to Improve U.S. Health Care. NEJM 2015 Jan 26; published o6nline first.

7 During January 2015, HHS announced goals for value-based payments within the Medicare FFS system 7

8 Target percentage of payments in FFS linked to quality and alternative payment models by 2016 and 2018 Alternative payment models (Categories 3-4) FFS linked to quality (Categories 2-4) All Medicare FFS (Categories 1-4) % ~20% 30% 50% 68% >80% 85% 90% Historical Performance Goals

9 Alternative Payment Model Impact Bundled Payments Payment or target price forall services associated with an episode of care Over 2,000 hospitals, physician groups, and post acutecare providers accepting financial risk and focused on improved quality Accountable Care Models Providers have shared responsibility for managing total cost and quality fora population of patients. Opportunity to earn shared savings payments when spending is reduced with high quality care Newer ACO models with populationbased payments Care Coordination 9

10 Partnership for Patients 2.0

11 Partnership for Patients Continues to Focus on 2 Breakthrough Aims partnershipforpatients.cms.gov

12 Partnership for Patients Achieves Results Through Full Court Press with 3 Engines 1. Innovation Center Investments Hospital Engagement Networks National Contracts Community Based Transition Program 2. Federal Programs Medicare Aging Network NHSN Team STEPPS Patients Medicaid QIOs CUSP Initiative SORHs Partnership for Patients 3. Partners Unions Associations Long Term Care Patients Researchers States Providers National Quality Forum Employers CBOs

13 Original 11 PfP Areas of Focus Shall Continue as Required: Adverse Drug Events Catheter-Associated Urinary Tract Infections Central Line-Associated Bloodstream Infections Early Elective Deliveries Falls Obstetrical Adverse Events Pressure Ulcers Preventable Readmissions Surgical Site Infections Venous Thromboembolism Ventilator-Associated Pneumonia

14 New PfP Areas of Focus Proposed by Some in the Field Include: Former LEAPT Topics Sepsis & Septic Shock Clostridium difficile (C. diff) Antibiotic Stewardship Culture of Safety including worker safety Undue Exposure to Radiation Failure to Rescue Innovative New Additions Pediatric Safety Early intervention for mental health Safe diabetes management Multi-drug resistant organisms Expanded ADE sub-topics (e.g. anti-epileptics) Peripheral Intravenous Infiltrations/Extravasations Unplanned Extubations Pain Management And more!

15 Partnership for Patients 2.0 Hospital Engagement Networks (HENs) American Hospital Association 30 State Associations including Arkansas Hospital Association Ascension Health Carolinas HealthCare System Dignity Health Healthcare Association of New York State Hospital & Healthsystem Association of Pennsylvania Iowa Healthcare Collaborative Lifepoint Health, Inc. MHA Health Foundation Minnesota Hospital Association Health Research Education Trust of New Jersey Ohio Children s Hospital Solutions for Patient Safety Ohio Hospital Association Premier Inc. Tennessee Hospital Association VHA-UHC Alliance NewCo Inc. Washington State Hospital Association

16 Successes during PfP Round 1 Arkansas Hospital Association Decreased ADEs related to Warfarin by 47% Decreased CAUTI on tracked units by 71.6% Decreased CLABSI on tracked units by 77% EED reduction of 88.7% Injuries to neonates reduced by 80.7% All cause readmissions reduced by 12.8% Reduction in stage III or greater pressure ulcers by 50.6% Reduction in VTE by 80.4%

17 TMF QIN-QIO Learning and Action Networks (LANs) Behavioral Health Cardiovascular Health and Million Hearts Health for Life Everyone with Diabetes Counts initiative Healthcare-Associated Infections Immunizations Meaningful Use (of Health Information Technology) Medication Safety Nursing Home Quality Improvement Patient and Family Quality Improvement Initiative Readmissions Value-Based Improvement and Outcomes

18 Arkansas Providers Teaming with QIN-QIOs Participating with QINs through LANs: 7 Inpatient Psychiatric Facilities 9 Critical Access Hospitals 15 Ambulatory Surgical Centers 20 Home Health Agencies 53 Hospitals 170 Nursing Homes 9 one-star facilities 22 five-star facilities 255 Physician Practices 1,188 Physicians (eligible professionals)

19 Some of the public & private partners in the Partnership for Patients

20 Major Reductions in Harm AHRQ 2010 Baseline & Results to Date Harms/1,000 Discharges 142 Harms/1,000 Discharges 132 Harms/1,000 Discharges 121 Harms/1,000 Discharges TBD Source: Secretary Burwell announces results of patient safety improvement efforts, HHS News Release, December 2, 2014.

21 Preliminary 2013 AHRQ National Scorecard on HACs - Compared to 2010 Baseline 17% Reduction in HACs, from 4,757,000 to 3,960,000 from 145 per 1,000 discharges to 121 per 1,000 discharges $12B in Estimated Associated Cost Savings, $4B for 2011 and 2012 combined $8B for ,000 Lives Saved, ~15,000 lives saved for 2011 and 2012 combined ~35,000 lives saved for 2013 * Final MPSMS-based 2013 HACs, Preliminary 2013 NHSN-based HACs, and extrapolation of 2012 Data for 2013 PSI-based HACs; Partnership for Patients 12/1/14 press release

22 AHRQ Data Analysis Earns Geppetto Checkmark Fact Checker, by Glenn Kessler The Geppetto Checkmark the truth, the whole truth, and nothing but the truth Significant omissions and/or exaggerations One Pinocchio Some shading of facts Two Pinocchios Significant omissions President Obama uses AHRQ analysis in remarks on 5 th anniversary of ACA Fact Checker awards Geppetto Checkmark One of three Geppettos awarded* Most popular Fact Check for April 2015 AHRQ analysis published in December 2014 on the impact of the Partnership for Patients Three Pinocchios Significant factual errors *97 Fact Checker articles published January 2015 through April 15, 2015 see: 22

23 Transforming Clinical Practice Initiative

24 Transforming Clinical Practice Goals Support more than 140,000 clinicians in their practice transformation work Improve health outcomes for millions of Medicare, Medicaid and CHIP beneficiaries and other patients Reduce unnecessary hospitalizations for 5 million patients Generate $1 to $4 billion in savings to the federal government and commercial payers Sustain efficient care delivery by reducing unnecessary testing and procedures Build the evidence base on practice transformation so that effective solutions can be scaled

25 Practice Transformation in Action Transforming Clinical Practice would employ a three-prong approach to national technical assistance. This technical assistance would enable large-scale transformation of more than 140,000 clinicians and their practices to deliver better care and result in better health outcomes at lower costs.

26 What are the 5 phases of TCPI? Set Aims Use Data to Drive Care Achieve Progress on Aims Achieve Benchmark Status Thrive as a Business via Pay for Value Approaches

27 Transforming Clinical Practice Initiative (TCPI) Network ,

28 Key Accountabilities of Support & Alignment Networks Pursue and achieve the quantitative AIMS of the initiative. Align Their Multiple Programs and Drivers with Aims & Activities of TCPI Initiative: Continuing Medical Education Maintenance of Certification Registries Journals, Newsletters, Messaging to Members Professional Standards & Requirements Annual Meetings Awards Programs Help Recruit Members Into Initiative and Sustain Their Active Engagement Over 4 Years Support Practices with Person & Family Engagement

29 Transforming Clinical Practice Initiative: Support & Alignment Networks (SANs) American College of Emergency Physicians American College of Physicians, Inc. American College of Radiology American Medical Association American Psychiatric Association HCD International, Inc. National Nursing Centers Consortium Network for Regional Healthcare Improvement Patient Centered Primary Care Foundation The American Board of Family Medicine, Inc.

30 Key Accountabilities of Practice Transformation Networks Pursue and achieve the quantitative AIMS of the initiative Recruit clinicians/practices and build strategic partnerships Lead practices in continuous improvement and culture change Facilitate improved clinical practice management Utilize quality measures and data for improvement

31 Transforming Clinical Practice Initiative: Practice Transformation Networks (PTNs) Arizona Health-e Connection Baptist Health System, Inc. Children's Hospital of Orange County Colorado Department of Health Care Policy & Financing, Community Care of North Carolina, Inc. Community Health Center Association of Connecticut, Inc. Consortium for Southeastern Hypertension Control Health Partners Delmarva, LLC Iowa Healthcare Collaborative Local Initiative Health Authority of Los Angeles County Maine Quality Counts Mayo Clinic National Council for Behavioral Health National Rural Accountable Care Consortium New Jersey Innovation Institute New Jersey Medical & Health Associates dba CarePoint Health New York ehealth Collaborative New York University School of Medicine Pacific Business Group on Health PeaceHealth Ketchikan Medical Center Rhode Island Quality Institute The Trustees of Indiana University VHA/UHC Alliance Newco, Inc. University of Massachusetts Medical School University of Washington Vanderbilt University Medical Center VHQC VHS Valley Health Systems, LLC Washington State Department of Health

32 Mid-South Practice Transformation Network Vanderbilt University Medical Center Recruitment Summary Primary Care Clinicians Number committed at time of application 1550 Total number targeted during the TCPI Model 1600 Specialty Care Clinicians Number committed at time of application 1800 Total number targeted during the TCPI Model 2450 Total number of clinicians that the PTN will 4050

33 Projected Improvement Areas Improvement Area By the end of the Yr. 4 Improvement Area By the end of the Yr. 4 Colorectal Cancer Screenings Diabetes: Hemoglobin A1c poor control (>9%) Diabetes: Hemoglobin A1c poor control (<8%) Well child visits 3-6 years of life Post MI: Beta blocker therapy Post MI: ACE-I/ ARB therapy 30% 20% 20% 20% 20% 20% Heart Failure with LVSD: Beta blocker therapy Heart Failure with LVSD: ACE-I/ ARB therapy Pneumococcal Vaccinations Cost savings Unnecessary hospitalizations avoided 20% 20% 20% $275m in yr. 4 10%

34 Contact Information Jeneen Iwugo, MPA Deputy Director, Quality Improvement and Innovation Group