Population Health Management Ashley Rhude RHIA, CHTS-IM HIT Practice Advisor
Mission of OFMQ OFMQ is a not-for-profit, consulting company dedicated to advancing healthcare quality. Since 1972, we ve been a trusted resource through collaborative partnerships and hands-on support to healthcare communities.
OFMQ Areas of Expertise Analytics Case Review Education HIPAA IT Consulting Health Information Technology National Quality Measures Quality Improvement
HIT Service Lines HIPAA/Meaningful Use Security Risk Assessment - Level 1, 2, and 3 Meaningful Use Assistance Meaningful Use Audit Support Risk Management Consulting and Development Staff HIPAA Security Training Website Development & Secure Email IT Consulting
Ashley Rhude, RHIA, CHTS-IM AHIMA Approved ICD-10-CM/PCS Trainer Ashley holds a bachelor s degree in Health Information Management, as well as Health Care Administration. She is currently a Health Information Technology (HIT) practice advisor for the Oklahoma Foundation for Medical Quality. In this role, she assists providers, hospitals and nursing homes in the implementation and optimization of Electronic Health Records (EHR). Her specialties include: project coordination with EHR vendors, HIT security and privacy, workflow re-design and being an expert in meaningful use.
What is Population Health Management? The health outcomes of a group of individuals, including the distribution of such outcomes within the group. Medical care is only one of many factors that affect those outcomes. 6
Population Health Management (PHM) The goal of population health is to transform care delivery practices and administrative support to deliver improved outcomes and lower costs across the continuum of care for a specified population. Success will depend on changes in care practices, business processes and cross-organizational communications, all supported by information technology. Member Engagement Operational Performance Management and BI Cross-Continuum Care Delivery and Medical / Care Management Accounting Quality Outcomes Management / Reporting Integration and Infrastructure Source: HIMSS15-CBI-Population-Health-Management-Defined-20150223.ppt
Planning for Population Management This requires a significant change in the way of thinking and the practice patterns of providers. Instead of doing more to earn more, providers will be rewarded for efficiency and quality. 9
Pay for Performance Thinking MACRA- Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) reform Medicare payment. 10
What is MACRA? Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers services. Making a new framework for rewarding health care providers for giving better care not more just more care. Combining our existing quality reporting programs into one new system. 11
MACRA This will help CMS move more quickly toward their goal of paying for value and better care by: Merit-Based Incentive Payment System (MIPS) Alternative Payment Models (APMs)
MIPS A new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on: Quality Resource use Clinical practice improvement Meaningful use of certified EHR technology
APMs This will give CMS new ways to pay health care providers for the care they give Medicare beneficiaries. For example: From 2019-2024, pay some participating health care providers a lump-sum incentive payment. Increased transparency of physician-focused payment models. Starting in 2026, offers some participating health care providers higher annual payments. Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models.
Accountable Care Organizations (ACOs) Groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. 15
Patient Centered Medical Home (PCMH) The medical home concept. Team-based health care delivery model led by a health care provider that is intended to provide comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. Recognition is completed by The National Committee for Quality Assurance s (NCQA). 16
17 PCMH Recognition Elements
18 PCMH Recognition Elements
19 PCMH Recognition Elements
How can Technology help you? EHRs and automation tools should be used to support these essential PHM functions : Population identification Identification of care gaps Stratification Patient engagement Care management Outcomes measurement 21
Challenges and Next Steps CHALLENGES Practice standardization Resources Can t stop processes and can t add resources to change Needed to understand practice variation and standardize Informatics knowledgeable in in EMR support teams Challenge to implement tools to free up resources when processes and data aren t standardized (IT, informatics) Rapid cycle iteration is challenging for practice tools without significant resource involvement Decision rights who says this is the new process. NEXT STEPS Enterprise metrics Point-of-care registry and care management Patient consumer engagement utilizing EHR patient portal Source: HIMSS15-CBI-Population-Health-Management-Defined-20150223.ppt
In Conclusion By applying technology, automation or the medical home concept to every aspect of population health management, provider organizations and health systems will be able to deliver quality care to thousands of patients in an efficient and sustainable manner. 23
We Are Here To Help! Email: ofmqhit@ofmq.com arhude@ofmq.com Call: (877) 963-6744 Visit: www.ofmq.com Questions?
Sources http://www.waystationinc.org/filestoview/phm Report.pdf https://www.cms.gov/medicare/quality- Initiatives-Patient-Assessment- Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/MACRA-MIPS-and-APMs.html http://www.ncqa.org/programs/recognition/prac tices/patient-centered-medical-homepcmh/pcmh-2014-content-and-scoring-summary HIMSS15-CBI-Population-Health-Management- Defined-20150223.ppt
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