Monday, February 02, 2015

#onc2015 Delivery Reform. A panel moderated by @SusanDentzer

The Monday Afternoon session kicks off with a panel session on Health Information and Delivery System Reform

Panel: Use – Health Information and Delivery System Reform (International Ballroom)

  • Moderator: Susan Dentzer, Senior Health Policy Advisor, Robert Wood Johnson Foundation (@SusanDentzerWeb Site Disclaimers)
  • Patrick Conway, M.D., Deputy Administrator for Innovation & Quality, Centers for Medicare & Medicaid Services (@CMSGov)
  • John Blair, IPA, Hudson Valley
  • Lew Sandy, M.D., EVP of Clinical Advancement, UnitedHealth Group (@myUHCWeb Site Disclaimers)

Talking about more efficient, higher quality system where people are incentivized to deliver better care.

“CMS is the 800 pound gorilla in health care delivery.”

Pat Conway

Delivery System Reform

  • Incentives

30% of payments to be value based by 2016, 50% by 2018.

2011 = 0%, 2014 = 20%

  • Care Delivery
  • Information

Health Care Payment Learning in Action Network

ACOs are investing in technology solutions beyond their core systems
State Innovation Models to focus on smarter pending models.

What is the role of CMS in getting to higher levels of interoperability:
– Need to get the right information at the right time to the Patient, the clinician and the caregiver.

Information and interoperability:

Meaningful Use: Simplicity
Getting the right information at the point of care.


Transparency on cost and quality.

From a regulatory standpoint how do we encourage open source.
Do we have regulatory barriers that discourage competition? Privacy and Security principles. eg. Some controls limit the ability to manage mental health.
Investing in mobile, telehealth, precision medicine.

CMS has an evolving data environment. eg. virtual data centers for researchers.

Lew Sandy, United Health

Supporting the move to value-based payments. In 2013 $36B of value-based payments. 2016 target is $65B.

Optum serves 2M patients and provides technology for better care.

HouseCalls program on Medicare Advantage serves 750,000 patients.
High touch and technology enabled.

“Interoperability is the stuff that needs to happen to create better outcomes.”

Incentives are focused around value-based contracts.
Applying incentives around a developmental pathway model. eg. Pay for structure then migrate to pay for process (best practice) then evolve to pay for outcomes.

Paying for outcomes drives change. eg. Close gaps in care. Which drives better information exchange.

How do we afford healthcare? Huge opportunities to improve practice management by working in tandem with clinical systems.

Better integration of physical and mental health can lead to better health management. There are issues around privacy and data security.

Non-medical issues can prevent people getting access to care. eg. Transportation, Time off work for care givers.

John Blair, Hudson Valley IPA

Integration and Transformation. Need to re-define workflows. Create incentives to encourage adoption.

Technology and Infrastructure. 90% of providers run certified EHRs. This drives demand for interoperability.

Standard EHR implementation for outpatient/primary care.
Interoperability: Push via Direct. Pull via Health Information Exchange. Both are necessary.

Interoperability: When patient moves across the continuum of care, the information is available and available when more information is needed.

Push so far has been about moving providers off paper. Direct has been helpful but is not just email.

Leadership and buy-in has been critical to driving adoption.

Developmental Pathways work. Jumping to outcomes is too big a leap. So Start with Structure and process as a foundation.

Practicing providers are focused on making the current technologies work.

There is optimism about the future strategic plan.

FHIR/Open APIs will be important. They need to be implemented well and incentives have to support adoption and use.

Physician Outlook:

  • Need EHR that enhances the relationship with patient.
  • Don’t reduce providers to scribes

Pat Conway: Need to tune MU to support User-centered design and interoperability
Lew Sandy: HIT needs to support the clinician and patient.
John Blair: Sometimes you need to reimplement EHR to meet clinician needs.

Outcome oriented measures are needed. Measure the outcome not the action.

Q: What’s coming next at intersection of interoperability

Pat Conway: Executing on move to value-based payments. Developments in data APIs
Lew Sandy: Improve the consumer experience.
John Blair: With Infrastructure in place. Now we will see uptick in use of Direct for improved transitions of care.

[category News, Health]

[tag health cloud, blue button, ONC2015]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Stay up-to-date: Twitter @ekivemark

I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
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