Health Care Reform and Its Impact on EMS:

1. Health Care Reform and Its Impact on EMS: Volume to Value, Improving Population Health and Other Paradigm Shifts

3. The “Triple Aim” Better care for individuals Better care for populations Hospitals Support the Triple Aim Reducing per capita costs

4. Insurance Underwriting Changes • Individual Mandate • Employer Mandate • Finance & Delivery Systems Redesign • Cost Containment ACA Overview of Key Provisions

5. CHBE Strategies Price Leader: The CHBE as a Driver of Low Premiums Service Center: The CHBE as a Consumer Destination Change Agent: The CHBE as a Catalyst of Finance and Delivery Reform Public Partner: The CHBE Aligned with Medi-Cal

6. Opportunities for Health Care Cost Reduction Source: Harold D. Miller, Center for Health Care Quality and Payment Reform Improved Inpatient Care Processes Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Hospitals and Specialists Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! All Providers Reduction in Preventable ER Visits and Admissions Primary Care Practices Reduction in Unnecessary Tests and Referrals Improved Practice Efficiency Improved Prevention and Early Diagnosis

7. Opportunities for Health Care Cost Reduction Improved Inpatient Care Processes Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Hospitals and Specialists Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! All Providers Reduction in Preventable ER Visits and Admissions Primary Care Practices Reduction in Unnecessary Tests and Referrals Improved Practice Efficiency Improved Prevention and Early Diagnosis MEDICAL HOME

8. Opportunities for Health Care Cost Reduction Improved Inpatient Care Processes BUNDLING Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Hospitals and Specialists Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! All Providers Reduction in Preventable ER Visits and Admissions Primary Care Practices Reduction in Unnecessary Tests and Referrals Improved Practice Efficiency Improved Prevention and Early Diagnosis

9. Opportunities for Health Care Cost Reduction Improved Inpatient Care Processes ACCOUNTABLE CARE ORGANIZATION Use of lower-cost treatments Reduction in Adverse Events Reduction in Preventable Readmissions Improved Management Of Complex Patients Hospitals and Specialists Use of Lower- Cost Settings And Providers Lower Total Health Care Costs! All Providers Reduction in Preventable ER Visits and Admissions Primary Care Practices Reduction in Unnecessary Tests and Referrals Improved Practice Efficiency Improved Prevention and Early Diagnosis

10. Concept • Define the “region” THE GEOGRAPHY • Local communities within the region • Identify the healthcare needs and available resources • Identify the vision for the region • Articulate goals: region and local communities • Structure the “delivery model” the “Network of Care” MG Community Clinics Dr. Ambulatory Care Dr. Dept. of Public Health Facility Dr. MG PAC Facility CAH Dr. MG FQHC Dr. Patient Population The Camden Group

11. ACO Structure • Infrastructure(Provided or Contracted ACO Operations) • Information Technology • EMR, CPOE, PACS • Data warehouse • Reporting • HIE • Care Management • Hospitalists and Intensivists • CMO • Disease management • Clinical protocols • Advanced analytics and modeling • Call center • Utilization management • Knowledge management • Health Network • Delivery network • Financial/Payment Systems Physicians Outpatient Clinics/ Centers Hospital SNF ACO Home Health Rehab Behavioral Medicine Pharmacy • ACO responsible for: • Clinical care management (clinical integration) • Capture data for continuum of care • Measure and monitor costs and quality The Camden Group

12. Strategic Issues for Caregivers: • Enhance efforts to improve quality • Increase clinical and operational efficiencies • Increase efforts to improve patient satisfaction • Reduce avoidable readmissions • Assess and strengthen planning for HIT • Examine readiness for payment and care redesign • Foster physician alignment and clinical integration

16. Strategic Issues for EMS: • Continuation of below-Cost payment for Medi-Cal • Increase in use of EMS providers • Change in flow patterns • Engage in hospital integration plans • Educate/Prepare workforce

17. Questions

18. Jim Lott, Executive Vice President Hospital Association of Southern California 515 S. Figueroa St., Suite 1300 Los Angeles, CA 90071-3300 (213) 538-0777 JLott@hasc.org www.hasc.org