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Health Care Reform: Where are the Pharmacists? Opportunities and Challenges for Pharmacists in Health Care Reform PowerPoint PPT Presentation


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Health Care Reform: Where are the Pharmacists? Opportunities and Challenges for Pharmacists in Health Care Reform. Anthony D. Rodgers CMS Deputy Administrator Center for Strategic Planning June 2011. Rationale for CMS Strategic Direction To Transform the US Healthcare Delivery System.

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Health Care Reform: Where are the Pharmacists? Opportunities and Challenges for Pharmacists in Health Care Reform

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Health care reform where are the pharmacists opportunities and challenges for pharmacists in health care reform

Health Care Reform: Where are the Pharmacists?Opportunities and Challenges for Pharmacists in Health Care Reform

Anthony D. Rodgers

CMS Deputy Administrator

Center for Strategic Planning

June 2011


Health care reform where are the pharmacists opportunities and challenges for pharmacists in health care reform

Rationale for CMS Strategic Direction

To Transform the US Healthcare Delivery System

“The US healthcare system produces significant level of unjustified variance in patient safety, healthcare cost, quality performance and health outcomes.”


Health care reform where are the pharmacists opportunities and challenges for pharmacists in health care reform

The Three Part Aims of CMS

Better care, better health, and lower costs through continuous improvement for all Americans


What is the end of the game with health reform

“What is the end of the game with Health Reform?”


The essential elements of a transformed healthcare system

The Essential Elements of a Transformed Healthcare System

Informed and

Activated

Patient

Productive

Interactions

Prepared

Clinical

Team

Common

Set of Patient

Health Information

  • Electronic Health Records

  • Exchange of Health Information

  • Multi-disciplinary team

  • Coordinated Care Management

  • Web based health e-learning,

  • Electronic Care Planning

  • Self Care Management Tools


Patient centered care

Supported by ACO or Integrated Care System

Patient Centered Care

Electronic Health Record & HIE

Informed and

Activated

Patient

Productive

Interactions

Prepared

Clinical

Team

Supported By E-Health and Learning Tools

Clinical and Value Based Integrated Care Management Decision Making


Driving health care system transformation

Integrated

Health

  • Patient/Person Care Centered

    • Patient/Person centered Health Care

    • Productive and informed interactions between Family and Provider

    • Cost and Quality Transparency

    • Accessible Health Care Choices

  • Aligned Incentives for wellness

  • Integrated networks with community resources wrap around

  • Aligned reimbursement/cost Rapid deployment of best practices

  • Patient and provider interaction

    • Aligned care management

    • E-health capable

    • E-Learning resources

Driving Health Care System Transformation

Healthcare Delivery

System 3.0

Healthcare Delivery

System 2.0

Healthcare Delivery System 1.0

Accountable Care

Episodic

Non Integrated

Care

  • Transparent Cost and Quality Performance

    • Results oriented

    • Access and coverage

  • Accountable Provider Networks Designed Around the patient

  • Focus on care management

  • and preventive care

    • Primary Care Medical Homes

    • Utilization management

    • Medical Management

  • Episodic Health Care

    • Sick care focus

    • Uncoordinated care

    • High Use of Emergency Care

    • Multiple clinical records

    • Fragmentation of care

  • Lack integrated care networks

  • Lack quality & cost performance transparency

  • Poorly Coordinate Chronic Care Management


Cms strategic plan focus

CMS Strategic Plan Focus

  • Delivery System Transformation

    • ACO and Integrated Care Management Delivery System Models Diffusion

    • Medical/Health Home Diffusion

    • Electronic Health Record and HIE Infrastructure

  • Patient Safety

    • Reduce Hospital Readmission Rates

    • Reduce Hospital Acquired Conditions Rates and Patient Harm

    • Improve Care Transitions

    • Improved Medication Management

  • Cost and Quality

    • Value Base Purchasing

    • Aligned Performance Incentives and Penalties

    • New payment models

    • Quality and Cost Public Transparency and Accountability

  • Coverage and Access

    • Healthcare manpower capacity development (e.g. use of mid-levels, telemedicine)

    • Medicaid/CHIP expansion

    • Health Insurance Exchanges

  • Special Populations

    • Dual Eligible Individual

    • Complex Chronic Disease

    • Special Need Children

    • Frail Elderly and Disabled


Case study 1 health delivery system performance geographic variation in cost and quality outcomes

Case Study # 1Health Delivery System Performance: Geographic Variation in Cost and Quality Outcomes


Hospital referral region per capita spending varies dramatically

Hospital Referral Region Per Capita Spending Varies Dramatically

Medicare per capita spending in Miami, FL is more than 2 times Medicare per capita spending in Honolulu, HI !

10


Health care reform where are the pharmacists opportunities and challenges for pharmacists in health care reform

Sample Data Table for High-Cost Hospital Referral Region (HRR)

A ratio for each HRRxHCC


Health care reform where are the pharmacists opportunities and challenges for pharmacists in health care reform

Sample Data Table for Low-Cost Hospital Referral Region

A ratio for each HRRxHCC


Geographic variation in potentially avoidable hospitalizations

Geographic Variation In Potentially Avoidable Hospitalizations


Potentially avoidable hospitalizations

Potentially Avoidable Hospitalizations


Health care reform where are the pharmacists opportunities and challenges for pharmacists in health care reform

Patient Settings : Variation in Results by Setting


Case study 2 dual eligible beneficiary population potentially avoidable hospitalizations

Case Study #2Dual Eligible Beneficiary Population: Potentially Avoidable Hospitalizations


Current dual eligible population hospitalization rates

Current Dual Eligible Population Hospitalization Rates


Health reform dual eligible with complex chronic disease

Health Reform: Dual Eligible with Complex Chronic Disease


Health care reform where are the pharmacists opportunities and challenges for pharmacists in health care reform

The CMS Strategic PlanSystematically guiding the Health Care System to achieve targeted measurable improvements in care management, cost reduction, and population health.


Cms tools for transforming the delivery system

CMS Tools for Transforming the Delivery System


Cms levers and initiatives to improve care reduce cost impact population health

CMS Levers and Initiatives to Improve Care, Reduce Cost, & Impact Population Health

  • Policy Levers and Initiatives

    • Align the Healthcare Industry to CMS Strategic Aims and Direction

    • Initiate and Lead Major National Campaigns and Initiatives

    • 10th Scope of Work for QIOs

    • Program Policy Alignment

    • Payment Reform and Incentives

    • CMS Public Reporting, Public Access Databases

    • Graduate Medical Education policy and funding

    • Provide or Sponsor Learning Collaborative

    • Innovation Center Initiatives and Investments

    • Public-Private Partnering on strategic aims

    • Building Knowledge Resources - Health Information Databases, Collaborative Insight and Knowledge Discovery


Deploying integrated care delivery system models

Deploying Integrated Care Delivery System Models


An accountable system for beneficiary patient centered care

An Accountable System for Beneficiary/Patient-Centered Care

Accountable Care Design Elements

Expected Outcomes

Improved Care Coordination and Integrated Delivery of Care

Increased Provision of Evidence-Based Care

Results In

Patient Activation and Increased Health Literacy

Efficient Delivery of Care and Elimination of Waste

Reduce and Contain Cost of Care

Population Health Improvement


Advanced primary care medical home

Advanced Primary Care Medical Home


Clinical pharmacist role in health care reform

Clinical Pharmacist Role in Health Care Reform

  • Patient Compliance

  • Comparative Effectiveness


Questions

Questions?

Thank you!


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