1. Using Technology to Improve Quality Charles DeShazer, MD VP, Quality, Medical Informatics & Transformation Dean Health System Madison, WI

2. Key Industry Assumptions Current cost inflation curve is unsustainable Payers are moving towards paying for value rather than volume EHR will become a standard tool Quality will become not only the “ticket to play” but also one basis of competition (value = quality/cost) Primary care will be the engine for quality

3. Overall Rank Ordering of Health System Characteristics 2010 Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity). Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).

4. ACO model represents a shift of COST RISK to Providers through payment mechanisms…

5. Complex Case Management 1000 Lives 25% Disease/Demand Management 14,000 Lives 50% 15,000 Lives 15% Health Mgmt 70,000 Lives 10% Population vs. Costs vs. Interventions Example of 100,000 People in a Population % of Cost % of Population 1% 14% 15% 70%

6. 24 hours in the life of a PCP “The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care,” a report from the American College of Physicians, 2006 Yarnall KS, et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93:635 Ostbye T, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005; 3:209

9. Creation of Diabetic Care Model Primary care restructuring as medical home Added care management resources Outsourced health coaching and outreach Leveraged EHR for process management and communication Created quality measurement dashboard with actionable drill-down, filtering and sorting capabilities Developed standardized workflows aligned with Clinical Decision Support Better leveraged non-physician staff Enhanced patient engagement via education, PHR, email, behavioral health integration and outreach

10. Results Statistically significant improvement in 6 of 9 commercial and all Medicare HEDIS metrics within 1 year Became one on the top performing regions in Diabetic care 3 years after implementation beginning to see decreased cost secondary to decreased strokes, heart attacks and amputations consistent with modeling (Achimedes)

11. Does Use of EHRs Help Improve Quality? “For patients with diabetes, 51 percent of those receiving care in an EHR practice received all the recommended care, as compared with 7 percent of those who received care in a paper-based practice.” Source: http://www.rwjf.org/files/research/72480af4qehr201106.pdf(Accessed 7/8/2011) Better Health Greater Cleveland: http://www.betterhealthcleveland.org/

12. Leverage Meaningful Use as a Springboard

13. Key System Challenge is to address FRAGMENTATION Poor Coordination of Care Is Common,Especially If Multiple Doctors Are Involved Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2011. ** On average, Medicare beneficiaries see 6.4 MDs and fill 20 prescriptions annually. Beneficiaries with 5+ chronic conditions see 14 MDs and fill 57 prescriptions annually (Source: N Engl J Med 2007;356:1130-9)

14. Key Technical Functions for Next Level Quality Management EHR is necessary but not sufficient. The next level of quality management will require a Health Information Technology (HIT) “ecosystem” especially a robust analytic infrastructure. Standalone EHR may not be able to provide all of these functions.

15. Provider Organizational Cultural Shifts Critical Success Factors for Transformation Now Future Volume Focus Value Focus Physician Autonomy Organizational Standards Independence Interdependence Physician Captain Physician Coach & Mgr Accountability External Accountability Internal HIT optional HIT Core to Strategy My data is my data TRANSPARENCY!!

16. Looking Ahead… MU Stage 2 & 3 ICD-10 ACO development (success or flop?) Evolution of Value-Based Reimbursement Genomics

17. QUESTIONS?