VBID and Health Information Technology

1. VBID and Health Information Technology Thomas Tsang, MD, MPH Senior Advisor to the Governor State of Hawaii November 16th, 2011 tom.tsang@hawaii.gov

2. Disclosures No financial support from any companies or products mentioned in this presentation.

3. HITECH Framework: Meaningful Use at its Core ADOPTION Regional Extension Centers Workforce Training Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery Medicare & Medicaid Incentives and Penalties MEANINGFUL USE State HIE Program Standards & Certification Privacy & Security EXCHANGE Health IT Practice Research

4. The Ultimate Goal of Improved Health Sustainable Health Outcomes: Improved Quality, Efficiency, Population Health Innovative Care Delivery Redesign, Value Based Insurance Redesign, and Payment Reform Health IT Infrastructure: Electronic Health Records and Information Exchange

5. Payment Reform

6. Value Based Payments • Clinical Quality Measures need to be reported with improvement or attainment • Clinical Quality Measures are reported via claims or EHR data • Measure will play a new critical role in shaping provider behavior • Providers and Hospitals will receive penalties on payments or incentives based on quality improvement or attainment

7. Hospital Payment Interactions • Hospital Acquired Infections • HACs reported through claims do not qualify DRG payment for severity adjustment-potentially – potentially .02% reduction • Meaningful Use • reduction to annual market basket update by ¼, ½, and ¾ in 2015, 2016, and 2017, respectively for hospitals that have not qualified as meaningful users. • Hospital Inpatient Quality Reporting • 2% reduction in annual market basket update for non-reporting of clinical quality measures

8. Provider Value Based Payment • Physician Quality Reporting System -Affordable Care Act (ACA), 2010 —The act expands the incentive payments through 2014 and adds a payment adjustment or penalty for eligible professionals who do not satisfactorily report the PQRS measures. (also a website Physician Compare) • 2011 reporting period = +1.0 % of the total estimated allowed charges • 2012 through 2014 = + 0.5 % • 2015= potential reduction of -1.5% • Meaningful Use penalties 2015: -1% up to -3% of Medicare payments (need to report quality measures)

9. Delivery System Redesign Using HIT

10. Applied HIT in Beacon Communities Transitions of Care • Information flow; hospital discharge process improvement and standardization; transitions coordinators (work with patients on medication reconciliation and self-care plans through transitions); includes PCPs, hospitals, specialty practices, and long-term care settings Care Management • Trained individuals using standardized protocols for identifying and managing high risk patients and others needing follow-up and services, and working with patients and PCPs in creating self-care plans, including medication management. Computerized Clinical Decision Support • Embedded within EHR and/or HIE systems and Utilized by multiple members of the care team (e.g. physicians, care managers, etc.) Physician Data Reporting & Performance Feedback • QI reports informing providers of actionable items to maintain the highest standard of care in their patient population (e.g., guidelines and/or specific cost, quality, population health measure outcomes and/or analytics) Public Health Registry-Based Management • Registries could target preventative services and could be disease-based; often in partnership with public health departments Others (e.g., PHRs, telemedicine, telehealth)

11. Consumer eHealth in the Beacons 11

12. VBID Using HIT

13. Value Based Insurance Design • Use a super-fine scalpel rather than a blunt saw • Target clinically valuable services with different co-payments coupled with adherence predictive models specific to patient’s characteristics • Create “bundled” high value services with differential co-pays

14. New Data Analytic Capabilities • EHRs and Health Information Exchanges allow for risk factors to be included in data source (e.g.- smoking status, family history, past history of heart attacks, adverse reactions to medicines, lab results) • Coupled with evidence-based real time clinical decision support tools • Incorporation of genetic data (e.g. P450 drug metabolism) • Patient reported outcomes-PHQ-9; SF-12/36; Patient Activation Scale

17. Example- Anvita • Adjust Price Using Evidence-Based Medicine in Real-Time (vs. passive physician education) • Dangerous Treatments are dis-incentivized (high cost) • Effective Ones are incentivized (low-pay) • Physicians are given recent evidence

18. Applies patent-pending targeting analytics to maximize the impact and ROI of medication adherence programs. • Makes accurate predictions of patient adherence, ex ante—as early as the first Rx. • Makes recommendations that target available interventions to the patients most likely to benefit, optimizing return on investment. 45% of patients who start cholesterol medications today will be adherent—RxAnte knows who they are.

19. Personalizing Medication Support Interventions Based on Patient Characteristics Patient Y would benefit most from this intervention Intervention Effectiveness Patient X would benefit most from this intervention Intervention Cost

20. Conclusion • Technological advances allow for differentiation of high value therapies based on patient characteristics • Ability to assess and “predict” risk on the delivery of care side can customize therapies and interventions • Reduction of inefficiencies in system