The future of Health is Mobile+ Kaiser Permanente now has a mobile optimized web site for 9M members.

This afternoon I am joining Kaiser Permanente to learn about their Mobile App for members. Kaiser Permanente is a major forward thinking health care provider. It is great to see them embracing Mobile.  I have being saying for a long time that the patient/member is often not at a computer when they are receiving service in the health care system. The device they do have to hand is typically their cell phone.  

What is needed is a Mobile+ solution. A desktop based solution doesn't work in isolation, neither does a Mobile only solution. You can see this when you look at the emerging consumer wellness sensor market. The Bodymedia device has a website and a mobile application. But the two platforms aren't connected.  The new Jawbone UP is a neat wristband but it only has an iOS app. That may be fine for on the go data entry but deeper analysis just cries out to work on a desktop browser. Fitbit remains my favorite tool for wellness. The immediacy of the on device readout is great. I don't need an app to get immediate feedback on my level of activity, the stairs I have climbed or the steps I have taken. However, the mobile app allows me to enter data and get a quick snapshot, as of the last sync event. If I go to the web browser on my laptop I can get an immediate update of anything entered in to the mobile app. It is this Mobile+ approach that health system developers need to embrace. 

Mobile is not the panacea. It is a part of a complex puzzle. Patients/Members/Consumers will choose the access method that works for them, and that may change based upon their situation.

Anyway.... time for me to get off that little soap box. Let's take a look at what Kaiser Permanente has been up to...

So KP is launching a mobile app to support 9M members. This is a massive roll-out of a mobile health platform.

The major components of the App:

- Medical Record

- Pharmacy Center

- Appointment Center

- Message Center

- Location Finder

KP.org is now mobile-aware. If you sign on with your smartphone or tablet it will present a mobile friendly format.

The authentication for the app leverages the same mechanisms used for the standard web app.

The Medical Record on mobile gives access to:

- Allergies

- Reminders

- Health Summary

- Immunizations

- Ongoing health conditions

- Past visit history

- Test Results

Some of the most popular features are therefore available from a smartphone such as:

- Message Center

- Appointments

- Test Results

KP promises a two day turn around for messages but the typical practice is to provide a same day response.

15% of traffic is currently coming from mobile devices. This helped drive KP to produce a mobile friendly site.

The Mobile App is available on Android and iOS.

Bill Marsh: The transition to mobile is positively transforming the trusted relationship between patient and physician. Mobile amplifies the relationship in real time.

in Colorado 40% of support is currently delivered virtually. Mobile will expand this further.

HealthConnect is being tested on tablets and mobile devices. They are heading in that direction but it is not widely deployed yet.

@healthyThinker asked about use of lab results. Everything that is accessible online is also available on mobile.

The vast majority of routine tests are auto-released. Only those that are sensitive or regulated by state regulations not autoreleased.

Per @epatientdave "This is what everything should be in health care"

The mobile platform allows more accessible access to care. People are shifting away from using their desktop/laptops and switching to mobile.

Expect to see geo-location and other mobile specific services to be incorporated as the mobile platform is developed. 

The truth is that the KP web site has always been accessible from a smartphone with a good browser (think iOS, Android or Palm). The latest development is to optimize the experience on mobile devices. This is obviously the first step to enhancing for mobile.

The plethora of standards for video are barriers to implementation. Then add in security to the mix. KP is already testing solutions. Facetime (form Apple) has already been identified as HIPAA compliant. Since Apple built Facetime using industry standard protocols we really need to see other developers producing cross platform versions of Facetime "clones". It would be great to have a Facetime on Windows and Linux devices.

KP is producing a family of mobile apps. The mobile optimized web site will launch the KP Locator app to help members find a local KP facility. Expect to see more apps join this family.

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Curing US HealthCare… Coding reform and payment reform go hand in hand

This week I took part in the Care Innovations Summit in Washington DC. On Wednesday I was at the Kaiser Permanente Center For Total Health for a pre-Summit networking day. It was great to work with Danielle Cass and Ted Eytan from Kaiser to facilitate a day long event that I heard people describe as "The Best Networking Day. Ever"

The day was a mix of networking exercises, fireside chats with people that are shaping the future of health care and panel discussions that really made people think. If you get chance to spend time with Jack Cochran, MD, Executive Director, The Permanente Federation, Kaiser Permanente grab the opportunity. He has a life history that would make a great movie and his views on the future of health care and how to improve health are worth listening to and he takes his energy and relentlessly applies it to achieving that aim of better care. 

Joe Smith, MD, PhD, Chief Medical and Science Officer, The West Wireless Health Institute is equally vocal about improving our health care system. While Joe didn't get on stage at the Summit itself, he was one various panel discussions at the pre-summit. You really need to listen to his ideas. West Wireless Health Institute is doing great things to promote new approaches to health care. Joe is one of the people shaping the future. 

The themes that kept surfacing at the pre-networking event where two fold: Coding Reform and Payment reform. The two need to go hand in hand. As the industry is about to go through a transition that multiplies the number of CPT codes in use complexity is going to try to drive another nail in the coffin of transparency. We can't let this complexity win.  If we are not careful we will become so focused on diagnosing exactly what is wrong with a patient that we will forget that it would have been better to have avoided the patient having to come in for a diagnosis in the first place. 

If CPT Coding stays focused on minutely identifying an action or condition it risks missing the big picture and enabling preventative actions by physicians. Yet prevention is the big win in healthcare. It is something that has been lost in the Pay for Volume model that is the lot of the vast majority of US Health Care - with certain notable exceptions - like Kaiser Permanente.

When I look back at this week I wish Daniel Palistrant (of Sermo and Par8o) had been at the pre-networking event. His would have been an interesting voice to add to the discussion. He has a provocative article on his blog this week that complimented the CPT and Payment reform discussion. Check out his latest blog post:

"I Know Cancer When I See It"

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Here is the full Tweet Reach report for #CISummit - Provided by HealthCamp as a service to Health Innovators everywhere

I was asked by someone at CMS if I could get a copy of the Tweets from the Care Innovations Summit (#CISummit). So here as a service to the Innovation Community is a copy of the report from TweetReach - both the old style report and the jazzy new version.

Old Style Report:

TweetReach_cisummit_or_hcidc_org-OldStyle.pdf Download this file

New Style Report:

TweetReach_cisummit_or_hcidc_org-NewStyle.pdf Download this file

If you want to show some love for this service you can always head over to HealthCa.mp and make a small token donation.

It was a great event and I am looking forward to a repeat next year. We should all thank West Wireless Health Institute and the Centers for Medicare & Medicaid Services for putting together a great event. Thanks should also go to Kaiser Permanente for working with West Wireless to host the pre-event networking day at the Kaiser Permanente Center For Total Health. The feedback we have had from that high energy event has been fantastic. I heard understated comments like: "Best Networking Event. Ever!" The only downside of the networking day was the complaint from people that they had heard great reports about the event but didn't hear about before hand so that they could take part.

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#CISummit Don Casey wraps up the summit

Don Casey:

CMS gets very little positive feedback. They took a risk and engaged with a passionate audience.
Let's thank CMS for all their efforts.

1200 people at the event.

2400 people listened to web cast for extended periods.

Invest in putting the patient at the center - this is the path to better outcomes at lower cost.

Can we engineer a jailbreak for HealthCare. The question is how quickly.

Talk is cheap - what are you doing?

We need to take action quickly.

Westhealth Policy Center working on a fellowship program to create research with actionable outcomes.

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#CISummit - Wrap up in the Innovation Hot Tub

5:15- 5:45pm

Fireside chat with Susan Dentzer Editor-in-Chief, Health Affairs  Jonathan Blum Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services (CMS)  Cindy Mann Deputy Administrator Director Centers for Medicare & Medicaid Services  Rick Gilfillan, MD Director, Center for Medicare & Medicaid Innovation ("CMS Innovation Center")

Susan Dentzer suggests that a hot tub is a more appropriate metaphor since there is no fireplace.

Innovation is doing! Like cooking. 

Payment is an important part of the innovation soup.

Secret sauce is Culture Change

Scaling for Culture is hard to do.

Technology and Data is key.

Data is an enabler and the rocket fuel of innovation.

Evidence is key. 

We need to Share.

How do we move forward:

Jonathan Blum:  What does it take to be a high performing doctor or technician.

Best practice audits to review top performing plans and learn what the secret sauce is. Then communicate this information to others to apply.

[ED:]Scaling Positive Change is the same challenge as patient medication adherence. We can package it like a pill but medication is not the only part to a cure. People have to want to get better. If providers don't buy in to new processes they will not perform at the same level as the top performers.

Rick Gilfillan: We (the Feds) don't have to build a new delivery system. The care services in their local communities will build what works.

[ED: The challenge is to provide the payment systems that enable innovative methods of care to be implemented.

Looking in the upcoming CMS Challenge for ideas that engage people/patients in these new models.

Cindy Mann: our doors are open . Come forward with ideas.

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#CISummit Ignite Talks - Part 3

3:45- 4:00pm

Ignite Talks: Rapid Fire Innovation Pitches Facilitated by Joe McCannon Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS)  Will Shrank, MD Director, Rapid Cycle Evaluation Group, Centers for Medicare & Medicaid Services (CMS)  David Eddy MD, PhD Co-Founder, Archimedes

Joe McCannon -  Asked the question:

- Who would you most like to meet?

- What innovation has captured your imagination?

I know I want to learn more about the Allscripts challenge. 

Will Shrank - Rapid Cycle Evaluation Group - CMS

Medication Non-Adherence - Americas other drug problem

$0.5T problem due to medication non-adherence.

No magic bullet.  But....

Better education and communication

Pharmacists are potent communicators

Benefit design to remove payment barrier.

Simple reminders

Better labeling and packaging

HIT is the backbone of any adherence initiative. Social Networks are powerful tools.

Engage family and friends.

Tom Lee - One Medical Group

Entrepreneur behind epocraties

Redesigned primary care service at lower cost. Same day appointments. More time with patients. 

Not a concierge model.

Ideas are cheap. It is putting them in to practice that takes effort.

There is waste in the system. First concentrate on internal waste.  Started looking at support staff. Typical practice has 4.5 FTE's per MD.

But that depends on handling many, many patients.

Dropped it to 1.5 FTE per MD

Classic People - Process - Technology challenge.

Instituted email. - what a concept! 

Simple systems. Email, web forms, simple EHR

Don't specialize

What was learned:

- The bar is low.

- Expectations are rising.

Creativity is thinking new things - Innovation is doing new things.

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#CISummit - Chronic Care Management - The discussion

Atul Gawande leads a discussion on Chronic Care Management.

2:00- 3:30pm Panel 2

Care Delivery/Chronic Disease Innovation Case Study Moderator: Atul Gawande, MD, MPH Surgeon, Writer, Public Health Researcher  Kenneth Coburn, MD, MPH Chief Executive Officer and Medical Director, Health Quality Partners (HQP)  Alan Hoops Chairman and Chief Executive Officer, WellPoint/CareMore  Debbie James Vice President, Healthways Fitness Division, Healthways  Mary Naylor, PhD, RN Professor in Gerontology, University of Pennsylvania School of Nursing

DJ: Complex model. Targeted messaging based on demographics. 

Mail campaigns (majority of activity), phone calls. some clients they work with physicians. (Healthways client is the health plan or employer)

Fitness centers are trained to deal with seniors. 

MN: Nurse "hold the family and patient's hand through the transition from hospital to home. This starts before release. Patients in hospital go from 24x7 care to 24x7 nothing upon release. 

AH: The component pieces of care are nothing new. What is new - for Health Plans to be accountable. CareMore focuses on the 10-20% of patients that exceeds the PCP's ability to care for them. 

So.... CareMore is an outsource model. 

50% of chronic condition seniors admitted to hospital are either dead or readmitted within 12 months.

MN:  Focus on medicare and dual eligibles, multiple chronic conditions, multiple acute service use. Work in hospital and with PCP's. Pick people up at a point of risk and support them to a point where they are no longer at risk.

DJ: beenfits seen in Year 1, benefits pay for all participants in Year 2.

KC:  High risk groups has ROI in first year. Wider beneftis in 4.5 yrs. Once people ar ein the program they stay in and continue to benefit.

MN: TCM has a continued investment needed in systems and training. Hospitalized patients show an ROI within months. 

AH: CareMore Model is a platform and patients are divided in to many sub-groups. Differing payback returns. CareMore looks for broken systems that enable 20-50% reduction in cost in a 6 month time frame.

Innovative models don't fit the regulations. Regulations are designed for the healthier 75% and not the sickest 25%.

MN: Our biggest barrier is us

KC: No part of health system can stand apart. We need collaborative models.

DJ: Short term risk is short term thinking about costs

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#CISummit Chronic Disease Management moderated by @atul_gawande

2:00- 3:30pm Panel 2

Care Delivery/Chronic Disease Innovation Case Study Moderator: Atul Gawande, MD, MPH Surgeon, Writer, Public Health Researcher  Kenneth Coburn, MD, MPH Chief Executive Officer and Medical Director, Health Quality Partners (HQP)  Alan Hoops Chairman and Chief Executive Officer, WellPoint/CareMore  Debbie James Vice President, Healthways Fitness Division, Healthways  Mary Naylor, PhD, RN Professor in Gerontology, University of Pennsylvania School of Nursing

How do we care for patients that normally slip through the net.

Debbie James - HealthWays

Physical Activity improves health. Silver Sneakers Fitness Program. Better health at lower cost for seniors.

46% of participants in the program have never been into a fitness center.

Engagement - get them there... keep there.

Access and Variety are important factors. 

Need access (within 5 miles)

Create community - Social is important.

Customize programs for older adults. Make them comfortable and take away fear of the unknown.

Program leads to better health at lower costs.

23-37% lower cost for silver sneakers members.

9M Medicare Advantage and Medicare Supplement Program members have access to Silver Sneakers.

Ken Coburn - Health Quality Partners

Community-based care management.

Aim: improve health, independence and reduce suffering of chronically ill older adults.

 Focus on preventive services.

Person-centered model. A long haul relationship.

Run in parallel with Primary Care Providers.

200 Performance measures used internally.

35 Nurse interventions.

"A High contact sport"

9 year program..

Looking for technology partners to develop program further. 

Mary Naylor - U of Penn School of Nursing

The Transitional Care Model - A 20 year old model. 

Nurses as hub of a care giving model.

A huge opportunity in community-based organizations to get seniors back on their feet. 

We have know since 1999 that this program works Shame on US Health Care! Surely a lawyer is going to take a class action suit against the medical community.

.

Scale TCM across the system

Deploy TCM workforce

Improve and Sustain....

Data driven quality improvement.

Alan Hoops - CareMore

50% of members in special needs plans.

Address chronic diseases and conditions.

A platform that looks for system breakdowns and replace with something that works.

50% reduction in hospitalization amongst dialysis patients. Simply by placing case managers in the dialysis unit. Divert to appropriate care instead of defaulting to ER visits.

Chronic Care management

Episodic Care management 

Predictive modeling and intervention

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#CISummit Joe McCannon introduces the next round of Ignite Talks

1:45- 2:00pm

Ignite Talks: Rapid Fire Innovation Pitches Facilitated by Joe McCannon Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS)  Bob Masters President and CEO, Commonwealth Care Alliance  Jennifer DeCubellis Area Director, Hennepin Health  Tom X. Lee, MD Chief Executive Officer, 1Life Healthcare and One Medical Group

Joe McCannon is based in the CMS Innovation Center and focuses on learning diffusion.

Bob Masters - Commonwealth Care Alliance

Based in MA.

Once in a generation opportunity to improve care for the most vulnerable - Dual Eligibles.

CCA focuses in MA on 3800 mostly home bound frail elders and 600 younger beneficiaries.

A lot of money spent but even more money saved.

How we care for the mentally ill is shameful.

75% are dual eligible. Average life expectancy is 53 years.

Implementing new Primary Care models. 

Jennifer DeCubellis - Hennepin Health

A social disparities approach to healthcare reform.

Patient Centered Care where care is Coordinated.

Add Pharmacists to care teams. Reduce medications and side effects and increasing time for Doctors. 

Mobile Crisis Home Visits. 24x7 crisis line. 

32% of population are in unstable housing. Providing services for the homeless.

Housing support helps place individuals - this reduces hospital stays. 

Interpreters help families navigate the system.

Vision care - don't overlook this. Imagine being able to read your prescriptions.

Dental Care has been attached to emergency departments - this reduces ER visits and prescription of pain medications.

Food Pantries help patients deal with upset stomachs that impact medicatin adherence.

This just shows that you have to treat the whole person and not the condition.

Tom Lee - 1Life HealthCare and One Medical Group

Guidelines as key to physician-patient decision making.

Evidence-based medicine is not enough.

Guidelines are too simplistic. They focus on one risk factor at a time.

We need to look at each individual and take into account all risk factors. 

Calculate risks of all outcomes.

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A contagion of healthcare disruptors conspiring at #cisummit

@aviars
@pjmachado
@davidrosenman
@susannahfox
@mindofandre
@ctorgan
@lygia

And @epatientdave ducked out or a minute.

Who else did I miss?

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#CISummit - Key points and quotes part 1 - the morning sessions

Don Casey: Don Casey says healthcare costs are 17.9% of the GDP and may reach north of 30% if left unchecked. This could cripple the economy.

Dr. Atul Gawande: Health Care (cost) is destroying the American Dream

We forget the bell curve of impact and cost. The two curves do not match. This gives us hope. We want the positive deviants.

HealthCare today is like driving a car with a speedo that tells what speed we were traveling 4 years ago. Data is the key!

Rick Gilfillan: "No one went to school to provide fragmented, expensive care"

@Todd_Park: Data is rocket fuel for innovation

@Todd_Park: There is no problem America can't innovate its way out of - apply the innovation mojo!

Dr. Brian Prestwich - The EMR of today is completely inadequate for the family doctor. They need to be connected. They need knowledge from the patient. They need population information for comparison. (Lots of applause)

Dr. Brian Prestwich: Make it simple to reduce the cognitive workload

David Kirchhoff - Obesity is a lifestyle issue. Difficult and messy.

Lonny Reisman: Technology is essential but not sufficient

Farzad Mostashari: Data as oxygen for innovators.

Aneesh: Has ONC just put forward the idea of OpenTable for Health Care?

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#CISummit - More Ignite Talks

12:15- 12:30pm

Ignite Talks: Prizes and Challenges Facilitated by Aneesh Chopra United States Chief Technology Officer, Assistant to the President and Associate Director for Technology, Office of Science & Technology Policy (OSTP)  Toby Samo, MD Chief Medical Officer, Allscripts  Leigh Burchell Vice President, Policy & Government Affairs, Allscripts  Michael Williams Vice President of Primary Care, Pfizer  Suzanne Blaug Head, Janssen Alzheimer Immunotherapy, a Janssen Pharmaceutical Company  Farzad Mostashari, MD, ScM National Coordinator for Health Information Technology, Office of the National Coordinator for Health IT (ONC)

Toby Samo - Allscripts

Allscripts Million Hearts Clinical DEcision Support Challenge.

Fighting Cardiovascular Disease. $50,000 top prize. 

CVD: $400B cost in direct and indirect costs in 2010.

Expand the use of clinical decision support. 

Machine readable format that can be read by any EMR.

Michael Williams - Pfizer / Suzanne Blaug - Jansenn Alzheimer Immunotherapy

Over 13M people may have Alzheimers

12.5B unpaid Care hours

Dementia costs $1T per year.

Alzheimer cost is larger than Walmart's annual revenue.

Need:

1. Tools to detect early symptoms

2. Tools to monitor and track changes over time.

A devastating disease because symptoms go undetected. 

Develop a simple cost effective, reliable high touch tool that can detect Alzheimers and track changes over time.

Enter data in to EMRs 

Be user friendly.

www.alzheimerschallenge2012.com

Farzad Mostashari - ONC

Data as oxygen for Innovators.

Care Transitions Challenge #2 . Post-Discharge Follow-up Appointments.

More EMR adoption in last 2 years than in last 20 years. Adoption doubled.

BUT we need interoperability.

Meaningful use means you change outcomes

Quality Measurement BY providers NOT TO providers.

70% of rural PCPs work with a Regional Extension Center.

130,000 PCPs working with local non-profits to change care delivery.

Challenge #1 was around Transitions of Care.

Challenge #2 is a simple thing....

How to get a patient to have an appointment with their doctor after they leave hospital.

But it hides a lot of complexity.

The prize isn't money....

The prize is connection.... to communities that want to implement the solution.

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#CISummit Care Delivery Care Innovation - The discussion

Care Delivery/Primary Care Innovation Case Study

Moderator: Mohit Kaushal, MD, MBA

Executive Vice President of Business Development and Chief Strategy Officer, West Wireless Health Institute 

Christopher Chen, MD

Chief Executive Officer, ChenMed 

Frank Ingari

President and Chief Executive Officer, Essence Healthcare 

Brian Prestwich, MD

Assistant Professor of Family Medicine, Keck School of Medicine, University of Southern California 

Lonny Reisman, MD

Chief Medical Officer, Aetna 

David P Kirchhoff

President and Chief Executive Officer, Weight Watchers

2% incentive for Docs is a small number. Small number = small change.

FI: Aggregation to deal with scale. Episodes of care has issues with boundaries of care.

Capitation is the long term solution. 

LR: A continuum of solutions for delivery solutions. starting from basic EMR implementation building to full risk management/share.

AETNA doing a lot of consultation that leads to development of payment models that work for the delivery system.

Orientation around the patient is an awakening. The solution to health is not in the doc's office or hospital

FI: The model today is a reactive patient presentment model. We need to flip the model so that the provider is reaching out before the patient presents.

CC: We need a cultural change for doctors. We should expect docs to help innovate. 

BP:  Risk-based registries are critical to population care. We need time to reflect on patient story and payment options to allow e-consults.

DK:  Working with Cleveland Clinic,  State of Oregon.  We need to move to focus on prevention. eg. for avoiding diabetes.  Alignment works. Patient, Payer, Provider

FI:  Reducing obesity would have massive ROI for Medicare participants. 

LR: Technology is essential but not sufficient.  Support and incentives are a critical addition. More collaboration needed to achieve success.

 CC: After a heart attack a patient has an average of 11 drugs to take. Put the drugs in their hand don't send them to a pharmacy. This removes one barrier. 

BP:  We need to help patients do workflow on their own life/health.

BP: The LA Innovation Corridor covers 11M people. 

 What would you do to help achieve the Triple Aim:

DK: Rewire the system so that incentives align with processes.  We need proactive preventive care.

BP: HIT  that supports the patient and population view. Dashboards that guide care. Take care of patients well and the risk takes care of itself.

CC: Scaling culture is hard. We need to rewire from transactions to outcomes.

FI: Use Meaningful Use Phase 2 /3 to be more open. Allow information to flow in AND out.

LR: We need to spend more time thinking about Health - Engagement and motivation. Patients don't automatically do what the doctor suggests. 

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#CISummit: Frank Ingari - Essence Healthcare / Chris Chen of ChenMed / Brian Prestwich - Keck School of Med USC / Kirchhoff - @WeightWatchers

10:45am-12:15pm Panel 1

Care Delivery/Primary Care Innovation Case Study Moderator: Mohit Kaushal, MD, MBA Executive Vice President of Business Development and Chief Strategy Officer, West Wireless Health Institute  Christopher Chen, MD Chief Executive Officer, ChenMed  Frank Ingari President and Chief Executive Officer, Essence Healthcare  Brian Prestwich, MD Assistant Professor of Family Medicine, Keck School of Medicine, University of Southern California  Lonny Reisman, MD Chief Medical Officer, Aetna  David P Kirchhoff President and Chief Executive Officer, Weight Watchers

Larry Ingari - Essence Healthcare

Reinvented insurer as logistics and evidence provider.

Eliminating acute episodes is not enough.

Medicare Advantage  addresses flaws in original plans.

Essence provides data for free to their providers.

timely, accurate with continuous learning.

Detailed performance summaries.

Collaboration on benefit design referral and other policies.

Initiatives are driven by Care Management.

Christopher Chen - ChenMed

Another instance of a family of physicians discovering the experience of a patient.

No one accountable for care/results.

Principles:

1. Invest in patients upfront

focused on moderate to low income senior population (focus on a specific population)

2. Physician Culture - deliver outcomes and not procedures

3. Develop technology to achieve goals.

Design a one stop shop approach for a focused population.

Then you need to get access for the population. They provide transportation to/from the clinic.

Restrict panel size so patients can be seen monthly. 

Technology is designed to support the doctor patient relationship.

Brian Prestwich - Keck School of Medicine - University of Southern California

The Greater LA Care Innovation Corridor. 

Doctors need time. They need support.

Doctors need information. 

The EMR of today is completely inadequate for the family doctor. They need to be connected. They need knowledge from the patient. They need population information for comparison.

Redesigning team-based care.

Redesigning the Physician work day.

Group care works for complex patient issues.

Figure out what you want to do

Fix the care model

Implement technology to support the care model.

Educate the patient to take better care of themselves.

Make it simple to reduce the cognitive workload

David Kirchhoff - Weight Watchers

Obesity is a lifestyle issue.

It is difficult and messy

The NHS in the UK works with Weight Watchers. Doctors can provide vouchers and refer patients to Weight Watchers.

12 Session course on PCP referral. 45 UKL at no cost to patient.

A Cambridge study showed PCP+Weight watchers program is twice as effective. Doctor creates sense of urgency. Weight Watchers delivers program and payer supports. 

WW does 45,000 meetings per week globally (20k in USA)

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#CISummit Mohit Kaushal - Care Delivery/Primary Care Innovation Case Study

10:45am-12:15pm Panel 1

Care Delivery/Primary Care Innovation Case Study Moderator: Mohit Kaushal, MD, MBA Executive Vice President of Business Development and Chief Strategy Officer, West Wireless Health Institute  Christopher Chen, MD Chief Executive Officer, ChenMed  Frank Ingari President and Chief Executive Officer, Essence Healthcare  Brian Prestwich, MD Assistant Professor of Family Medicine, Keck School of Medicine, University of Southern California  Lonny Reisman, MD Chief Medical Officer, Aetna  David P Kirchhoff President and Chief Executive Officer, Weight Watchers

Lonny Reisman - AETNA:

Tiered Networks as an emerging standard. Constrained networks (to ACO as most constrained) driving quality improvements.

AETNA is building HIT tools to power ACOs.

Sharing and Interoperability is important. ETNA has acquired Medicity to provide a Health Information Exchange.

Analytics are important. 

We need precision of information. We need workflow tools to maximize performance.

AETNA has 3 models:

1. Enhanced Clinical capabilities

2. Population Management

3. White Label Payer 

Eliminating co-pays for patients have demonstrated improvements in care. ie. reduce the patients barrier to care.

Free drugs after a heart attack led to only 51% compliance. This indicates that there is far more to be done in caring for the patient.

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#CISummit @aneeshChopra is up with Ignite Talks on prizes and Challenges (@DDDiabetes, @KP JandJ

Aneesh Chopra: Rousing the crowd. Aneesh has to build on the @Todd_Park mojo.

Innovation will grow new industries and new businesses. 

America Competes gives the government new tools to spark breakthrough ideas.

Ignite Talks on Prizes and Challenges

1. Dennis Urbaniak: Sanofi - Diabetes Challenge

Crowdsourcing Health

2012 Data Design Diabetes Innovation Challenge:

1. Crowdsource applications

2. Open Submission

3. Mentorship

4. Demo Day

5. Support 

Tweet using @DDDiabetes

2. Johnson & Johnson / Janssen Healthcare 

Janssen Connected Care Challenge.

Caring for a person who has been hospitalized is very challenging. Can we develop a tool or system to help people coordinate care.

1 in 3 people discharged don't see their physician inside 30 days.

This is a $15B problem. $12B is preventable!

How do you connect caretakers, medication, therapy, physician, hospital in a coordinated care plan.

The challenge is looking for approaches to improve connected care. Prizes range from $50,000 to $100,000.

www.janssenhealthcareinnovation.com

3. James Albino - White House /  Michael Horberg - Kaiser Permanente.

Kaiser Permanente HIV Innovation Challenge

www.kp.org/hivchallenge

KP's systemic approach to HIV treatment leads the nation. mortality rates are much lower than national average. Their approach also eliminates the treatment disparities  amongst disadvantaged communities.

KP is largest provider of integrated HIV care in the USA.

Get patients diagnosed, in to care and on a course of treatment leads to better outcomes and productive lives.

Multi-disiplinary care. using the EMR, coordinated treatment.

The challenge: join KP and benefit from their lessons learned.  No cost access to the toolkit they have compiled.

Access to mentorship and treatment and care guidelines.

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#CISummit Rick Gilfillan, MD - Director CMS Innovation Center and @Todd_Park

Rick Gilfillan - Director of CMS Innovation Center with Todd_Park, CTO and Entrepreneur in Residence at Health and Human Services.

The CMS Innovation Center Approach:

Is the Triple Aim possible?

Amongst diabetics: Treatment (insulin and blood strips) = $3600 per year v leg amputation for ulcerated foot = $50,000

A system that is good at providing "care fragments" 

The Emergency Room is becoming the only viable place to get care for a growing population.

Achieving the three part aim:

1. Commitment:

2. Innovation

3. Spread the innovations with wide adoptions

Innovation approaches:

Medical Homes

Accountable Care Organizations

Bundled Payments

"No one went to school to provide fragmented, expensive care"

If something CMS Innovation Center tests something that can improve care with positive results then they can promote regulations to aodpt the new payment structures.

This provides the opportunity to move from pay for volume to pay for outcomes.

Multi-Payer Primary Care Practice

Federally Qualified Health Centers Medical Homes

Dual Eligible population: 9M have Medicare and Medicaid coverage.

Pioneer ACOs - 32 contracts to test ACO models reaching 87,000 medicare beneficiaries.

Diffusion and Scale: 

- Innovation Advisors

- Million Hearts (could save 1M lives over 5 years)

- Partnership for Patients (focusing on patient safety and care transitions)

The Innovation Challenge: $1B of awards to demonstrate new methods of care.

A large portion of the audience are interested in this challenge which closes on Friday January 27th - Tomorrow!

Data is critical. 

Todd Park now talks about how data will get to innovators.

CMS is embracing the power of Data Liberacion.

Data is rocket fuel for innovation

Strategic priority to unleash the power of CMS data to improve health care - while protecting patient privacy..

Blue Button - VA, Medicare beneficiaries can download their own personal health or claims record.

500,000 people have downloaded their data. Adoption is accelerating. This is expanding to private sector organizations. 

Robert Wood Johnson have established bluebuttondata.org

Data for ACOs

Medicare Data Sharing for Performance Measurement - these reports will be made available to the general public.

www.healithindicators.gov

These are just the beginning. Improving accessibility and serviceability of data is a core service function for CMS.

There is no problem America can't innovate its way out of - apply the innovation mojo!

Rick Gilfillan: Now is the time to decide - adopt innovation. Change the way we think. It is not abstract. It is a real issue.  Doing nothing is making the decision to standstill. 

It is not easy. it is difficult. Remember the first rule of medicine: Do no harm.

CMS pledges to be a constructive force in this change.

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#CISummit - Dr. Atul Gawande - How do doctors get good?

From the Care Innovations Summit:

Dr. Atul Gawande, Surgeon, Writer, Public Health Researcher.

How do Doctors get to be good at what they do?

In last 10 years an ordinary Family has seen a rise in pay of $23k but all but $85/month has gone to paying higher health care costs.

The same has been seen in MA in the education sector. Every penny of increased investment has been diverted to health care for teachers.

Health Care (cost) is destroying the American Dream

in 1937 (pre-penicillin days) Health Care was cheap and ineffective.Hospitalization's major benefit was food and warmth.

Since then we have discovered 13,600 diagnoses and 4,000 surgical procedures and 6,000 medications.

No other industry has to deliver on 13,600 product lines to every person in every community.

Our delivery methods have not significantly changed despite this explosion in diagnosis and treatment.

We trained and rewarded independent cowboys when we want pit crews for patients.

The medical community can't cope on their own. Clinicians are baffled by the cost discussion.

We forget the bell curve of impact and cost. The two curves do not match.
This is a sign of hope. If the curves matched we would be talking about rationing of care. But that is not the case.We need to identify the positive deviants. The most successful behave like systems and not independents.
Data is an under utilized resource in Health Care. Data is the window to answers.

HealthCare today is like driving a car with a speedo that tells what speed we were traveling 4 years ago.

The major illnesses of the 5% highest cost medicare beneficiaries in 2010:

Ischemic Heart failure 32% of all beneficiaries and 68% of high cost beneficiaries.

Airlines and Restaurants use Checklists.
Applying checklists to surgery can make a big impact. Average reduction in deaths was 47%. VA has adopted this approach. leading to 18% reduction in deaths.
Implementing Discoveries:

We have to deal with resistance.
We must change who we train, how we work together and how we get our jobs done.

Values:
1. Humility (we all make mistakes)
2. Discipline (Repeat practice)
3. Teamwork (More knowledge than we can handle alone)

We need to define what great performance and great care looks like and then design the payment system to support that outcome.

We are battling for the soul of American Medicine. The fundamental issue of this century.

In early 1900's Food was 40% of a family budget.
Government provided data. Weather, crop reports, prices etc.
Incentives: eg. Farmer cooperative banks.
Comparative Effectiveness studies. Cost effectiveness studies.

Intending to bend the cost curve they halved the cost within 20 years.

We face the same challenge in Health care today. This is a 20 year journey that starts by setting out to bend the cost curve.

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#CISummit - Marilyn Tavenner Acting Administrator - CMS

Marilyn Tavenner talking about the work of CMS in support of the Triple Aims and the Innovation Center.

Two years since Affordable Care Act (ACA) went in to law.

ACA addresses:

- Insurance companies

- Higher Quality of Care

- Improved Access to Care

- Innovation

2010: 

- Filled in the donut hole

- Created the high risk pool to serve high risk patients with pre-existing conditions.

- Children can't be blocked from coverage due to pre-existing conditions

- Medical Loss Ratio set at 80% (ie. 80% of premiums to go to care spending)

- Free health risk assessments /wellness visits.

By 2011: 22M on medicare have received at least one free service.

here to talk about 2012 and beyond.

In October hospitals will be paid based on quality of care.

- Coordinating care

- Improvements in Technology

- Changes in Delivery Systems

- Public Private Partnerships

Innovation Center:

- More than a dozen initiatives launched.

- Value not Volume and putting the patient at the center.

Don Berwick has been repeatedly acknowledge at Summit events as the master architect of the reengineering of CMS. He has been masterful in shaping the future in an entirely positive manner. 

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#CISummit We have to work together to build a Health Economy that is built to last

Live blogging from the Care Innovations Summit:

The Triple Aim:
- Better Care- Better Health
- Lower Cost

Susan Dentzer - Editor-in-Chief, Health Affairs is MC'ing the day.

Health is not (or should not be) a partisan issue.

Health is not red or blue - it is purple (Go Ravens! :))

Public and Private Sectors need to work hand in hand.

Disclaimer: CMS is not endorsing the West Wireless Institute or the participants at the summit.

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#CISummit Care Innovations Summit kicks off in Washington DC

Today is the Care Innovations Summit at the Renaissance Grand in Washington DC. The event is organized by the Centers for Medicare and Medicaid Services, West Wireless Health Institute and Health Affairs.

This is a major gathering of Health Innovators.
Don Casey is introducing the day. We are looking forward to an exciting day with a number of fast paced ignite talks.

Gary and Mary West funded the West Wireless Health Institute with $100M to drive medical research.

This event is about "Jailbreaking" healthcare.

There must be a better way:

- How do we transform healthcare to deliver better care and better outcomes
- How do change healthcare
- How do we deliver health care at a price we can afford.

CMS pays for 35% of all US Health Care.

CMS wants to transform health care through innovation. The CMS Innovation Center is at the forefront of this change.

The Triple Aim:
- Better Care- Better Health
- Lower Cost

Start a revolution: Take 1 idea home and IMPLEMENT it!

The Challenge form Don Casey:

- 10 new business cards- 3 New Innovation Ideas

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#CISummit - Policy discussion towards Accountable Care - Payment reform at the heart of change

Nancy Taylor - VP PUblic Policy and External Relations at the Permanente Federation
Jonathan Blum - Deputy Administrator and Director of CMS

One theme for the day is the need to change CPT Coding and Payment reform. People follow the money and until we pay for health and stop paying for sickness we will not see significant change.

Fee Schedules will remain important while they
72% of people in Medicare use fee for service. This is shrinking as people choose alternative private plans. Encouraging plans to think about wellness and managing care.

Shared Savings program - driven by need to create multiple pathways for people at different stages of development as an Accountable Care Organization (ACO) to participate.

The Pioneer track is created using CMS' innovation authority.

32 Pioneers have signed contracts. They will test different options including payment methodologies, including capitated payment models.

Track 1 has no downside risk for first 3 years.
Track 2 has up and down side risk.
Pioneers - a responsibility to teach the world what works.

Slow change from Fee for Service models.

Moving from Fee For Service needs additional capabilities such as Data Warehousing which is slowing adoption.

CMS has an advanced payment model that helps organizations make the change to alternate risk-based cost models.

Bundled payments and changes to hospital readmission payments will drive push to better care.

Pioneer applicants came from across the country and was not limited to high cost areas.

ACO program is not just about payment changes - but about care improvement. Also want to understand HOW the results were achieved. What works and how that can be incentivized through payment policy.

CMS is trying to understand best practices. Five Star Private Plans will be reviewed for best practice to understand how they achieve their rating and how those practices can be spread to other plans.

CMS has to be based on a shared savings model with re-baselining using processes that work.
Who do the savings belong to: the payer, physician or the patient?

Recent CBO review and report indicated that past CMS tests had mixed results in the area of care coordination. The old traditional model of reporting took too long. This prompted congress to approve a more dynamic process to test, review and disseminate results.
CMS sees a lot of interest in payment reform models. The volume of interest tells them that they must scale up quickly. Projects are based around the notion that they can be scaled.

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