#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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#CISummit Hurdles to Better Care, Better Health at lower cost discussion

A lunchtime panel addressing how to overcome the hurdles to achieving Better Care, Better Health at Lower Cost:

- Kelsey Gowin (Special Assistant to Richard J Gifilan, CMS Innovation Center
- Jack Cochran (Executive Director, Permanente Federation)
- Joseph Smith (Chief Medical and Science Officer, The West Wireless Health Institute)

The panel is moderated by Jean-Luc Neptune, Health 2.0.

West Wireless is focused on cost because it threatens our health system. It is an uncomfortable conversation.
Responsibility over cost does not automatically mean rationing. Technology has the opportunity to improve the cost picture. Ample room to do more at lower cost.

CMS - The Three Part aim has an implicit Patient Centric approach.

Health is not isolated. Health is part of a patient's overall life. It impacts their wealth. Over half of all personal bankruptcies are due to medical costs.

No single aim is the most important. We have disparities, shortages, all compounded by a severe recession and an explosion in baby boomers. We have to deal with all the issues - they are inter-related.

Joe Smith - Put health care on the same footing as every other technology-based industry.

In no other industry do you consume the product and after the fact find out what you received and what it cost.

Consumerism is a driving force emerging in Health Care.

CMS is excited by the level of response to challenges and innovation programs.
KP is excited by the move from good to excellent results in conjunction with the transition to Team-based delivery of service.

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#CISummit Bernadette Loftus KP and Patrick Conway CMO at CMS have a fireside chat

Bernadette Loftus - Be relentless in driving improvement

How to improve quality:

Extract data and present and share it. Set numerical discreet goals. 

It is not just a primary care job. The EMR prompts specialists to ensure follow ups happen - even outside their specialty.

Patrick Conway:

Acts as a clinical voice in CMS quality programs.

Set the goals and let people figure out the How.

How do you work on rapid cycle change (90 days)?

BL: 

- First believe that you can make change happen.

- Line of sight accountability. Connect owners to action.

PC: 

- Remove unnecessary regulation

- Focus on measures that matter to patients and clinicians

- Partnering to work with medicaid, CHIP and the exchanges. Act as a catalyst.

Physician Leadership - what is the role in Quality.

BL: Move the attitude to move the results. Be mindful and systematic.

What does success look like for CMS in 5 years?

The point of the innovation center is to test different models. Don't pre-suppose the answer. 

Fostering delivery systems  that offer high reliability in their change systems.

Move the vast majority of people in to "Systems of care"

How do you spread innovation?

BL: facilitate the conversation.

Reward the innovation

Innovation is also a process. Create innovation access points. - using Innovation Consultants in medical centers to give people an entry point for change.

Evidence-based medicine:

PC: Evidence should inform coverage decisions. 

Cancer Screening approaches:

BL: Screening tests must be deliverable across a mass population. 

Forward sweep - Watch for people on planned visits - what tests are they missing.

Clinical Workflow - Do all tests during appointments.

Back sweep - Look at those that missed testing

How can this group of participants help CMS?

PC: - do more of what is being done - faster!

We need to speed up the pace of change. Engage broad collaborations. 

Collaborate and innovate.

Share. 

Learn from best practice.

Keep in mind:

"What would you do if you knew you couldn't fail?"\

"What is best for the patient?"

How do we embed better care in the community?

- Move from volume to value reimbursement.

- Workforce redesign

Moving from Sick Care to Well Care

KP has moved from a primary care comprehensive testing (multi-phasic) approach to a connected network of physicians that can address their specialties and ensure that there are no gaps in testing and care. Patients can attend an appointment and have multiple specialist encounters in a single visit.

Move Faster:

Testing models quickly. Does it save money and does it scale. 

The Next Generation of Patients

How do we educate people to establish their electronic health records and sharing their electronic records with researchers.

We need to develop the capability for shared decision making. Making sure their is real engagement.

What is CMS doing to change how Patients are engaged in the policy discussions?

PC: we need more patient engagement in clinical and policy arenas.

The patient needs to be the decision maker. 

KP is putting more emphasis on the voice of the patient.

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#CISummit Mohit Kaushal and Joe Smith from WWHI

Live blogging from #CISummit.

West Wireless Health Institute - is co-sponsoring the day.
Healthcare costs are rising at rate above every other metric in the US economy.
WWHI is driven to drive down the cost of health care. They are doing this through innovation and commercialization.

WWHI has opened a policy center. Policy can drive change.

"Most smart people work somewhere else" We need to collaborate. There is so much to be done.

Let's get stuff done!

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#CISummit @tedeytan introduces his boss - Jack Cochran for the networking day @kptotalhealth

I am live blogging from the pre-summit day at the Kaiser Permanente Center For Total Health.

"Our greatest responsibility is to be good ancestors" - This is why we need to change HealthCare.

The USA faces tough challenges and tough choices and health care is a major part of the economy - running around 20% of GDP.

Too many families have had the fabric of their American Dream ripped apart. Health Care impacts both financially and socially.

Quality, safety, accessibility and affordability are still major issues.

The american people want fairness in health. Legislation is not the only answer. We need solutions.

"The role of patient is an involuntary act"

Small victories are not enough. We need to learn from each other. We need to leverage meaningful collaboration.

Take the enthusiasm and energy and use it as a platform to improve dramatically.

People want affordable access to safe care - when they need it.

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