#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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