#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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