Frisse - One Step at a Time

© 2013, Mark Frisse

One Step at a Time

Mark Frisse, MDHIMSS NW Technology & Education Symposium

14 October, 2013

the Program

KN: Frisse

Big Data/Analytics

Biz Case ICD-10 Skill Sets

Population Mgmt OR / WA HIE ACO Value

KN: Global to Local

Clin Analytics State, Fed, Local EHR Replacements

Analytics/ Pop Hlth OHSU Security

KN: Risk-Based Pop Mgmt

Analytics

KN: Frisse

Big Data/Analytics

Biz Case ICD-10 Skill Sets

Population Mgmt OR / WA HIE ACO Value

KN: Global to Local

Clin Analytics State, Fed, Local EHR Replacements

Analytics/ Pop Hlth OHSU Security

KN: Risk-Based Pop Mgmt

Sustainability

KN: Frisse

Big Data/Analytics

Biz Case ICD-10 Skill Sets

Population Mgmt OR / WA HIE ACO Value

KN: Global to Local

Clin Analytics State, Fed, Local EHR Replacements

Analytics/ Pop Hlth OHSU Security

KN: Risk-Based Pop Mgmt

Systems

KN: Frisse

Big Data/Analytics

Biz Case ICD-10 Skill Sets

Population Mgmt OR / WA HIE ACO Value

KN: Global to Local

Clin Analytics State, Fed, Local EHR Replacements

Analytics/ Pop Hlth OHSU Security

KN: Risk-Based Pop Mgmt

Analytics, sustainability, & systems

KN: Frisse

Big Data/Analytics

Biz Case ICD-10 Skill Sets

Population Mgmt OR / WA HIE ACO Value

KN: Global to Local

Clin Analytics State, Fed, Local EHR Replacements

Analytics/ Pop Hlth OHSU Security

KN: Risk-Based Pop Mgmt

© 2013, Mark Frisse

Keynote: Four parts…

The Turbulence• Forces driving change

The Confusion• Uncertainties & immature markets

Some vital Elements• Components for forging solutions

An emergence• Reaching our goals – one step at a time

© 2013, Mark Frisse

the Turbulence

characterized by conflict, disorder, or confusion; not controlled or calm;

unsteady movement

Old

ExpectationEntitlementMoral Hazard

Uninformed

Inadequatelyprepared

Sick

Turbulence: decades in the making

Diverse

CostComplexityOpacity

© 2013, Mark Frisse

HITECH: a stimulus effort

source: http://dashboard.healthit.gov/onc/

ICD-10

Workforce

HIE

MeaningfulUse

Analytics

The initiatives before us

Privacy

Finances

Revenue Cycle

Care Transitions

EHR Standards

Consumers

© 2013, Mark FrisseSource: Halamka JD. The Future of Standards.

And we have given ourselves limited time

© 2013, Mark Frisse

So we face local & national challenges

© 2013, Mark Frisse

Even some supporters of the Affordable Care Act worry that the flaws in the system, if not quickly fixed, could threaten the fiscal health of the insurance initiative, which depends on throngs of customers to spread the risk and keep prices low.

© 2013, Mark Frisse

The relationship of policy and technology

1997 (Paul Starr)

When [Clinton health care] reform collapsed, so did the momentum to build an information infrastructure for a new system.

Today (2013)

Is it possible that inadequate execution of HIT systems will place needed health care reforms at risk?

Starr, P., Smart technology, stunted policy: developing health information networks. Health Affairs (Millwood), 1997. 16(3): 91-105.

© 2013, Mark Frisse

We are in the Northwest

© 2013, Mark Frisse

Summary: Turbulence

Titanic demographic and economic circumstances urge action….but how fast can culture change?

© 2013, Mark Frisse

the Confusion

lack of understanding; uncertainty; the state of being bewilderedCon-fusion: melting down and

recreating

© 2013, Mark Frisse

Remarkable adoption of office-based EHRs

http://dashboard.healthit.gov/HITAdoption/Office-based provider adoption: basic EHRs

© 2013, Mark Frisse

Remarkable adoption of hospital systems

http://dashboard.healthit.gov/HITAdoption/

Urban: 47.7%Rural: 33.5%

© 2013, Mark Frisse

MU: Penalty adjustments to PFS

Meaningful Use: Penalty adjustments to Medicare Physician Fee Schedule (PFS)

Image source: Acumen Physician Solutions. http://www.acumenmd.com/avoiding-the-approaching-meaningful-use-penalty/

© 2013, Mark Frisse

Mixed results for HITECH state HIE

Tripathi to HIT Policy Committee: State HIE program Status

© 2013, Mark Frisse

Some Pioneer ACOs are opting out

7 – Medicare Shared Savings2 – Opting out entirely

source: Advisory Board, September 2013. The population Health Leaders Reading List

© 2013, Mark Frisse

Inconsistent privacy policy implementation

CONSENT:- Context

- Information- Roles

- Relationships- Terms

USE:- Context

- Information- Roles

- Relationships- Terms

{A} {B}

InstitutionPolicies Contracts State Law Federal Law

If the interpretation of any privacy policy is excessively risk-averse, authorized health information may not be transmitted

© 2013, Mark Frisse

Concerns rise from all quarters (as expected)

• Interoperability• Sustainability• ICD-10• Certification• Quality metric

simplification• HIPAA • Oversight & fraud• Government shut-down

© 2013, Mark Frisse

The “hospital” mentality is pervasive

A B C D

© 2013, Mark Frisse

Ambulatory care is more fragmented

A

BC

D?

Medicare beneficiaries see at least five different physicians and many more pharmacists, therapists, and other clinicians.

source: Pham, H.H., et al., Care patterns in Medicare and their implications for pay for performance. N Engl J Med, 2007. 356(11): p. 1130-9.

© 2013, Mark Frisse

How fragmented is ambulatory care?

Slide: David Kibbe. http://www.directtrust.org/

© 2013, Mark Frisse

Summary: Confusion

What works in some places does not easily work everywhereProgress is unevenly distributed

© 2013, Mark Frisse

some vital Elements

a part of aspect of something – especially one that is essential or

characteristic

© 2013, Mark Frisse

Change begins with us

• Patients & families• Providers• Plans• States• Federal Government• Vendors (broadly defined)• Integration & analytics groups• Quality bodies

© 2013, Mark Frisse

Widespread agreement on many remedies

Lewin JC, Atkins G, McNeely L. The Elusive Path to Health Care Sustainability. JAMA. 2013;():-. doi:10.1001/jama.2013.280147.

© 2013, Mark Frisse

HIE can create a single record

A

BC

D

Data are made available to those who require access

© 2013, Mark Frisse

Sophisticated planning systems exist

© Mia Levy, 2013

© 2013, Mark Frisse

Collaborative planning systems

© Mia Levy, 2013

Activation

Task Management

TaskPerformance

Analysis

Plan

TaskPerformance

© 2013, Mark Frisse

A single record; a single plan

measurableoutcomes

a single, personalized plan of care for the individual

© 2013, Mark Frisse

Our search for effective analytics

source: https://www.explorys.com/docs/data-sheets/explorys-overview.pdf NOT a product endorsement

© 2013, Mark Frisse

Summary: Elements

We have components and new markets for HIE (e.g., ACOs, CINS, bundles)Planning paradigms can advance incrementally

© 2013, Mark Frisse

an Emergence

the process of coming into being, or becoming important or prominent

© 2013, Mark Frisse

Task: A new model for regional HIE?

Director other

HIE services

Frisse’s Hunch:• A number of “hub & spoke” HIE efforts

formed as a result of partnerships, ACO or CIN relationships

• Some MDs will belong to multiple clouds• Some MDs communicate only via Direct

© 2013, Mark Frisse

Task: “Push” only to respond to “pull”

Value-based payment Aligned incentivesEfficient administrationAligned CMS and health plansConnectivitySystems thinkingEngineered approachesAnalytics & decision supportPatient / consumer engagement

NEEDSDESIGNSPRACTICES

Iterative cycles of systems-based interventions

© 2013, Mark Frisse

Task: Solid foundations (Version 1.0)

• A systems view• Governance• Authentication & authorization• Directories• Record linkages• Simple messaging• Engineered privacy• Effective & efficient audit logs

© 2013, Mark Frisse

Task: Improve provider quality of life

• A realistic near-term vision • Quick wins• First, do one or two things well• Minimize administrative burdens• No inaccurate / unnecessary

documentation• Automate simple quality reporting• Make fraud almost impossible

© 2013, Mark Frisse

Task: Design for population management

• Early, demonstrable benefits• Governance & data use• Low-cost, secure connectivity• Meaningful metrics• Effective analytics• Consumer engagement• Incentives & behavioral economics

© 2013, Mark Frisse

Summary: Emergence

Progress through renewed emphasis on our critical goals combined with a component-based, systems approach incrementally executed with tangible early results

© 2013, Mark Frisse

Summarizing…

Turbulence• Demographics make this inevitableConfusion• Uncertainty is a by-product of changeElements• We have some components. Must focus on gaps

Emergence• We are proceeding …….. one step at a time

© 2013, Mark Frisse

Frisse ME. Health Affairs 28.2 (2009): w379-w384.