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... for Medical Home Improvement, the Oregon Medical Hom


... for Medical Home Improvement, the Oregon Medical Home Project, The National ... in five clinical areas shows significant improvement in quality results ... – PowerPoint PPT presentation

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Title: ... for Medical Home Improvement, the Oregon Medical Hom

Trends in Healthcare for the 2007 Vision
ElementsPublic Employees Benefit Board
Meeting of the Board of DirectorsTuesday,
November 21, 2006
Purpose of Todays Presentation
  • To present a high level overview of the trends in
    the PEBB Vision elements over the recent past
  • To provide feedback and an assessment of PEBBs
    plan to accelerate change and improvement in the
    health of their members and the health care
    system in Oregon

Consensus Has Developed for the Role of the
Medical Home Provider
  • Agreement(1) on the essential elements of the
    Patient-Centered Medical Home includes
  • A primary care team of healthcare professionals
  • Partnership between the primary care team, the
    patient and the family
  • Use of a care plan developed with the patient and
  • Coordinates care and information across the
    providers and community organizations
  • Uses a proactive approach to management of
    chronic condition care
  • PEBB is contributing to the growth of the
    Patient-Centered Medical Home through its carrier
  • (1) Between the Center for Medical Home
    Improvement, the Oregon Medical Home Project, The
    National Quality Forum, the American College of
    Physicians, the American Academy of Family
    Physicians, and the American Academy of Pediatrics

Evidence-based Care/Practice Guidelines Slow
Growth Continues - Where Strong Provider
Relationships Exist, Growth is Faster
  • Strong physician leadership among peers is
    required to obtain buy-in
  • Cost of roll-out can be prohibitive to implement
    across multiple settings of care
  • Guidelines from credible sources abound
  • OHSUs Oregon Evidence-based Practice Center
    (EPC) provides systematic evidence reviews on
    guidelines related to screening and prevention
    services dozens are available
  • OHSU and Kaiser Permanentes Center for Health
    Research are currently working on a dozen more
  • HHS provides dozens on its website

Evidence-based Care Spread of Other Elements is
Starting to Accelerate
  • Pay for Performance Programs using Evidence-based
    criteria begins to spread
  • Premier/CMS Hospital Quality incentive
    Demonstration Project
  • First year results in five clinical areas shows
    significant improvement in quality results
  • Bridges to Excellence Pay for Performance
  • Designed to re-engineer physician office
  • Focused on producing better outcomes for patients
    with diabetes and cardiovascular disease

Member Self-Management Efforts Have Been
Historically Disease-Specific
  • Pittsburg Business Group on Health LivingMyLife
    program (Diabetes)
  • The Pittsburgh Business Group on Health (PBGH),
    an employer-only coalition, has joined with the
    American Pharmacists Association (APhA)
    Foundation for the program
  • Physicians, diabetic educators and pharmacists
    act as coaches to help the diabetic patient to
    gain knowledge needed to manage their care

The Scope of Member Self-Management Efforts is
Widening Beyond Clinical Support for a Specific
  • Pacific Business Group on Health Breakthrough
  • The program includes a variety of strategies in
    addition to clinical teaching and support such as
    general health promotion, lifestyle behavioral
    change, and consumer decision support
  • HMOs, PPOs and consumer driven models are
    included and some employ consumer incentives

State Agencies Lead Developments in Service
  • Most efforts are being sponsored by state
    Departments of Human Services
  • They combine formal coordination of delivery
    systems and use a service brokering program in
    which staff coordinate services for physical or
    mental health, substance abuse, housing,
    childrens services, and domestic violence

Developments in Infrastructure Make Steady
  • The federal government takes an affirmative step
    by Executive Order in August, 2006
  • Federal agencies administering insurance directed
    to improve interoperability of agency information
    systems dealing with health insurance
  • Spread of Electronic Medical Records continues
    despite lack of financial incentives to
    physicians at the federal level
  • Gap widens between small and large practices for
    adoption of EMRs

Steady Progress In Infrastructure
  • Overlap begins to appear between organizations
    utilizing clinical systems and Health Information
    Exchanges (Shared Health)
  • Medical and pharmacy claims/encounter data is
    pulled from two information exchanges backed by
    business coalitions and fed into a Health
    Information Exchange made available online to all
    the physicians contracted to BlueCross BlueShield
    of Tennessee
  • Oregons Health Information Security and Privacy
  • Is a joint initiative between OHPR and the
    private sector to identify solutions and an
    implementation plan to address business practices
    and state laws that affect privacy and security
    practices and permit interoperable health
    information exchange
  • comment from the group is expected within a year

Federal Support of Transparency Develops
  • The federal government takes initiative by
    Executive Order
  • Sharing cost information
  • CMS posts costs for hospitals for 30 elective
    procedures as inpatient admissions
  • CMS will post costs for Ambulatory Surgery
    Centers, hospital outpatient and physician
    services next
  • The federal government will develop measures of
    quality at the provider and health plan level
  • Federal agencies were directed to develop
    approaches that facilitate high quality,
    efficient care

States Accelerate Developments in Transparency
  • The creation of The Oregon Patient Safety
    Commission was a turning point
  • Implemented voluntary and confidential reporting
    of medical errors in hospitals in 2003 and most
    Oregon hospitals have joined
  • Advocates disclosure of the medical error to the
    patient and family and analysis and process
    improvement as follow up to the error
  • Implementation is next for nursing homes and
  • Last month OHPR released the second annual report
    on death rates in hospitals for selected
    procedures and medical conditions

Purchasers and the States Take the Lead in
Developments in Transparency
  • Health Information Exchanges sponsored by
    business coalitions of purchasers are
    proliferating at an almost exponential rate
    sharing regional claims based data to report cost
    and quality information

Managing for Quality Modest Progress
  • The National Healthcare Quality Report concludes
    improvement in Quality is moving at a modest
  • Improvement is variable with some areas of high
    performance for example
  • The 100,000 Lives Campaign efforts to reduce the
    number of lives lost to medical errors by 100,000
    a year include
  • The development of rapid response team for
    clinical assessment in hospitals
  • Significant reduction of medication errors in the
    inpatient setting
  • Computerized physician order entry (CPOE) reduces
    transcription errors
  • Implementation of CPOE is spreading quickly
    because the technology is available now to
    support its use in real time

Developments in Managing Quality Purchasers
Prove They Can Drive Change
  • TheLeapfrogGroup
  • Regional Roll-Out leaders include local
    hospitals, health plans, physicians, unions, and
    consumer groups
  • The Regional Roll-Outs encourage the
    implementation of Leapfrogs four recommended
    quality and safety practices or leaps
  • Implementation of computer physician order entry
    (CPOE) systems
  • Staffing ICUs with intensivists
  • Referring patients to hospitals with the best
    results for treating certain high risk conditions
  • Implementation of The National Quality
    Forum-endorsed Leapfrog Safe Practices

Developments in Managing Quality Purchasers
Prove They Can Drive Change
  • TheLeapfrogGroup - continued
  • Western Oregon is one of 28 Roll-Out Regions
  • 11 out of 57 Oregon hospitals have shared data
    for public disclosure with TheLeapfrogGroup
  • Providence Milwaukie and McKenzie-Willamette were
    the two new members from Oregon in 2006

  • The lines between initiatives to achieve the
    Vision elements are beginning to blur and efforts
    overlap as change in healthcare and benefit
    coverage accelerates
  • PEBBs plan for Implementation of the Vision is
    keeping pace with developments in the industry
  • Aon recommendation is to continue to implement
    from the individual carrier work plans (matrices)
    to execute the Vision stretch goals
  • Consistency in collaboration produces results
  • The satisfaction of successful achievement is the
    best motivator for your collaborating partners to
    participate in future efforts
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