# Presentation: 083308

## “The Role of Health IT in Improving Health Care Quality”June 8,2005

**“****The Role of Health IT in Improving ****Health Care Quality”****June 8,2005**

**Presented by:**
**Reed V. Tuckson, M.D.****SVP, Consumer Health and Medical Care Advancement**

## “The American health care delivery system is in need of fundamental change.  The current care systems cannot do the job.  Trying harder will not work.  Changing systems of care will.”                              Committee on Quality Health Care in America

**“****The American health care delivery system is in need of fundamental change.  The current care systems cannot do the job.  Trying harder will not work.  Changing systems of care will.”****                              ****Committee on Quality Health Care in America**

**The Fundamental Issue: Healthcare Quality is Sub- Optimal**

_**Consequences**_

## The Premise of This Meeting:

**The Premise of This Meeting:**

**Health IT offers meaningful opportunities to improve quality and reduce the costs of medical care and health enhancement delivery **

## Aging and Chronic Illness

**Aging and Chronic Illness**

**Five Determinant Forces that Define the Context of Our Discussion**

**Cost Escalation**

**Care Variation From Best Scientific Evidence**

**Consumptive Society: **
**Everybody Wants Everything**

**New Knowledge,**
**Drugs and Technology**

## Escalation

**Escalation**

**Cost**

## Care Variation From Best Scientific Evidence

**Care Variation From Best Scientific Evidence**

## Consumptive Society: 

**Consumptive Society: **
**Everybody Wants Everything**

** ****	****Pharma marketing ****	****expenditures increased ****	****14.1% annually since ****	****1999**
** ****	****DTC to consumers $4B ****	****in 2004**

**Patient’s requests for clinical services are persuasive and influential: successful 45% of time****  ****(Kravitz Annals Int Med 2003)**

## New Knowledge,

**New Knowledge,**
**Drugs and Technology:  How Will Assets Be Used?**

** ****	****20,000 journals**
** ****	****17,000 new books**
** ****	****6,000,000 references**
** ****	****400,000 new entries**

**Cost Escalation**

**Care Variation From Best Scientific Evidence**

## Consumptive Society: 

**Consumptive Society: **
**Everybody Wants Everything**

**Consumers are using information independently of their relationship with their physicians.**

**“****Make an Appointment for Your Ultra-fast Electron Beam Tomography Today!”**

## Patient Centered Care in an Era of Aging and Chronic Illness

**Patient Centered Care in an Era of Aging and Chronic Illness**

**Right care, for the right person, at the right time, from the right facility and the right health professionals**

## “The American health care delivery system is in need of fundamental change.  The current care systems cannot do the job.  Trying harder will not work.  Changing systems of care will.”Committee on Quality Health Care in America

**“****The American health care delivery system is in need of fundamental change.  The current care systems cannot do the job.  Trying harder will not work.  Changing systems of care will.”****Committee on Quality Health Care in America**

## 1. Decrease Administrative Costs:The Age of Card Services Has Begun

- Eligibility and payment cards will merge into one card

**In 2005**

## 2. Best Evidence “Just in Time” At the Point of Care

**2. Best Evidence “Just in Time” At the Point of Care**

***“******Care depends upon the clinical decision-making capacity of autonomous individual practitioners for problems often beyond human cognition” ******IOM Chasm Report***

## 2. “Just In Time Access” to Information Necessary for Individually Focused Patient Care

## 3. Performance Assessment and Feedback to Improve Quality and Close Gaps in Care

**3. Performance Assessment and Feedback to Improve Quality and Close Gaps in Care**

## Essential Data and Analytic Infrastructures are Progressing Rapidly

** ****Data Warehoused and Aggregated into  Clinically Relevant Groups (280 discrete ETG’s)**

**Essential Data and Analytic Infrastructures are Progressing Rapidly**

## Promising Developments in EMR Adoption

**Goal:  ****To accelerate the adoption of functional,robust, **_**interoperable**_** and secure ambulatory healthcare information technology while delivering**
**value to providers, vendors, and purchasers and payers**

**Conveners:**
** ****	****American Health Information Management Association  (AHIMA)**
** ****	****Healthcare Information and Management Systems Society  (HIMSS)**
**  ****The National Alliance for Health Information Technology  (Alliance)**

**Timeline:**
** ****	****A first-step certification process ready for pilot implementation by the**
**	****summer of 2005**

**Promising Developments in EMR Adoption**

**Increase the confidence of providers to invest in and adopt HIT**
**Facilitate interoperability of HIT products within the emerging health information infrastructure**
**Enhance the availability of HIT adoption incentives from public and private purchasers/payers **

## Intense Interest in Physician Performance Assessment

**Intense Interest in Physician Performance Assessment**

## Ambulatory Care Quality Alliance (AQA) 

**	****Measuring**_** **_**performance at the physician level**
** ****Collecting and aggregating**_** **_**data in the least**
**	****burdensome manner**
** ****Reporting meaningful information to consumers, **
**	****physicians, and other stakeholders to inform **
**	****choices and improve outcomes**

**	****	****	**_**Sponsors**_
**	****Agency for Healthcare Research & Quality**
** ****American College of Physicians**
** ****American Academy of Family Physicians**
** ****Americas Health Insurance Plans**

**An “Industry Standard” for Physician Performance Assessment**

**Ambulatory Care Quality Alliance (AQA) **

## AQA Ambulatory Quality Measures:A Mix of Claims and Office Chart Data

**Prevention Measures**
**Breast cancer screening**
**Colorectal cancer screening**
**Cervical cancer screening**
**Tobacco use**
**Advising smokers to quit**
**Influenza vaccination**
**Pneumonia vaccination**

**Coronary Artery Disease**
**Drug therapy for lowering LDL**
**Beta blocker post discharge for MI**
**Heart Failure**
**Ace inhibitor/ARB for CHF and LVSD**
**LVF assessment**
**Diabetes**
**HbA1C management**
**HbA1C management control**
**BP management**
**Lipid measurement**
**LDL <130**
**Eye Exam**

## AQA Ambulatory Quality Measures:A Mix of Claims and Office Chart Data

**Asthma**
**Percent with persistent asthma appropriately prescribed medications**
**Percent with persistent asthma prescribed the proper therapy**
**Depression**
**Acute phase medication management**
**Continuation phase medication management**
**Prenatal Care**
**Screening for HIV**
**Anti-D Immune Globulin for D(Rh) negative unsensitized patients**

**Overuse or Misuse**
**Appropriate use of antibiotics for children with URI**
**Appropriate testing of children with Pharyngitis who were treated with antibiotics**

**Next Steps **
**Efficiency measures:  scheduled for September 2005**
**Specialty care measures**
**Patient experience with care assessment**
**Data aggregation!!! **

## An “Industry Standard” for Hospital Performance Assessment:

**An “Industry Standard” for Hospital Performance Assessment:**
**Electronic Records and Inter-connects Are Key**

## Connecting Performance, Contracting, and Financial Incentives 

**Connecting Performance, Contracting, and Financial Incentives **

## 4. Care Coordination and Support for Individually Appropriate Health Decisions

**Quality**

**Efficiency**

## 90 days Pre-event 

- 90 days Pre-event

- 360  Days Post-event

**“****Anchor” Cardiac Procedure Performed**

**Analyze all of the tests,  interventions, complications and outcomes that occurred **_**after**_** the procedure**

**	****Longitudinal tracking of **_**total episode of care **_***risk-adjusted***** data**

**Analyze all of the diagnostic tests used **_**before**_** the intervention**

**New Competencies in Evaluating Total Care Quality and Efficiency Outcomes For Hospitals and Physicians, Separately and Together**

## Total Resource Consumption + Quality Assessment +  Efficiency Analysis = Actionable Differentiation

- 40

- 37

- 55

- 17

- 9

- 23

- -150.00%

- -100.00%

- -50.00%

- 0.00%

- 50.00%

- 100.00%

- 150.00%

- $0

- $2,000

- $4,000

- $6,000

- $8,000

- $10,000

- $12,000

- $14,000

- $16,000

- $18,000

- $20,000

**Overall Complication Rate Compared to Expected**

**Complication Rate vs. Cost Per Admission for a Percutaneous Cardiovascular Procedure Over 12 Months**

**Expensive &**
**Poorer quality**

**Less expensive &**
**lesser quality**

**Less expensive &**
**better quality**

**Expensive &**
**better quality**

**Total Resource Consumption + Quality Assessment +  Efficiency Analysis = Actionable Differentiation**

## The Complete Picture: 

**The Complete Picture: **
_**Hospital-based Physician**_** Quality Plus **_**Hospital**_** Efficiency Analysis**

**Overall Complication Rate by Physician vs. Hospital Cost/Admission**

- 13

- 21

- 14

- 13

- 14

- 35

- 90

- 85

- 79

- 59

- 43

- 26

- -5.00%

- 0.00%

- 5.00%

- 10.00%

- 15.00%

- 20.00%

- $0

- $5,000

- $10,000

- $15,000

- $20,000

- $25,000

- $30,000

- $35,000

- $40,000

- $45,000

**Cost Per Admit**

**Complication Rate (# Complications/Cases)**

**QUALITY**

- COSTS

## Coordinating Care for Complex Patients

**Data aggregated**
**into clinical clusters**

**Coordinating Care for Complex Patients**

## The Power Curve

**The Power Curve**

**The “Consumerism” Movement is Gaining Momentum**

## Develop Effective Information Tools

## “People are segmented by their desire and capacity to seek information, their health status, and the course of their illness.”

**“****People are segmented by their desire and capacity to seek information, their health status, and the course of their illness.”**
**FACCT**

## Creating activated, competent, and value-conscious consumers/patients

**Creating activated, competent, and value-conscious consumers/patients**

## Lot’s of Information Coming at People

**Benefit, Transaction**
**Capabilities**
**(How much do I have in**
** ****my PBA or FSA?)**

**Evidence-based**
**Condition/Procedure ****Management**
**(What do I have/need?**
**What are my alternatives?)**

**Health Risk **
**Assessment**
**(What am I at risk for?**
**How can I intervene early?)**

## People Need Help in Understanding and Applying Information About Quality

**People Need Help in Understanding and Applying Information About Quality**

## We Have A long Way to Go to Assist People In Actually Using  Available Information

*Source:  National Trends in Healthcare Consumerism: The Quality-Conscious **Consumer Third Annual Report from Solucient, LLC, September 2004*

## Integrating All “Touch-points” to Maximize Appropriate Choices for “Influenceable” Events

**Integrating All “Touch-points” to Maximize Appropriate Choices for “Influenceable” Events**

**Nurseline**

**Health Risk****Assessment**
**High Risk Patients**

**Decision****Support**
**By Phone**

**Member ****Services**

**Care**
** ****Coordination**

**Physician Portal**

**Clinical****Operations**

**UnitedHealthcare**

**Education & Steerage****Welcome Kit**

**Mailings and Call-outs**

**Premium Network****SM** **Info**
**Cardiac Care Clinical Content**
** ****E-mails to users**

**“****Health Coach” Inbound Calls****Mailings**

**Premium Network****SM** **Info**
**Targeted Communications**

***THE KEY:  Getting the right person, the right care, at the right time, from the right place, from the right health professional!***

**Notes:**
Our Consumer Engagement Approach
Goal
Engage consumers to take an active role in choosing the most appropriate hospitals for cardiac care
Objective
Educate consumers that there is a difference in level of care for cardiac procedures and that where they go matters
Tactics
 Provide consumers with decision support tools to help them before, during and after care
Health Coach, myuhc.com, Employer materials
Academic Detailing with local physicians to leverage the power of patient/physician relationship
Call to action: 
Encourage consumers to call a Health Coach or log on to myuhc.com for more information

Key Messages
Where you seek cardiac care matters
UnitedHealthcare has done the homework for you
UnitedHealth PremiumSM program empowers you with the evidenced based information you need to make an informed decision about where to receive high quality treatment for your cardiac condition
Benefits include
Increased confidence about making smart health care decisions
Access to care at facilities that have demonstrated a commitment to quality service in cardiac care 
Potential for healthier outcomes
Easy to use – no referrals necessary

Channel	Message/Content
Physician Portal	
Display Premium NetworkSM cardiac specialty centers  
Display Premium NetworkSM hospital/physician by conditions

   myuhc.com	
Display Premium NetworkSM general content
Display Premium NetworkSM hospitals/facilities selection tool
Display Premium NetworkSM hospital/physician by conditions

General member communications 	
Leverage Welcome Kit 
Distribute Employer materials for consumers (ie Employer toolkit)

Optum NurseLine	
Educate on Premium NetworkSM Program
Provide list for Premium NetworkSM hospitals and physicians for 3 conditions
Direct to other resources 

Member Services (CSRs)	
Educate on Premium NetworkSM Program
Steer members to Premium NetworkSM hospitals/physicians  
Identification of Physicians and Hospitals 
Promote benefit differential (when available)

Optum Care Coordination	
Educate on Premium NetworkSM Program
Provide list for Premium NetworkSM hospitals and physicians for 3 disease states

Targeted direct-to-consumer	
Distribute postcards/newsletters based on UHC Arizona pilot results
Additional cost may apply

## “The American health care delivery system is in need of fundamental change.  The current care systems cannot do the job.  Trying harder will not work.  Changing systems of care will.”                              Committee on Quality Health Care in America

**“****The American health care delivery system is in need of fundamental change.  The current care systems cannot do the job.  Trying harder will not work.  Changing systems of care will.”****                              ****Committee on Quality Health Care in America**

**The Fundamental Issue: Healthcare Quality is Sub- Optimal**