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Innovation Through the Lenses of HITECH and Health Reform
1. Innova&on
through
the
Lenses
of
HITECH
and
Health
Reform
Wil
Yu,
Innova&ons
Wil.Yu@HHS.gov
HHS
2. Innova&on
Goals
• Encourage innovations that will be required to
help enhance health and well being for all
Americans
• New products, services, ideas
– Support Meaningful Use and health information Exchange
– Support health reform
– Support of ONC and HHS strategy and priorities
2
3. Current
Context
for
Health
IT
Innova&on
• Enacted legislation and current administration policies & rule-making
have created new markets for health IT and healthcare
(…and displaced old markets)
• Innovation will happen naturally in the marketplace whether or not
we engage
• Innovation in the private sector cannot be sustained without
pathways to true markets
• By encouraging and facilitating communication & collaboration, we
can influence magnitude, timing, and velocity
• By encouraging and facilitating communication & collaboration, we
can influence efficient deployment of resources – e.g. ideation, mkt.
transparency, risk identification, search costs, etc.
3
4. Recovery
Act
/
HITECH
Programs
Obstacle Intervention Funds Allocated
• Medicare and Medicaid EHR
Market Failure, Need for
Incentive Programs for Meaningful • $27.3 B
Financial Resources
Use
Addressing Adoption • Regional Extension Centers • $643 M
Difficulties • Health IT Research/Resource Center • $50 M
Workforce Training • Workforce Training Programs • $84 M
• Strategic Health Information
Addressing Technology • $60 M
Technology Advanced Research
Challenges and Providing
Projects (SHARP)
Breakthrough Examples • Beacon Communities Programs • $250 M
• Policy Framework Addressed
Privacy and Security • New Privacy and Security Policies across all
Programs
• NHIN, Standards and Certification • $64.3 M
Need for Platform for Health
• State Cooperative Agreement • $548 M
Information Exchange
Program
*estimate
4
5. How
it
all
fits
together
Regional Extension Centers
ADOPTION
Workforce Training
Improved
Individual
&
Popula+on
Health
Outcomes
Medicare
and
Medicaid
Increased
Incen+ves
and
Penal+es
MEANINGFUL USE Transparency
&
Efficiency
Improved
Ability
to
Study
&
State Grants for Improve
Care
Delivery
Health Information Exchange
Standards & Certification Framework EXCHANGE
Privacy & Security Framework
Health IT Research and Innovations
5
6. DC-‐to-‐VC
Engagements
• Core Value: Promote engagements between
diverse, but critical stakeholders necessary for
early stage entrepreneurship and innovation
• Intense, bi-directional,
communication
• In collaboration with
White House Startup
America Initiative
6
7. Prizes
and
Challenges
Inves&ng
in
Innova&ons
(i2)
• Core Value: Encourage open innovation and community building
• Context:
– America Competes 2010
– Alternative to Grants
– Alternative to Contracts
• Benefits:
– Engage new participants
– Community building
• 2 years; 30+ challenges
7
8. Innova&on
Exchanges
for
Health
IT
• Core Value: Convene sessions between groups
of innovators and potential adopters towards
short-term testbed opportunities
• Help innovators reach proof-of-concept stage
• Provide care organizations with access to
leading edge technologies
8
9. Suppor&ng
Early
Stages
of
Innova&ons:
A
Framework
Concept Proof of Early Optimize Late
+ Prototype Concept Adoption + Adoption
Ideation Refine
Innovation risk and cost
high low
9
10. Suppor&ng
Early
Stages
of
Innova&ons:
A
Framework
Concept Proof of Early Optimize Late
+ Prototype Concept Adoption + Adoption
Ideation Refine
Innovation risk and cost
high low
Innovation Scanning
Innovations Exchange Beacon Communities
i2 - Prizes and Challenges
HIE Challenge Grants
DC-to-VC
Innovation Exchanges
S&I: Direct / NwHIN
SHARP
CHDI / Health Data.gov
10
12. The Innovation Center
Mission Statement
Be a constructive and trustworthy partner in identifying,
testing, and spreading new models of care and payment
that continuously improve health and health care for all
Americans.
12
13. A Future System
• Affordable
• Accessible – to care and to information
• Seamless and coordinated
• High Quality – timely, equitable, safe
• Person and Family-Centered
• Supportive of Clinicians in serving their patients needs
• Engaged with the community and ful lling its population s unique needs
13
14. Measures of Success
1. Better health care - Improve individual patient experiences of care along
the IOM 6 domains of quality: Safety, Effectiveness, Patient-Centeredness,
Timeliness, Efficiency, and Equity
2. Better health - Focus on the overall health outcomes of populations by
addressing underlying causes of poor health, such as: physical inactivity,
behavioral risk factors, lack of preventive care, and poor nutrition
3. Reduced costs - Lower the total cost of care for Medicare, Medicaid and
CHIP bene ciaries by improving quality of care and patient experience
14
15. Innovation Center Menu of Options
Global
Pioneer
Payment
ACO
–
ACOs
ACO
–
Track
2
Track
1
Medical
Homes
Bundled
Payments
for
Care
Improvement
Million
Hearts
Partnership
for
Pa&ents
Meaningful
Use
16. Innovation Center Initiatives to
Support Care Transformation
• ACO Initiatives: Shared Savings Program, • Medicaid Health Home State Plan
Pioneer, Advance Payment, Learning Option
Sessions
• State Demonstrations to Integrate
• Bundled Payments for Care Improvement
Care for Dual Eligible Individuals
• Innovation Advisors Program
• Demonstration to Improve Quality
• Multi-Payer Advanced Primary Care of Care for Nursing Facility
Practice Demonstration Residents
• Comprehensive Primary Care Initiative
• Financial Models to Support State
• Partnership for Patients Efforts to Coordinate Care for
Medicare-Medicaid Enrollees
• Federally Quali ed Health Center (FQHC)
Advanced Primary Care Practice • Innovation Center Initiatives
Demonstration
Support Care Transformation
16
17. Accountable Care Organizations
• Accountable Care Organizations (ACOs) are groups of doctors, hospitals,
and other health care providers, who come together voluntarily to give
coordinated high quality care to the Medicare patients they serve
• Coordinated care helps ensure that patients, especially the chronically ill,
get the right care at the right time, with the goal of avoiding unnecessary
duplication of services and preventing medical errors
• When an ACO succeeds in both delivering high-quality care and spending
health care dollars more wisely, it will share in the savings it achieves for
the Medicare program
17
18. ACO Types
• Medicare offers several ACO programs, including:
• Medicare Shared Savings Program—a fee-for-service program
• Advance Payment Initiative—for certain eligible providers in the Shared
Savings Program
• Pioneer ACO Model— population-based payment initiative for health care
organizations and providers already experienced in coordinating care for
patients across care settings
18
19. Transforming Health Care Through
Active Engagement
• No one organization or region has a monopoly on innovation
• Innovators across the country have developed other effective care delivery
and payment models
• These innovations offer us pathways to building a future health system that
is more effective than the current system at improving health care, health,
and lowering costs
19
20. The Infrastructure Implications of
Accountable Care
• New IT infrastructure models will be required
– EMRs/Meaningful Use and health IT adoption
– Health information exchange and other
• Address challenges of care coordination and risk management at an
organizational level and across potentially diverse organizations
• à Investments in data collection, integration, and analytics
– Population health management, cost analytics, risk modeling and predictive analytics
• à Investments in patient engagement
– Personal health records
20
21. Innovation Imperative
• Success of new models predicated on our ability to innovate
• New markets are being created but there is a window for proof-of-concept
• Magnitude and velocity of our ability to innovate will be critical to our
ability to implement, learn, diffuse
21
22. Introducing the Health Care Innovation
Challenge
• The Innovation Center has received over 500 suggestions and ideas from
across the country.
• This initiative is an open solicitation to innovators across the country to
identify and test innovative service delivery/payment models including
infrastructure support.
• This Challenge will strengthen the Innovation Center s current menu of
options and will address unique needs of communities and populations
across the country.
22
23. Challenge Objectives
• Engage a broad set of innovation partners to identify and test
new care delivery and payment models that originate in the eld
and improve quality while lowering the total cost of care.
• Support innovators that can rapidly deploy care improvement
models within six months of the award through new ventures or
expansion of existing efforts.
• Identify new models of workforce development, training and
deployment that support new models either directly or through
new infrastructure activities.
23
24. Challenge Area: Service/Payment Delivery
Model
• $1 billion to fund innovative service delivery and payment models
to support those innovative models
• Successful proposals will
– De ne and test a clear pathway to sustainability
(higher quality and lower total system cost)
– Demonstrate care improvement within six months of award
– Support care transformation with enhanced infrastructure activity
– Rapidly develop and deploy a health care workforce Proposals are encouraged to
focus on high-cost/high-risk populations
– Including those with multiple chronic conditions, mental health or substance abuse
issues, poor health status due to socioeconomic and environmental factors, or the frail
elderly
24
25. Challenge Area: Infrastructure Support
• New types of infrastructure will enable others to learn from
and support more effective and efficient system-wide function
• Enhancing infrastructure activity is critical to fully achieving
better care, better health, and lower costs
• Examples:
– Implementation of registries
– Medication reconciliation systems
– Shared-decision making systems
– Innovation or Improvement Networks
– Community collaboratives
25
26. Challenge Area: Workforce Impact
• Transforming our health system requires transformation of
our health workforce
• Need to identify and test new ways to create the workforce
of the future that will deliver and support new care models.
• Examples:
– New roles and skills for existing health professionals
– New types of workers to support care transformation
– Team-based models to better utilize a mix of health providers
26
27. Challenge Area: Speed to Implementation
• Proposed models should be operational and capable of
rapid expansion or sufficiently developed to be rapidly
deployed.
• Proposals will be expected to deploy care improvement
models within 6 months of the award.
• Training programs are eligible for funding but should be
intensive, brief programs connected to the model being
tested.
27
28. Challenge Area: Pathway to Sustainability
• Proposed models are expected to
– De ne and test a clear pathway to ongoing sustainability
– Inform future bene t design and/or payment approaches for CMS
consideration and
– Provide recommendations for the scaling and diffusion of the proposed
model
• Preference will be given to proposals that can achieve sustainability as
soon as possible within 3 years.
• Examples of sustainability approaches:
– Public-private partnerships
– Multi-payer approaches
– Proposed service delivery agreements with entities such as ACOs or
Advanced Primary Care models, mental health/public health
systems
28
29. Selection Criteria
• Model Design
• Organizational Capacity
• Workforce
• Sustainability and Finances
• Evaluation
29
30. Learning and Diffusion
• The Innovation Center will identify and diffuse successful
practices that achieve better health care, better health,
and lower costs
• Awardees will engage in shared learning activities
designed to
– Bring organizations together to learn from one another
– Actively measure success
– Share breakthrough ideas to accelerate progress
30
31. Eligible Applicants
• Provider groups • Public-private partnerships
• Health systems • Private sector organizations
• Payers • Faith-based organizations
• Community-collaboratives
• For-pro t organizations
• Community-based
organizations
• Local governments
31
32. Innovation through the lenses of
HITECH and Health Reform
Wil Yu
Director, Innovations
Wil.Yu@HHS.gov
HHS