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mHealth Initiative Spring Seminar
March 31, 2009 - Boston MA John Hancock Hotel & Conference Center 40 Trinity Place Boston MA 02116Registration (7:30am - 8am) Registration and complimentary Continental Breakfast Morning Sessions (8am - 12pm) mHealth Applications: Current Projects and their Status PHR on the Cell Phone Interoperability via Mobile Phones Accessing Resources (medication management, protocols, others) Disease Management Nursing Applications Financial Applications Lunch Break (12pm - 1pm) Lunch (included with registration) and networking Afternoon Sessions (1pm - 5pm) mHealth Ecosystem mHealth Marketplace Participatory mHealth: Community-wide Project D |
How good health, in the workplace and the community, is an economic driver for businesses, but also for all other public and private sectors
Reducing Overuse of Supply-Sensitive Care and Promoting Organized Care
We recommend that the federal government develop a multi year plan to reduce overuse of supply-sensitive care, promote the growth of organized care, and move the nation toward cost-effective management of chronic illness. The plan would begin with a voluntary shared savings program in which Medicare would return to participating providers a portion of the savings from lower utilization that would follow from improving care organization and matching medical resources to the patient population. Providers could be individual hospitals, hospital chains, multispecialty group practices, and large primary care groups. Routine performance reports, generated from Medicare claims (and now available in prototype on the Dartmouth Atlas website) can be used to monitor change and measure savings as providers improve efficiency. As a condition of participation in the voluntary program, providers would agree to establish an organized delivery system for caring for their populations of chronically ill patients. These systems would emphasize coordinated, community-based care over the course of illness. For many, if not most, participating systems, improving quality and efficiency will mean reducing capacity—cutting the number of ICU beds per capita, for example, and other overused resources such as imaging machines. The savings shared with providers would be targeted to cover the cost of downsizing (including the amortization of debt and reallocation of professional workforce to new tasks), and investments made in organizing care, such as the capital costs of installing electronic medical records and establishing the infrastructure for disease management. The greatest potential for generating savings for Medicare will be in regions where providers are the most disorganized and least efficient. For example, if in 2005, hospitals in Los Angeles had achieved the care intensity benchmark of Sacramento hospitals, Medicare would have spent $468 million less for inpatient care. We envision the voluntary phase as the testing ground for innovative, workable models for transforming today’s disorganized care systems into accountable care organizations (ACOs), capable of managing capacity and providing organized heath care delivery to their patient populations, particularly those with chronic illness. Organized practices such as the Mayo Clinic, Billings Clinic, and Kaiser Permanente would be well positioned to respond to the incentives of a shared savings program, by expanding within markets where they already have a presence, and entering new markets through the purchase of hospitals and recruitment of resident physicians. CMS could speed the growth of organized care by designating groups of providers and the hospitals with which they are associated as ACOs, which would be measured on the basis of how well they reduce excess utilization and coordinate care for a defined population of patients. We also anticipate that multi hospital systems would be interested in participating and could serve as the nucleus for rapid growth of organized care. In 2005, fully 30 percent of traditional Medicare enrollees hospitalized for chronic illness were treated in hospitals belonging to networks with 10 or more member facilities. Intermountain Healthcare provides a model for how hospital networks can develop into coordinated care systems. Primary care centered strategies for organized care may also emerge as part of the evolving concept of the medical home. We recommend that an overuse penalty be imposed on providers that are extreme overusers of the acute care hospital in managing chronic illness. An overuse penalty, although limited to only a few extreme outlier hospitals, would signal Medicare’s determination to eliminate wasteful, potentially harmful overuse of hospitals in managing chronic illness, and motivate providers to participate in a shared savings program.4 Over the long run, CMS would take steps to ensure that all Americans with progressive chronic illness who are enrolled in Medicare have access to organized care systems, which would provide coordinated care over the course of illness, integrate the various components of community-based care, and avoid the overuse of acute care hospitals.
Action Steps and Pay-for-Value Approaches from leading integrated health delivery systems (Kaiser, Intermountain Health Care, and Mayo Clinic)
Transforming Health Care Payment and Delivery Systems to Improve Quality and Reduce Costs
Scott Shreeve, MDA 2020 Vision and the Policies to Pave the Way
Scott Shreeve, MD
