Fireside Chat with Drs. Mark McClellan and Elliott Fisher (International Ballroom)
- Moderator: Karen B. DeSalvo, M.D., M.P.H., M.Sc. (@KBDeSalvoWeb Site Disclaimers)
- Elliott Fisher, M.D., M.P.H., Chair and Professor of Medicine, Director, Geisel School of Medicine and Dartmouth Institute for Health Policy & Clinical Practice (@ElliottFisher4Web Site Disclaimers)
- Mark McClellan, M.D., Ph.D., Director, Health Care Innovation and Value Initiative, Brookings Institution (@BrookingsInstWeb Site Disclaimers)
Elliott Fisher was thwarted by the New England Snow Storm and was unable to make it to Washington.
What does the future look like?
Comments from Elliott Fisher delivered by Mark McClellan:
Payment Reform and Technology changes are a means to an end: Better Care.
Has HIT evolved as expected over the last 10 years.
American Health information Collaborative – Started moving forward. Interoperability needs to keep a focus on practical things standards can do in the short term.
Quality-based payments is further along.
Brookings ACO Learning Network looks at developments in the ACO Sector.
Medicare ACO Payments are currently around shared savings. Fee for Service is the base payment. This is supplemented on benchmark payments based on quality performance.
Proposed regulations are looking to move further away from Fee for Service. Better support systems that rely on better data which drives more confidence in moving to performance based payment. This also encourages innovation since you are no longer tied to fee for service. ie. Per Beneficiary Per Month.
Health IT is helping organizations get to better results. We don’t have true interoperability but we have workarounds to move in the right direction.
Quality Measurements – what are the right ones?
199 Measures of care. Are they enough?
ONC is working to understand the fundamental building blocks to support those measures. Better quality measurement that is built in to workflow.
Two biggest complaints:
1. Measures don’t capture what is important for patients and provider. No reliable systems to provide this.
2. Measurements aren’t built in to workflow so drives additional work.
CMS is working on making it easier for measures to come out of the systems that ACOs use.
Only 25% of ACOs have systems that generate quality data directly. 75% are working with analytic partners to generate quality data.
“Collect Once and use multiple times.”
What are the opportunities if we get the data model right?
- Drug Surveillance data allowing automatic queries. Health Insurance claims are the best source currently. Automated Lab data collection can lead to more real time data analysis.
Opportunities in Medical Device Surveillance.
Currently require creation of separate registries and manual data entry. With standardization there is the opportunity to do better comparative effectiveness studies and reduce workload.
Does ACO Data model need to be institutionally focused?
Will some parts of the country not move to ACO and value-based models?
We will move to more personalized medicine but not sure how the institutional makeup will shake out.
Some of the fastest growing ACOs are small physician groups. They are not integrating with the full range of services but instead are managing patients whole health. This may lead to more ambulatory care delivery instead of Hospital-based.
May be the ACO of the future will be a virtual, cloud-based entity.
Advice for making path to transformation more understandable for providers?
Congress has got the message that providers feel there is an alphabet soup of standards that are confusing. Congress is looking at how to align payment and other models that are clearly aligned.
One of the uses of Interoperability that will matter for providers will be where it reduces the burden of reporting for quality and payments. The reduction of administrative burdens for providers.
Sec. Burwell pushed for definitive targets on value-based payments in order to provide some market certainty for those on the front-line of care.
States are very innovative. Can we capitalize on that innovation?
A lot of initiatives looking to help rural doctors.
Sec Burwell is aggressive in working with Governors to capitalize on work being done in the states.
Do you envision emergence of an ACO-type Medicaid Model?
A lot of activity in Medicaid ACO programs. Successful ACOs are looking beyond health care. ie. Attacking the other social determinants of health. eg. Housing, jobs etc.
Governance has more changes. Patients will become more involved in defining and guiding Governance.
Consumers have a vote and not just a voice in their care.
Little Data is not so small anymore. When will we see algorithmic support for data analysis?
The number of data points that need to be monitored keeps growing.
Providers typically don’t have data analytics, particularly predictive analytics. This needs patient confidence in sharing and using data.
[category News, Health]
[tag health cloud, blue button, ONC2015]
Health & Cloud Technology Consultant
Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
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I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.
I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
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