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Chronic Care Improvement: How Medicare Transformation Can Save Lives, Save Money, and Stimulate an Emerging Technology Industry

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Information about Chronic Care Improvement: How Medicare Transformation Can Save Lives,...
Health & Medicine

Published on November 26, 2008

Author: brown2020

Source: slideshare.net

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Presentation by Steve Brown and Harris Miller introducing the ITAA Whitepaper: Chronic Care Improvement: How Medicare Transformation Can Save Lives, Save Money, and Stimulate an Emerging Technology Industry
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Chronic Care Improvement: How Medicare Transformation Can Save Lives, Save Money, and Stimulate an Emerging Technology Industry May 10, 2004 Presentation by: Harris N. Miller, President Information Technology Association of America 1

ITAA and E-Health ITAA is Committed to Improving the Delivery of Healthcare and Controlling Costs through Transition to E-Health ITAA E-Health Committee Composed of Leading Companies in Sector Committee Activities Include White Papers and Webcasts Focused on Public Policy and Practitioner Trends 2

ITAA is Committed to Improving the Delivery of Healthcare and Controlling Costs through Transition to E-Health

ITAA E-Health Committee Composed of Leading Companies in Sector

Committee Activities Include White Papers and Webcasts Focused on Public Policy and Practitioner Trends

Our Agenda Today Trends in E-Health Overview of New Chronic Care White Paper Your Questions 3

Trends in E-Health

Overview of New Chronic Care White Paper

Your Questions

Healthcare IT Spending: A Comparison View Financial Services -spends 7% of revenues on IT Government - spends 4% of revenues on IT Healthcare - spends only 2-3% of revenues on IT 4

Financial Services -spends 7% of revenues on IT

Government - spends 4% of revenues on IT

Healthcare - spends only 2-3% of revenues on IT

An Overview of the Healthcare Industry IT for healthcare is a very large market, measured in the tens of billions of dollars Healthcare is already an active user of new technology Healthcare IT spending is growing rapidly - up 17% in one recent year 5

IT for healthcare is a very large market, measured in the tens of billions of dollars

Healthcare is already an active user of new technology

Healthcare IT spending is growing rapidly - up 17% in one recent year

The E-Health Challenge How much could IT help healthcare? What are the success stories? What are the barriers or inhibitors to using more IT in healthcare? 6

How much could IT help healthcare?

What are the success stories?

What are the barriers or inhibitors to using more IT in healthcare?

How Big is the Healthcare IT Opportunity? Previous ITAA white paper concluded that an industry-wide investment of $18.1 billion would yield over 6 years gross savings of $120 billion Roughly half the savings are administrative, half are clinical 7

Previous ITAA white paper concluded that an industry-wide investment of $18.1 billion would yield over 6 years gross savings of $120 billion

Roughly half the savings are administrative, half are clinical

Healthcare-Information Technology Opportunities Trends in Managed Care Impact on incentive Impact on integration of care Technological Solutions Computer-based Patient Records - a source of opportunity and of concern Data Warehousing - sophisticated analysis of care 8

Trends in Managed Care

Impact on incentive

Impact on integration of care

Technological Solutions

Computer-based Patient Records - a source of opportunity and of concern

Data Warehousing - sophisticated analysis of care

Reducing Healthcare Costs Major Goals : Improve handling of financial and management information Decrease needless duplication of records Decrease duplicative and erroneous tests Reduce the costs of hospital stays 9

Major Goals :

Improve handling of financial and management information

Decrease needless duplication of records

Decrease duplicative and erroneous tests

Reduce the costs of hospital stays

Improving the Quality of Medical Care Major Goals: Real-time, data-driven medical decisions Real-time, data entry by mobile medical personnel Real-time global transport of complex medical records 10

Major Goals:

Real-time, data-driven medical decisions

Real-time, data entry by mobile medical personnel

Real-time global transport of complex medical records

Improving the Quality of Medical Care Increase productivity by shifting time from paperwork to patient care More efficient patient care management Automated patient records Use of expert systems and diagnostic tools to assist professionals 11

Increase productivity by shifting time from paperwork to patient care

More efficient patient care management

Automated patient records

Use of expert systems and diagnostic tools to assist professionals

Getting to E-Health: The Opportunities for Using IT in the Healthcare Industry Using network technologies for chronic care is the “poster child” for opportunities in using IT effectively in healthcare. 12

Chronic Care Delivery System Shift in Emphasis from Acute to Chronic Care Delivery Integrate Technology-Based Solutions Communicate, Coordinate, Evaluate Save $30 Billion per Year Prevent 1.7 Million Hospitalizations 13

Shift in Emphasis from Acute to Chronic Care Delivery

Integrate Technology-Based Solutions

Communicate, Coordinate, Evaluate

Save $30 Billion per Year

Prevent 1.7 Million Hospitalizations

Technology-based Chronic Care Improvement Steve Brown, Health Hero May 10, 2004 14

The Challenge of Chronic Illness At least 45 percent of Americans – or 132 million people – suffer from chronic diseases Chronic diseases include heart failure, chronic obstructive pulmonary disease, diabetes mellitus, mental health disorders, asthma, and hypertension Patients with chronic disease account for 78 percent of U.S. healthcare spending Spending on chronic disease higher than necessary because healthcare system is oriented toward treating patients who reach a crisis, rather than keeping them healthy 15

At least 45 percent of Americans – or 132 million people – suffer from chronic diseases

Chronic diseases include heart failure, chronic obstructive pulmonary disease, diabetes mellitus, mental health disorders, asthma, and hypertension

Patients with chronic disease account for 78 percent of U.S. healthcare spending

Spending on chronic disease higher than necessary because healthcare system is oriented toward treating patients who reach a crisis, rather than keeping them healthy

Medicare and Chronic Illness 32 million Medicare beneficiaries have at least one chronic condition 8 million patients have five or more chronic illnesses and account for two-thirds of Medicare spending 16

32 million Medicare beneficiaries have at least one chronic condition

8 million patients have five or more chronic illnesses and account for two-thirds of Medicare spending

2004 Medicare Inpatient Costs: Select Chronic Diseases 17 Disease Discharges Cost per Total cost Coronary artery disease .9 million $29,000 $25.6 billion Chronic heart failure .8 million $19,000 $15.2 billion Chronic obstructive pulmonary disease .4 million $16,000 $6.2 billion Mental health disorders .2 million $16,000 $3.9 billion Diabetes .2 million $20,000 $3.8 billion Hypertension .1 million $22,000 $3.2 billion Asthma .07 million $13,000 $1 billion TOTAL 2.8 million $21,000 $59 billion

Chronic Care Improvement Program Model for Medicare Geared toward saving lives and saving money by proactively keeping patients with chronic disease healthier and out of the hospital Model based on daily monitoring, education, guidance, and management by healthcare providers Reinforcing patient self-care behaviors – diet, exercise, medication adherence – is critical Key factor is whether doctors and patients identify and deal with problems early, before patient needs hospitalization 18

Geared toward saving lives and saving money by proactively keeping patients with chronic disease healthier and out of the hospital

Model based on daily monitoring, education, guidance, and management by healthcare providers

Reinforcing patient self-care behaviors – diet, exercise, medication adherence – is critical

Key factor is whether doctors and patients identify and deal with problems early, before patient needs hospitalization

Medicare Chronic Care Improvement “Required Conduct of Programs” “ (G)uide the participant in managing the participant's health (including all co-morbidities, relevant health care services, and pharmaceutical needs) and in performing activities as specified under the elements of the care management plan of the participant; use decision-support tools such as evidence-based practice guidelines or other criteria as determined by the Secretary; and develop a clinical information database to track and monitor each participant across settings and to evaluate outcomes.” 19

“ (G)uide the participant in managing the participant's health (including all co-morbidities, relevant health care services, and pharmaceutical needs) and in performing activities as specified under the elements of the care management plan of the participant;

use decision-support tools such as evidence-based practice guidelines or other criteria as determined by the Secretary; and

develop a clinical information database to track and monitor each participant across settings and to evaluate outcomes.”

Medicare Chronic Care Improvement “Required Elements of Care Management Plans” “ To The Extent Appropriate… A designated point of contact responsible for communications with the beneficiary and for facilitating communications with other health care providers under the plan. Self-care education for the beneficiary (through approaches such as disease management or medical nutrition therapy) and education for primary caregivers and family members. Education for physicians and other providers and collaboration to enhance communication of relevant clinical information. The use of monitoring technologies that enable patient guidance through the exchange of pertinent clinical information, such as vital signs, symptomatic information, and health self-assessment. The provision of information about hospice care, pain and palliative care, and end-of-life care.” 20

“ To The Extent Appropriate…

A designated point of contact responsible for communications with the beneficiary and for facilitating communications with other health care providers under the plan.

Self-care education for the beneficiary (through approaches such as disease management or medical nutrition therapy) and education for primary caregivers and family members.

Education for physicians and other providers and collaboration to enhance communication of relevant clinical information.

The use of monitoring technologies that enable patient guidance through the exchange of pertinent clinical information, such as vital signs, symptomatic information, and health self-assessment.

The provision of information about hospice care, pain and palliative care, and end-of-life care.”

Proven Model of Technology-based Chronic Care Improvement In-home monitoring devices that guide patients in exchange of information with providers Personalized guidance and support through devices Nurse care managers to manage and coordinate care Decision-support tools to implement evidence-based practice guidelines Clinical information databases for accountability 21

In-home monitoring devices that guide patients in exchange of information with providers

Personalized guidance and support through devices

Nurse care managers to manage and coordinate care

Decision-support tools to implement evidence-based practice guidelines

Clinical information databases for accountability

VA Published Results from Technology-Based Chronic Care Improvement 40% reduction in emergency room visits 63% reduction in hospital admissions 60% reduction in hospital bed days of care 64% reduction in nursing home admissions 88% reduction in nursing home bed days of care Significant improvement in Quality of Life SF36V Source: Disease Management, Volume 5, Number 2, 2002 22

40% reduction in emergency room visits

63% reduction in hospital admissions

60% reduction in hospital bed days of care

64% reduction in nursing home admissions

88% reduction in nursing home bed days of care

Significant improvement in Quality of Life SF36V

Source: Disease Management, Volume 5, Number 2, 2002

VA Results Applied to Medicare If Medicare could achieve results similar to the VA’s with similar patients with a model of care coordination that integrates care coordination services with daily in-home monitoring and clinical information tools, Medicare could save $30 billion a year . 23

Realizing the Promise of Technology-Based Chronic Care Improvement Applying technology-based chronic care improvement to Medicare shifts thinking from raising taxes and cutting benefits to increasing quality while cutting costs Key obstacles are lack of awareness, systemic incentives toward crisis-oriented care U.S., Japan, EU beginning to see technology-based chronic care improvement as way to meet challenge of aging populations and foster a new industry Medicare transformation can keep program solvent while spurring innovation in key emerging industry 24

Applying technology-based chronic care improvement to Medicare shifts thinking from raising taxes and cutting benefits to increasing quality while cutting costs

Key obstacles are lack of awareness, systemic incentives toward crisis-oriented care

U.S., Japan, EU beginning to see technology-based chronic care improvement as way to meet challenge of aging populations and foster a new industry

Medicare transformation can keep program solvent while spurring innovation in key emerging industry

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