ekivemark: pre-blogspot

ekivemark: pre-blogspot

Mark Scrimshire  //  Health & Social Technologist, Strategist, Chief Instigator and Co-Founder HealthCamp Foundation.
Check out http://healthca.mp - Get involved in your future Health Care now. Socially Empowering Health Care Engagement.

BTW here is my main profile.

 
Jan 29 / 12:54pm

Curing US HealthCare… Coding reform and payment reform go hand in hand

by Mark Scrimshire
This week I took part in the Care Innovations Summit in Washington DC. On Wednesday I was at the Kaiser Permanente Center For Total Health for a pre-Summit networking day. It was great to work with Danielle Cass and Ted Eytan from Kaiser to facilitate a day long event that I heard people describe as "The Best Networking Day. Ever"

The day was a mix of networking exercises, fireside chats with people that are shaping the future of health care and panel discussions that really made people think. If you get chance to spend time with Jack Cochran, MD, Executive Director, The Permanente Federation, Kaiser Permanente grab the opportunity. He has a life history that would make a great movie and his views on the future of health care and how to improve health are worth listening to and he takes his energy and relentlessly applies it to achieving that aim of better care. 

Joe Smith, MD, PhD, Chief Medical and Science Officer, The West Wireless Health Institute is equally vocal about improving our health care system. While Joe didn't get on stage at the Summit itself, he was one various panel discussions at the pre-summit. You really need to listen to his ideas. West Wireless Health Institute is doing great things to promote new approaches to health care. Joe is one of the people shaping the future. 

The themes that kept surfacing at the pre-networking event where two fold: Coding Reform and Payment reform. The two need to go hand in hand. As the industry is about to go through a transition that multiplies the number of CPT codes in use complexity is going to try to drive another nail in the coffin of transparency. We can't let this complexity win.  If we are not careful we will become so focused on diagnosing exactly what is wrong with a patient that we will forget that it would have been better to have avoided the patient having to come in for a diagnosis in the first place. 

If CPT Coding stays focused on minutely identifying an action or condition it risks missing the big picture and enabling preventative actions by physicians. Yet prevention is the big win in healthcare. It is something that has been lost in the Pay for Volume model that is the lot of the vast majority of US Health Care - with certain notable exceptions - like Kaiser Permanente.

When I look back at this week I wish Daniel Palistrant (of Sermo and Par8o) had been at the pre-networking event. His would have been an interesting voice to add to the discussion. He has a provocative article on his blog this week that complimented the CPT and Payment reform discussion. Check out his latest blog post:

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Jan 27 / 9:23am

Here is the full Tweet Reach report for #CISummit - Provided by HealthCamp as a service to Health Innovators everywhere

by Mark Scrimshire
I was asked by someone at CMS if I could get a copy of the Tweets from the Care Innovations Summit (#CISummit). So here as a service to the Innovation Community is a copy of the report from TweetReach - both the old style report and the jazzy new version.

Old Style Report:

Click here to download:
TweetReach_cisummit_or_hcidc_org-OldStyle.pdf (4.01 MB)
(download)

New Style Report:

Click here to download:
TweetReach_cisummit_or_hcidc_org-NewStyle.pdf (4 MB)
(download)

If you want to show some love for this service you can always head over to HealthCa.mp and make a small token donation.

It was a great event and I am looking forward to a repeat next year. We should all thank West Wireless Health Institute and the Centers for Medicare & Medicaid Services for putting together a great event. Thanks should also go to Kaiser Permanente for working with West Wireless to host the pre-event networking day at the Kaiser Permanente Center For Total Health. The feedback we have had from that high energy event has been fantastic. I heard understated comments like: "Best Networking Event. Ever!" The only downside of the networking day was the complaint from people that they had heard great reports about the event but didn't hear about before hand so that they could take part.

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Jan 26 / 5:53pm

#CISummit Don Casey wraps up the summit

by Mark Scrimshire
Don Casey:

CMS gets very little positive feedback. They took a risk and engaged with a passionate audience.
Let's thank CMS for all their efforts.

1200 people at the event.

2400 people listened to web cast for extended periods.

Invest in putting the patient at the center - this is the path to better outcomes at lower cost.


Can we engineer a jailbreak for HealthCare. The question is how quickly.

Talk is cheap - what are you doing?

We need to take action quickly.

Westhealth Policy Center working on a fellowship program to create research with actionable outcomes.

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Jan 26 / 5:47pm

#CISummit - Key points and quotes - Part 2 adds memorable quotes from the afternoon session

by ekive
Don Casey: Don Casey says healthcare costs are 17.9% of the GDP and may reach north of 30% if left unchecked. This could cripple the economy.

Dr. Atul Gawande: Health Care (cost) is destroying the American Dream
We forget the bell curve of impact and cost. The two curves do not match. This gives us hope. We want the positive deviants.

HealthCare today is like driving a car with a speedo that tells what speed we were traveling 4 years ago. Data is the key!

Rick Gilfillan: "No one went to school to provide fragmented, expensive care"

@Todd_Park: Data is rocket fuel for innovation

@Todd_Park: There is no problem America can't innovate its way out of - apply the innovation mojo!

Dr. Brian Prestwich - The EMR of today is completely inadequate for the family doctor. They need to be connected. They need knowledge from the patient. They need population information for comparison. (Lots of applause)

Dr. Brian Prestwich: Make it simple to reduce the cognitive workload

David Kirchhoff - Obesity is a lifestyle issue. Difficult and messy.

Lonny Reisman: Technology is essential but not sufficient

Farzad Mostashari: Data as oxygen for innovators.

Aneesh: Has ONC just put forward the idea of OpenTable for Health Care?

After lunch:

Ken Coburn: No part of health system can stand apart. We need collaborative models.

Debbie James: Short term risk is short term thinking about costs

Will Shrank - Medication Non-Adherence - Americas other drug problem

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Jan 26 / 5:47pm

#CISummit - Wrap up in the Innovation Hot Tub

by Mark Scrimshire

5:15-
5:45pm

Fireside chat with Susan Dentzer

Editor-in-Chief, Health Affairs 

Jonathan Blum

Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services (CMS) 

Cindy Mann

Deputy Administrator Director Centers for Medicare & Medicaid Services 

Rick Gilfillan, MD

Director, Center for Medicare & Medicaid Innovation ("CMS Innovation Center")

Susan Dentzer suggests that a hot tub is a more appropriate metaphor since there is no fireplace.

Innovation is doing! Like cooking. 

Payment is an important part of the innovation soup.

Secret sauce is Culture Change

Scaling for Culture is hard to do.

Technology and Data is key.

Data is an enabler and the rocket fuel of innovation.

Evidence is key. 

We need to Share.

How do we move forward:

Jonathan Blum:  What does it take to be a high performing doctor or technician.

Best practice audits to review top performing plans and learn what the secret sauce is. Then communicate this information to others to apply.

[ED:]Scaling Positive Change is the same challenge as patient medication adherence. We can package it like a pill but medication is not the only part to a cure. People have to want to get better. If providers don't buy in to new processes they will not perform at the same level as the top performers.

Rick Gilfillan: We (the Feds) don't have to build a new delivery system. The care services in their local communities will build what works.

[ED: The challenge is to provide the payment systems that enable innovative methods of care to be implemented.

Looking in the upcoming CMS Challenge for ideas that engage people/patients in these new models.

Cindy Mann: our doors are open . Come forward with ideas.

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Jan 26 / 5:12pm

#CISummit - Cancer Care.

by ekive

4:00-
5:15pm


Panel 3

Cancer: Journey Toward Better Health, Better Care and Lower Costs Case Study


Moderator: Simmi P. Singh

Senior Advisor, Health Innovation, Office of the Secretary, Department of Health and Human Services

Amy Abernethy, MD

Associate Professor, Division of Medical Oncology, Duke University School of Medicine and Medical Director of Oncology Quality, Outcomes and Patient-Centered Care in Duke University Health System

Amy Berman, RN

Program Officer, John A. Hartford Foundation 

Jeffrey Elton, PhD

Co-Founder and Board Member, Kew Group, Inc. 

Bruce Johnson, MD

Head of Thoracic Oncology, Dana Farber Cancer Institute 

Chris Olivia, MD

Board Member, Eviti, Inc.

Simmi Singh 

Cancer is 4th leading cause of death. 

Cancer = uncontroled cell reproduction.

Bruce Johnson - Dana Faber Cancer Institute

- How the Human Genome project has influenced cancer treatment.

- The past decade - what have we learned

The human genome was sequenced at the cost of $1B.
We can now sequence an individuals genome for $1,000.

Lung cancer is the most common form of cancer death. (156,940 in 2011 in USA)
85% of patients die.

Using the lessons from genome research is allowing pills targeting specific sub sets of cancer. This replaces chemo therapy or infusion with a simple pill that works for longer.

Jeffrey elton - Kew Group

Personalized Oncology Management in the community.

Quality based reimbursement+ Molecular diagnostics + Clinical Research

This is precision medicine.

Chris Olivia - Eviti

50% of cancer diagnostics are wrong. 

32-40% of treatments deviate from guidelines.

45% of patients don't take medications as prescribed.

Cancer has seen an explosion in data requirements to support cancer decision making.

Eviti can reduce approvals for treatment from days or weeks to 15m

Amy Abernathy - Duke University

Rapid Learning HealthCare - IOM in 2007 (but nothing happened.....)

Patient reported outcomes have been discarded as unreliable - how do we improve that so they can be relied upon.

Community oncologists are at the forefront of using patient reported outcomes.

Sequentially Link data connect disparate datasets. 

Data needs to be re-purposable.

Amy Berman - Hartford Foundation

Talking about her story about the diagnosis of her inflammatory breast cancer.

The message is that we have to consider the patient and their quality of life. 

Amy has chosen to not do the high cost, high impact procedures and instead preserve quality of life.

The patient needs to be able to make informed choices and the medical community needs to place value of the patients set of values.

The Discussion
20% of research pipeline in pharma and elsewhere is going in to oncology.

We spend $150-$200B on Cancer Treatment.

The increased specialization of cancer treatment raises issues in running clinical trials and treatment. 

Chris Olivia gives a hats off to the work of CMS to unleash data and drive innovation to effect change. 

BJ - we may need to come up with different method of practicing as we unravel the secrets of cancer in the genome. Let's hope our payment systems of the future don't prevent this adaptation.

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Jan 26 / 4:09pm

#CISummit Ignite Talks - Part 3

by Mark Scrimshire

3:45-
4:00pm

Ignite Talks: Rapid Fire Innovation Pitches


Facilitated by Joe McCannon

Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS) 

Will Shrank, MD

Director, Rapid Cycle Evaluation Group, Centers for Medicare & Medicaid Services (CMS) 

David Eddy MD, PhD

Co-Founder, Archimedes
Joe McCannon -  Asked the question:

- Who would you most like to meet?
- What innovation has captured your imagination?

I know I want to learn more about the Allscripts challenge. 

Will Shrank - Rapid Cycle Evaluation Group - CMS

Medication Non-Adherence - Americas other drug problem

$0.5T problem due to medication non-adherence.

No magic bullet.  But....

Better education and communication

Pharmacists are potent communicators

Benefit design to remove payment barrier.

Simple reminders

Better labeling and packaging

HIT is the backbone of any adherence initiative. Social Networks are powerful tools.
Engage family and friends.

Entrepreneur behind epocraties

Redesigned primary care service at lower cost. Same day appointments. More time with patients. 
Not a concierge model.

Ideas are cheap. It is putting them in to practice that takes effort.

There is waste in the system. First concentrate on internal waste.  Started looking at support staff. Typical practice has 4.5 FTE's per MD.
But that depends on handling many, many patients.

Dropped it to 1.5 FTE per MD

Classic People - Process - Technology challenge.

Instituted email. - what a concept! 

Simple systems. Email, web forms, simple EHR

Don't specialize

What was learned:

- The bar is low.

- Expectations are rising.

Creativity is thinking new things - Innovation is doing new things.

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Jan 26 / 3:22pm

#CISummit - Chronic Care Management - The discussion

by Mark Scrimshire
Atul Gawande leads a discussion on Chronic Care Management.

2:00-
3:30pm


Panel 2

Care Delivery/Chronic Disease Innovation Case Study


Moderator: Atul Gawande, MD, MPH

Surgeon, Writer, Public Health Researcher 

Kenneth Coburn, MD, MPH

Chief Executive Officer and Medical Director, Health Quality Partners (HQP) 

Alan Hoops

Chairman and Chief Executive Officer, WellPoint/CareMore 

Debbie James

Vice President, Healthways Fitness Division, Healthways 

Mary Naylor, PhD, RN

Professor in Gerontology, University of Pennsylvania School of Nursing
DJ: Complex model. Targeted messaging based on demographics. 
Mail campaigns (majority of activity), phone calls. some clients they work with physicians. (Healthways client is the health plan or employer)

Fitness centers are trained to deal with seniors. 

MN: Nurse "hold the family and patient's hand through the transition from hospital to home. This starts before release. Patients in hospital go from 24x7 care to 24x7 nothing upon release. 

AH: The component pieces of care are nothing new. What is new - for Health Plans to be accountable. CareMore focuses on the 10-20% of patients that exceeds the PCP's ability to care for them. 

So.... CareMore is an outsource model. 

50% of chronic condition seniors admitted to hospital are either dead or readmitted within 12 months.

MN:  Focus on medicare and dual eligibles, multiple chronic conditions, multiple acute service use. Work in hospital and with PCP's. Pick people up at a point of risk and support them to a point where they are no longer at risk.

DJ: beenfits seen in Year 1, benefits pay for all participants in Year 2.

KC:  High risk groups has ROI in first year. Wider beneftis in 4.5 yrs. Once people ar ein the program they stay in and continue to benefit.

MN: TCM has a continued investment needed in systems and training. Hospitalized patients show an ROI within months. 

AH: CareMore Model is a platform and patients are divided in to many sub-groups. Differing payback returns. CareMore looks for broken systems that enable 20-50% reduction in cost in a 6 month time frame.

Innovative models don't fit the regulations. Regulations are designed for the healthier 75% and not the sickest 25%.

MN: Our biggest barrier is us

KC: No part of health system can stand apart. We need collaborative models.

DJ: Short term risk is short term thinking about costs

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Jan 26 / 2:41pm

#CISummit Chronic Disease Management moderated by @atul_gawande

by Mark Scrimshire

2:00-
3:30pm


Panel 2

Care Delivery/Chronic Disease Innovation Case Study


Moderator: Atul Gawande, MD, MPH

Surgeon, Writer, Public Health Researcher 

Kenneth Coburn, MD, MPH

Chief Executive Officer and Medical Director, Health Quality Partners (HQP) 

Alan Hoops

Chairman and Chief Executive Officer, WellPoint/CareMore 

Debbie James

Vice President, Healthways Fitness Division, Healthways 

Mary Naylor, PhD, RN

Professor in Gerontology, University of Pennsylvania School of Nursing
How do we care for patients that normally slip through the net.

Debbie James - HealthWays

Physical Activity improves health. Silver Sneakers Fitness Program. Better health at lower cost for seniors.

46% of participants in the program have never been into a fitness center.

Engagement - get them there... keep there.

Access and Variety are important factors. 

Need access (within 5 miles)

Create community - Social is important.

Customize programs for older adults. Make them comfortable and take away fear of the unknown.

Program leads to better health at lower costs.

23-37% lower cost for silver sneakers members.

9M Medicare Advantage and Medicare Supplement Program members have access to Silver Sneakers.

Ken Coburn - Health Quality Partners

Community-based care management.

Aim: improve health, independence and reduce suffering of chronically ill older adults.
 Focus on preventive services.

Person-centered model. A long haul relationship.

Run in parallel with Primary Care Providers.

200 Performance measures used internally.
35 Nurse interventions.

"A High contact sport"

9 year program..

Looking for technology partners to develop program further. 

Mary Naylor - U of Penn School of Nursing

The Transitional Care Model - A 20 year old model. 
Nurses as hub of a care giving model.

A huge opportunity in community-based organizations to get seniors back on their feet. 

We have know since 1999 that this program works Shame on US Health Care! Surely a lawyer is going to take a class action suit against the medical community.
.
Scale TCM across the system
Deploy TCM workforce
Improve and Sustain....

Data driven quality improvement.

Alan Hoops - CareMore

50% of members in special needs plans.

Address chronic diseases and conditions.

A platform that looks for system breakdowns and replace with something that works.

50% reduction in hospitalization amongst dialysis patients. Simply by placing case managers in the dialysis unit. Divert to appropriate care instead of defaulting to ER visits.

Chronic Care management
Episodic Care management 
Predictive modeling and intervention

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Jan 26 / 2:06pm

#CISummit Joe McCannon introduces the next round of Ignite Talks

by Mark Scrimshire

1:45-
2:00pm

Ignite Talks: Rapid Fire Innovation Pitches


Facilitated by Joe McCannon

Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS) 

Bob Masters

President and CEO, Commonwealth Care Alliance 

Jennifer DeCubellis

Area Director, Hennepin Health 

Tom X. Lee, MD

Chief Executive Officer, 1Life Healthcare and One Medical Group
Joe McCannon is based in the CMS Innovation Center and focuses on learning diffusion.

Bob Masters - Commonwealth Care Alliance

Based in MA.

Once in a generation opportunity to improve care for the most vulnerable - Dual Eligibles.

CCA focuses in MA on 3800 mostly home bound frail elders and 600 younger beneficiaries.

A lot of money spent but even more money saved.

How we care for the mentally ill is shameful.
75% are dual eligible. Average life expectancy is 53 years.

Implementing new Primary Care models. 

Jennifer DeCubellis - Hennepin Health

A social disparities approach to healthcare reform.

Patient Centered Care where care is Coordinated.
Add Pharmacists to care teams. Reduce medications and side effects and increasing time for Doctors. 

Mobile Crisis Home Visits. 24x7 crisis line. 
32% of population are in unstable housing. Providing services for the homeless.

Housing support helps place individuals - this reduces hospital stays. 

Interpreters help families navigate the system.
Vision care - don't overlook this. Imagine being able to read your prescriptions.

Dental Care has been attached to emergency departments - this reduces ER visits and prescription of pain medications.

Food Pantries help patients deal with upset stomachs that impact medicatin adherence.

This just shows that you have to treat the whole person and not the condition.

Tom Lee - 1Life HealthCare and One Medical Group

Guidelines as key to physician-patient decision making.

Evidence-based medicine is not enough.
Guidelines are too simplistic. They focus on one risk factor at a time.

We need to look at each individual and take into account all risk factors. 
Calculate risks of all outcomes.

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