THE
COMMONWEALTH
FUND
Wither or Bloom? Moving from Successful Pilots on
Reducing
g Avoidable Rehospitalizations
p
to National
Transformation: A Roundtable Discussion
Academy Health Annual Research Meeting
June 2010,
2010 Boston
THE
COMMONWEALTH
FUND
2
Panelists
Anne Marie J.
Anne-Marie
J Audet,
Audet M
M.D.,
D
MSc.,SM.Vice President,
Health System Improvement
and Efficiency; The
Commonwealth Fund
Randall Krakauer, MD, FACP,
FACR
National Medical Director,
C
Consumer
S
Segmentt
Aetna
Amy Boutwell, M.D., M.P.P.,
Director of Strategic
Improvement Policy,
The Institute for Healthcare
Improvement
Jane Brock, M.D., M.S.P.H.,
Clinical Coordinator, Medicare
Quality
y Improvement
p
Program, Colorado
Foundation for Medical Care
Joe McCannon,
Vice President and Campaign
Manager, The Institute for
Healthcare Improvement
Context
•
The US healthcare system is poised to undergo significant transformation in
the next decade
decade.
•
Momentum is growing towards a number of national priorities: creating
accountable care networks, strengthening primary care through the medical
home building the national health information technology infrastructure.
home,
infrastructure
•
Given the magnitude of the problem, avoidable rehospitalizations (avr) have
also emerged as a priority of national scope.
•
In 2009, the Obama Administration, MedPAC, and Congress identified avrs as a
significant source poor quality and of costly waste.
•
A growing number of provider-level, community, regional, state and national
efforts are now specifically focused on reducing avrs.
•
The evidence base re
re. effective interventions is improving
improving. The challenge is no
longer so much what to do, but getting the will and organizing to act.
•
It is a question of execution, diffusion and scalability.
3
Goals
•
Engage in rigorous conversation about how to design a national
strategy to achieve rapid and sustainable system transformation
transformation, with
a focus on reducing avoidable rehospitalizations (avrs).
•
At the end of the discussion, participants should have achieved the
following:
– A Checklist to start thinking about all the levers available to reduce
rehospitalizations
– Learned about new approaches to issues that are commonly
encountered
– Learned approaches to working beyond organizations’ 4 walls –
g
in the community
y
across organizations,
– Identified colleagues to engage in further networking
4
Framing
g the Issue
•
Growing literature of evidence-based practices proven effective in
controlled environments and trials
•
Major challenge is spread - scalable, broad and rapid
•
Seventeen years for evidence to be adopted (25 year lag for B blockers)
•
National multi-level and multi-lever strategy to enable system
transformation and impact
•
Gawande: Some problems cannot be solved, they need to be managed
5
Drivers of Spread and
Sustainability
•
Comprehensive set of change levers (intrinsic/extrinsic motivations;
rewards/penalties)
d /
lti ) will
ill have
h
to
t be
b applied
li d together
t
th to
t achieve
hi
any progress
–
–
–
–
–
•
Levers appropriate to each level of the health care system
–
–
–
–
•
Transparency
Payment
Recognition
Professionalism
Public engagement
Local
Regional
State
National
Example: payment strategies are necessary but financial incentives sufficient for
effective and durable change might cause unintended responses. Leadership at the
national, state and regional levels is equally important, and require new forms of
accountability between groups that have functioned independently
independently. Theories and
models of spread will be needed to achieve diffusion of innovation at a rapid pace.
6
Topics of Discussion
1. Why a focus of execution, diffusion and scalability is timely and
essential?
2 Community Perspective: what are the levers for improvement based on
2.
the concept that “all healthcare is local”.
3. Payer Perspective: what are the levers (such as financial incentives
and payment reform, and care management models) being used by a
large private payer to foster care redesign and how would this
approach lead to nationwide impact?
4. State Perspective: what are state roles to accelerate and ensure
sustainable success in system redesign to reduce avrs.
5. Models of Spread: how can all the various stakeholders effectively
align their activities towards successful national impact?
7