HEALTH CARE CONSUMERISM
AND HIT
Kenneth W. Kizer, MD, MPH
April 10, 2013
Presentation Preview
 Introduce the Institute for Population Health
Improvement
 Highlight selected recent advances in HIE in
California
 Provide a context and construct for how to
think about health care consumerism and HIT
WHAT IS THE INSTITUTE FOR POPULATION
HEALTH IMPROVEMENT?
Institute for Population Health Improvement
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Established as an independent operating unit in the UC Davis Health
System in mid-2011; has since developed a diverse portfolio of funded
activities >$70M
Population health – the intersection of public health and the clinical
sciences
New value-based health care payment models require that population
health management be a core competency for health care systems
Serves as a resource for:
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Health care reform
Clinical quality improvement
Building health leadership capacity
Developing clinical intelligence
Health policy
Assists government health-related agencies design, implement and
administer programs
Promotes understanding of the multiple determinants of health and
appreciation of health being a function of the totality of one’s
circumstances
SELECTED IPHI ACTIVITIES
 Provide technical assistance in quality improvement and other support to the
state Department of Health Care Services for Medi-Cal (California’s $60B/yr
Medicaid program)
 Medi-Cal Quality Improvement Program
 Evaluate the Delivery System Reform Incentive Payments (DSRIP) Program
 Design the CA-specific Evaluation of the California Medicare-Medicaid Dual Eligible
Demonstration Program
 Manage operations of the California Cancer Registry
 Manage the California Health eQuality (CHeQ) Program - California’s Health
Information Exchange Development Program
 Provide technical assistance and support for multiple statewide chronic disease
prevention and surveillance programs
 Conduct a statewide assessment of surgical adverse events
 Conducting various population health research programs
 Use of the OncotypeDx Genetic Assay in Medi-Cal Beneficiaries with Breast Cancer
 Evaluation of Opiate Overdose Prevention Policies (in collaboration with CHPR)
 Investigate the feasibility of developing Community Paramedicine
 Partnering with California Health & Human Services Agency on a CMMI-funded
Payment Reform Model for the California
SOME RECENT ADVANCES IN HEALTH
INFORMATION EXCHANGE IN CALIFORNIA
California Health eQuality (CHeQ) Program
 CHeQ was established in September 2012 to implement
California’s Health Information Exchange (HIE) programs, in
consultation with the California Health and Human Services
Agency (CHHS) under the state’s Cooperative Grant Agreement
with the ONC
 CHeQ administers programs outlined in the California HIE
Strategic and Operational Plan in support of ONC Program
Information Notice (PIN) priorities and the CHHS interagency
agreement.
 CHeQ seeks to improve health outcomes and coordinate care
by mobilizing information needed for health-related decision
making through HIE regional and enterprise
State HIE - Key Roles
CHHS
Recipient of the ONC funds for the Statewide
HIE Cooperative Agreement program
CalOHII Leading the formulation of statewide HIE
policy
IPHI
Implementing the statewide HIE strategy
HIOs
Implementing HIE at regional and enterprise
level
CHeQ Goals
 Improve health outcomes and integration of care by
mobilizing information needed for health-related
decision making
 Demonstrate measurable impact within the ARRA
funding period while laying a foundation for future
growth and sustainability
 Create a trusted environment for clinicians to
exchange information supporting local autonomy
 Integrate HIE into other similarly aimed programs or
initiatives
Trusted Exchange
Infrastructure
$1 million
Integrating Clinical Care
with Public Health
Increasing
Public Health
Capacity
$1.8 million
$0.7 million
California
Health eQuality
$16.6 million
Accelerating HIE
Adoption
Federal HIE Funds
Monitoring HIE
Adoption
$4 million
$0.9 million
Communications
and Education
$0.6 million
Personnel
$4.1 million
Operations
$1 million
Indirects
$2.5 million
Statewide HIE Strategy Includes
 Supporting and expanding exchange in regional and
enterprise initiatives (HIE Acceleration)
 Promoting uniform standards and reducing the cost of
interoperability (HIE Ready)
 Enabling inter-organizational and interstate exchange
(Creating a Trust Environment)
 Supporting public health reporting and population
health improvement (Expanding Public Health Capacity)
 Minimizing centralized infrastructure
X VA
10 Apr 2013
12
Infrastructure and
Interface Awards
$1.7 million
Lab Data
Standardization
Program
$275,000
HIE
Acceleration
$4 million
Proposed
“Blue Button”
Demonstration
$1.1 million
Data Analytics
Awards
$550,000
10 Apr 2013
Rural HIE Incentive
Program
$350,000
13
HIE Acceleration Grants
 Planning awards for emerging community HIOs
(complete)
 Expansion and infrastructure awards for operational
community HIOs ready to expand their services
 Interface awards for community and enterprise HIOs to
increase their reach and lab interface assistance
 Rural program to address underserved regions,
populations
 Analytics program to provide higher-value services
 Blue Button initiative for Medi-Cal recipients
http://www.ucdmc.ucdavis.edu/iphi/Programs/cheq/cheqfunding.html
Rural HIE Incentive Grants
 Selected five designated rural HIE service providers.
 Providing services that include…
 Directed exchange, some including use of Direct standards
 Longitudinal community records, based on query-based
exchange, some including use of eHealth Exchange
 Portals and other means of engaging patients
 Subsidizing initial implementations during 2013
http://www.ucdmc.ucdavis.edu/iphi/Programs/cheq/cheqfunding.html
Rural HIE Incentive Grant Awardees
 Directed Exchange Services
Informatics Corporation of America (ICA)
Redwood Mednet
 Directed Exchange and Longitudinal Community Record
Services
Axesson
Inland Empire Health Information Exchange
Orange County Partnership Regional Health Information
Organization (OCPRHIO
http://www.ucdmc.ucdavis.edu/iphi/Programs/cheq/cheqfunding.html
HIE Acceleration Grants
 Analytics Program
 Provides resources for HIOs and provider organizations to implement data analytics across
unaffiliated provider systems to aid management of shared patient populations and provides
tools for population health management
 Incentivizes organizations to incorporate data analytics into existing modes of exchange and
to create a platform for data analytics that can be expanded to others
 Awards went to Inland Empire Health Information Exchange and Tahoe Forest Hospital
District
 Lab Data Standards
 Technical assistance to labs for mapping results to LOINC as required for Stage 2 Meaningful
Use
 Shared LOINC mappings and tools to train other labs to maintain mappings
 Blue Button
 Based on the Automated Blue Button Initiative (ABBI), extended to Medi-Cal managed care
 Partner with 1 to 2 Medi-Cal managed care plans to implement Blue Button for enrollees
• Provides patient access to health information from plan(s)
• Produces repeatable model for Medi-Cal managed care plans
WHAT’S THE HEALTH CARE PROBLEM?
Key Drivers of Health Care Reform
1. Unsustainable health care cost increases
2. Performance deficiencies
3. Health care purchasers/payers unsatisfied and
demanding change
4. Consumers have changing tastes and want a
different product
5. Population health is stagnating/deteriorating
Affordable Care Act: Are We There Yet?
20
HEALTH CARE OPERATES LIKE A COMPLEX
ADAPTIVE SYSTEM
Characteristics of Complex Adaptive Systems
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Nonlinear and dynamic; do not inherently reach fixed
equilibrium points
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Composed of independent agents whose needs and
desires are not homogeneous; their goals and
behaviors may conflict
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Agents are intelligent and learn. System behavior
changes over time
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No single point of control; no one is “in charge”
In complex systems, change cannot be
specified and controlled to the same degree
as in more linear processes such as most
manufacturing; instead, small changes in
critical elements of the system (change levers)
must be leveraged to produce systemic
change.
Health Care’s Key Change Levers
1. Financing/payment
2. Performance measurement (and public
reporting)
3. Health information technology
4. Consumerism, patient engagement
5. Regulation/regulatory relief
CHANGE LEVERS MUST BE ALIGNED AND
MUTUALLY REINFORCING.
IS INFORMATION TECHNOLOGY
EMPOWERING HEALTH CARE
CONSUMERS TO CHANGE HEALTH CARE
THE WAY THAT IT HAS EMPOWERED
CONSUMERS IN OTHER ENTERPRISES?
OVERALL, THE RESULTS TO DATE HAVE
NOT BEEN DRAMATIC
What is Health Care Consumerism?
 Patient centeredness
 Patient empowerment
 Patient engagement
 Patient autonomy
BUT WHAT DO TERMS THESE REALLY MEAN?
Health Care Consumerism – “The 5 C’s”
 Choice (Control)
 Convenience
 Collaboration (Connected)
 Comfort
 Cost
HOW CAN HIT TRULY EMPOWER HEALTH CARE
CONSUMERS SO THAT THEY ARE AT THE CENTER
OF THE HEALTH CARE UNIVERSE?
Empowering Health Care Consumers
Through Information Technology
 By providing data that is
 Actionable (Granular)
 Meaningful
 Reliable
 By addressing 2 or more of the 5 C’s
 By aligning with and reinforcing the other key
drivers for health care change
THANK YOU