agenda mission college august 2, 2012 the 2010 aca and its expected impact on hit and jobs cloud...

AGENDAMission CollegeAugust 2, 2012

The 2010 ACA and its Expected Impact on HIT and Jobs

Cloud Computing in Healthcare

How Students Can Establish Contacts In Their New Profession: Networking, Volunteering, and Internships in Healthcare

Benefits of ACHE Membership To Students / Grads

Mission CollegeAugust 2, 2012



Deborah Kohn, MPH, RHIA, FACHE, CPHIMSPrincipal

Dak Systems Consultingwww.daksystemsconsulting.com


2010 PATIENT PROTECTION and AFFORDABLE CARE ACT

with the Health Care and Education Reconciliation Act

aka HEALTHCARE REFORM ACTcovering ~30M more Americans

Key Components

PROVIDERS PAYERS PATIENTS


2010 PPACA (Healthcare Reform) Act

PPACA EFFECTIVE DATE: March 23, 2010

CMS PAYMENT REDUCTIONS 2010 INITIATIVES TO IMPROVE VALUE/ QUALITY 2012 PENALTIES – HIGH HOSPITAL READMISSION RATES 2013 MEDICAID: 2014

─ Coverage Expansion─ State Health Insurance Exchanges─ Payment Advisory Commission─ Disproportionate-share Payment Cuts

PENALTIES – HOSPITAL-ACQUIRED INFECTIONS 2015

SUPREME COURT UPHOLDS PPACA: June 28, 2012


2010 PPACA Actcreated the

Medicare Shared Saving Program

Accountable Care Organizations (ACOs) The MSSP allowed:

CMS to create ACO contracts by which the ACOs, through primary care, would accept responsibility for a set of Medicare patients (min 5,000 beneficiaries

enrolled in Parts A, B, D) with a mission to improve quality of care and lower costs

ACOs to receive a portion of the costs saved by their creation – an incentive for participation

Today, over 150 Medicare ACOs have been created and the number is growing


2010 PPACA Act

Accountable Care Organizations (ACOs)

SPONSORS – Not just Medicare Public - Medicare, Medicaid (MediCal)

Private - Not-for-Profit, For-Profit; Medical Groups, Acute Care Hospitals, Commercial Insurers


2010 PPACA Act

Accountable Care Organizations (ACOs) Consist of multiple, separate healthcare entities

Physician offices / Medical groups Acute care hospitals Home care agencies Patient-centered medical homes Payers

Emphasis and impact on chronic disease management

Use of an EHR is not a requirement! However, ….


2010 PPACA Act

Accountable Care Organizations (ACOs) Care must be coordinated

Financial risks and incentives must be better understood and managed

Individual patients must be engaged

Data integration must be simplified across the extended enterprise


2010 PPACA ActExpected HIT Impact

Accountable Care Organizations (ACOs) Need their IT systems to:

Identify patient populations in need of intervention in order to report on quality measures

Collect multiple streams of information, including claims, clinical records and health information exchanges

Allow bidirectional data exchange among the organization, providers and patients




Collect and report standardized, reliable health plan and provider performance data

Comply with HIPAA; support patient consent, provide de-identified data for clinical and business functions

Include value-based outcome analysis Provide point-of-care, evidence-based

guidelines and comparative research




Enable analysis across payers and populations to establish a benchmark and targets for quality-measure expenditures

Allow distribution and tracking of payments Manage episodes of care, not single events



Accountable Care Organizations (ACOs)In other, HIT words, there must be: Data / Information Governance Data / Information Exchange Management of the authentication and authorization of a

diverse population of legitimate users Interoperability of information systems in multiple settings A single source of truth for vocabularies Predictive modeling / analytics Personal Health Records Remote monitoring devices



Data Rich, Analytics Poor: Predicting and Avoiding Preventable 30-Day Re-hospitalizations (Elsevier / MEDai White Paper 2012)

As a result of the upcoming October 1, 2012 CMS Readmission Reduction mandate, hospitals across the country are paying increased attention to readmissions, especially preventable 30-day readmissions.

Q – How can a hospital systematically identify “at-risk” inpatients during an initial hospitalization, a requirement that alters and impacts a patient¹s post-discharge risk of readmission?

A – Predictive Analytics


CMS’ payment contractors to conduct medical reviews of claims BEFORE paying them; includes fraud provisions

Administrative Simplification: Between 2013 – 2016, a Single Set of Operating Rules for New and Existing HIPAA EDI Transaction Codes; Standardization for determining and updating Eligibility, Enrollment Benefits, and Claims Status

ICD Coordination & Maintenance Committee (ICD-9-CM) convened on September 15, 2010 and clarified that the “crosswalks” mentioned in ACA refer to the GEMs posted on the CMS and CDC websites

Online State Health Insurance Exchange Enrollment

2010 PPACA ActOther HIT Impacts


National Institute of Standards and Technology’s (NIST) official definition:

A model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction.

CLOUD COMPUTING


CLOUD COMPUTING

In other words, somebody, somewhere, is running a data center, whereby a customer 1) is paying them to run it instead of the customer running it themselves, and 2) is hoping the economy of scale they enjoy offsets the profits they demand.

Hosted, Shared System(s) Application Service Provider (ASP) Software-as-a-Service (SaaS) Cloud Computing


CLOUD COMPUTING

DEPLOYMENT MODELS Private (Healthcare facility; either inside the

organization’s firewall or a private space dedicated to the organization within a cloud-based service provider’s data center)

Public (Amazon.com; resources provided on demand over the Internet - streaming a movie, downloading an app to one’s smart phone)

Hybrid (Where public cloud services have been integrated with private delivery)


CLOUD COMPUTING

TRANSFORMATION

Web 1.0 (WWW) was built as an Internet protocol

Web 2.0 is being built in the CloudMost of the new, innovative applications and systems are being developed in the cloud.


CLOUD COMPUTINGIn Healthcare

Cost : No upfront capital costs and fewer overhead expenses; billed like a utility

Access: Immediate, anytime from anywhere using a Web-based client or Web browser

Elasticity: Storing patient data to mitigate capacity limitations

Business Continuity and Back-up

Information Privacy & Security: Is there a plan if there is a security breach? Who really owns the data being stored? Exactly where are the data being stored? How to comply with the myriad federal and state laws governing PHI?

Reliance on the Internet: Can never tell if and when Internet performance will be slow or disrupted



Information Privacy & Security HIPAA does not specify whether a

healthcare provider using a cloud-based EHR system owns the data or the cloud-based service provider owns the data!

HIPAA does specify that the database must be logically separated from the web server, requiring any type of provider to maintain at least two servers. This is not inexpensive!



Today’s Forecast: Partly Cloudy Only about 5% of overall cloud spending

come from the healthcare industry; i.e., healthcare won’t be leading the charge (Modern Healthcare July 2012)

Public Cloud – For small healthcare companies and provider organizations

Private Cloud – For all other healthcare organizations due to unique security and integration considerations



Tomorrow’s Forecast: Unavoidable future for the healthcare

industry Providers are wonderful diagnosticians but

poor server administrators “… the inevitable conversion of most

computing FROM mainframe – client/server – local network technologies TO the next generation of off-site, remotely hosted and managed services” (Modern Healthcare August 2009)


CLOUD COMPUTINGIn Healthcare?

Friday Night, June 29, 2012: Amazon.com Cloud Goes Down Taking Netflix, Instagram, and Pinterest With It!

How does a cloud-based service provider integrate disparate and / or silo’ed information systems?



Microsoft will be signing BAAs with its partners for its cloud offering and shouldering some of its cloud’s cost burden of ensuring HIPAA’s and HITECH’s Privacy & Security provisions.

This will lower some of the expensive MS hosting costs for meeting the HIPAA security regulations that require separating databases from web servers.

DISCUSSION

Mission CollegeAugust 2, 2012

How Students Can Establish Contacts In Their New Profession: Networking, Volunteering, and Internships in Healthcare


Jason LeeECG Management Consultants, Inc.

www.ecgmc.com

How Students Can Establish Contacts In Their New Profession:

Networking, Volunteering, and Internships in Healthcare

DISCUSSION

agenda mission college august 2, 2012 the 2010 aca and its expected impact on hit and jobs cloud...

Documents

dak systems consulting

health care

affordable care act

quality of care

primary care

medicare acos

expected impact

extended enterprise