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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
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Mission CollegeAugust 2, 2012
The 2010 ACA and its Expected Impact on HIT and Jobs
Cloud Computing in Healthcare
Deborah Kohn, MPH, RHIA, FACHE, CPHIMSPrincipal
Dak Systems Consultingwww.daksystemsconsulting.com
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The 2010 ACA and its Expected Impact on HIT and Jobs
© 2012 Dak Systems Consulting
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
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, ….
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
2010 PPACA ActExpected HIT Impact
Accountable Care Organizations (ACOs) Need their IT systems to:
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
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© 2012 Dak Systems Consulting
2010 PPACA ActExpected HIT Impact
Accountable Care Organizations (ACOs) Need their IT systems to:
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
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© 2012 Dak Systems Consulting
2010 PPACA ActExpected HIT Impact
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
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© 2012 Dak Systems Consulting
2010 PPACA ActExpected HIT Impact
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
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© 2012 Dak Systems Consulting
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
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Cloud Computing in Healthcare
© 2012 Dak Systems Consulting
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
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)
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© 2012 Dak Systems Consulting
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.
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© 2012 Dak Systems Consulting
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
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© 2012 Dak Systems Consulting
CLOUD COMPUTINGIn Healthcare
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!
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© 2012 Dak Systems Consulting
CLOUD COMPUTINGIn Healthcare
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
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© 2012 Dak Systems Consulting
CLOUD COMPUTINGIn Healthcare
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)
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© 2012 Dak Systems Consulting
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?
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© 2012 Dak Systems Consulting
CLOUD COMPUTINGIn Healthcare
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.
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DISCUSSION
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Mission CollegeAugust 2, 2012
How Students Can Establish Contacts In Their New Profession: Networking, Volunteering, and Internships in Healthcare
Benefits of ACHE Membership To Students / Grads
Jason LeeECG Management Consultants, Inc.
www.ecgmc.com
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How Students Can Establish Contacts In Their New Profession:
Networking, Volunteering, and Internships in Healthcare
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Benefits of ACHE Membership To Students / Grads
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DISCUSSION