Policy Roundtable Abstracts - AcademyHealth

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even more successful in reducing readmissions than many of the delivery system programs initiated to date. Amy E. Boutwell, Director of Health Policy Strategy, Institute for Healthcare Improvement. Dr. Boutwell will describe the STAAR (STate Action on Avoidable Rehospitalizations) initiative, a Commonwealth Fund supported project of the Institute for Healthcare Improvement. The aim of the STAAR initiative is to reduce rehospitalizations, and identifies the state as the unit of intervention. Dr. Boutwell will discuss the two-part, parallel strategy of the STAAR initiative: to support front-line process improvements in transitions of care and to leverage state-level multi-stakeholder leadership engagement to accelerate improvement at a regional level. STAAR provides technical assistance and strategic guidance to state-level steering committees which are tackling state-wide measurement issues, optimizing provider engagement in complementary payer-based initiatives, and initiating community-specific efforts to address pressing social challenges which contribute to hospital utilization. In addition, Dr Boutwell will discuss a unique element of the STAAR initiative: the cross-continuum team. Partnering hospital teams with community-based providers and non-clinical support services has been one of the most readily adopted recommendations in the program. Working as a cross-continuum team in a voluntary quality improvement initiative create a foundation for organizations in communities to take the “first steps” in the transitional phase between today’s practice and payment realities and the proposed models of a future state. Jane Brock, Medical Officer, Colorado Foundation for Medical Care and Clinical Lead, Transitions of Care Program Sub-national Theme. Dr Brock will describe the results and lessons to date resulting from the CMS QIO sub-national theme on Transitions of Care, a three-year project to improve care transitions and reduce rehospitalizations among Medicare beneficiaries in 14 geographically-defined communities throughout the US, covering approximately 1.25 million beneficiaries. The Care Transitions Project is unique in adopting a geographically defined patient population as the unit of interest. Dr Brock will describe the common and unique models of care that are being implemented in the 14 communities, and what the project is learning about successful strategies. In some cases, the most successful strategy to improve care transitions in a community was “providing a box of doughnuts and a pot of coffee!” Dr. Brock will share the midterm results of the project, including Medicare utilization savings as a result of averted hospitalizations of $100 million. Key measurement issues will be described, including the rationale behind abandoning the original measure was % of all discharges that were readmitted in favor of a readmission incidence measure. Implementation and sustainability issues from the field will be described. John Young, Senior Advisor to the Acting Director, Center for Medicare & Medicaid Innovation (CMMI), Office of the Administrator (OA), Center for Medicare & Medicaid Services (CMS). Mr Young is responsible for advising the Center for Medicare & Medicaid Innovation (CMMI) acting director on creating national coherency across the identification, evaluation, and diffusion of care redesign and bundled payment approaches through Accountable Care Organizations (ACO) and Medical Homes for Medicare and Medicaid beneficiaries. Mr Young will describe bundled payment approaches as conceptualized by CMS, and will relate the findings of Dr Epstein’s research and Drs Boutwell and Brocks’ implementation experiences to the system redesign goals intended by payment policy reforms. Constitutional Challenges to Health Care Reform Organizer/Moderator: Mark Hall Monday, June 13 * 4:45 p.m.–6:15 p.m. Panelists: Ken Wing, University of Washington; Timothy Stoltzfus Jost, J.D., Washington and Lee University; Mark Hall, J.D., Wake Forest University Roundtable Summary: Lawsuits challenging the constitutionality of the Affordable Care Act (ACA) threaten to overturn health insurance reform. Almost half the states have filed suit, in addition to a dozen or more suits by private individuals, provider groups, or public interest organizations. To date, two federal judges have upheld the ACA, one has struck down the individual mandate, and another has expressed considerable skepticism about the mandate’s constitutional validity. These, and other decisions that will likely be issued by the time of the conference, will be appealed to various circuit courts of appeal, and eventually to the Supreme Court. If some or all of the Affordable Care Act is declared unconstitutional, this obviously will have seismic impact on health policy. If the individual mandate, which is the main target, is stricken in isolation, the remaining insurance regulations could wreak market havoc, due to adverse selection. For that and other reasons, finding this major provision unconstitutional might sink much or all of the law, if a court were to invalidate all related provisions. Moreover, states challenge the constitutionality of requirements to expand Medicaid and to implement insurance exchanges. Also critical is to understand how long it will take courts to resolve these issues. Although the ACA’s major provisions do not take effect until 2014, litigation often takes several years, and looming uncertainty could be very disruptive to state and federal implementation efforts, and to anticipatory measures by market participants. This roundtable panel will explain the major components of this litigation, the likely procedural stages and timing, and the bases on which courts can be expected to rule. This will provide the audience a more informed foundation from which to interpret and anticipate unfolding legal events and their policy impacts. The presenters and their topics will be:
Timothy Jost, J.D., Washington and Lee University, will provide an overview of the various suits, their basic claims, and their likely progress through the courts. Mark A. Hall, J.D., Wake Forest University, will address the Commerce Clause challenges to the individual mandate, and the market consequences if the mandate is declared invalid. Ken Wing, J.D., Seattle Univ. and Univ. of Washington, emeritus, will address the political implications of these challenges, as well as constitutional arguments regarding individual rights. Also invited will be the Washington State Attorney General or a representative from his office, which is one of the suing states, to discuss claims that the ACA violates states’ sovereign rights. Implementing Electronic Health Records Organizer/Moderator: Melinda Beeuwkes Buntin Tuesday, June 14 * 8:00 a.m.–9:30 a.m. Panelists: Peggy Evans, Ph.D, Washington & Idaho Regional Extension Center for Health Information Technology; Eric Jamoom, National Center for Health Statistics; Vaishali Patel, Office of the National Coordinator for Health Information Technology; Mary Rubino, Health Affairs Roundtable Summary: By June 2011, thousands of providers will have received Medicare or Medicaid incentive payments for the “meaningful use” of electronic health records (EHRs). Many more will still be deciding whether or not to purchase an EHR or working to implement and use their EHR. In order to realize the goal of a health care system powered by information technology set out in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, providers will need information and assistance in choosing, implementing, and fully using an EHR. Only when a critical mass of providers have successfully implemented EHRs can the vision of a health care system in which data follows patients and seamlessly informs clinical decision-making be realized. Participants in this Policy Roundtable will discuss the latest data on EHR adoption, including success stories and areas that require policy attention, policies and strategies to boost EHR adoption and improve implementation, real-world examples of EHR implementations, and gaps in our understanding of the challenges of EHR implementation, from the viewpoint of multiple stakeholders. Vaishali Patel PhD, senior researcher at ONC, will provide an overview of what is known about the current status of electronic health records adoption. She will highlight areas of success, including the recent jump in adoption among primary care physicians, and groups which are lagging such as rural and critical access hospitals. Her comments will draw on the latest data from national surveys of physicians and hospitals and from new data available to ONC on electronic prescribing patterns. Dr. Patel has published extensively on consumer attitudes towards electronic health records and health information exchange and will also comment on how these factors affect the climate for adoption. David Blumenthal MD MPP, the National Coordinator for HIT, will provide an overview of federal strategies to promote the meaningful use of electronic health records. These include both the Medicare and Medicaid incentive programs and ONC’s own grant programs. ONC’s Regional Extension Center Program offers providers hands-on technical assistance, guidance and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records (EHRs). The extension centers are focusing efforts on primary care providers in smaller and safety-net practices and on critical access hospitals. The Beacon Community Grantees aim to demonstrate the vision of a future where hospitals, clinicians, and patients are meaningful users of health IT, and together the community achieves measurable improvements in health care quality, safety, efficiency, and population health. State Health Information Exchange Cooperative Agreement Program supports States or State Designated Entities (SDEs) in establishing health information exchange capability among healthcare providers and hospitals in their jurisdictions. ONC also supports a comprehensive workforce program including a Community College Consortia to educate Health Information Technology professionals, university-based training, curriculum development, and competency testing. Dr. Blumenthal will discuss the principles that guided the development of the meaningful use criteria and ONC’s constellation of grant programs. He will also report on the progress made by grantees and the challenges they are facing. Peggy Evans, PhD, CPHIT, Director of the Washington & Idaho Regional Extension Center (WIREC) for Health Information Technology, will provide insights from her perspective on the ground assisting providers in the northwest with successfully adopting electronic health records (EHRs) and reaching meaningful use. Dr. Evans will describe the strategies being used by WIREC to provide education, outreach, and direct assistance. Dr. Evans has testified before the House Energy and Commerce Committee on the implementation and use of EHRs and is an executive with Qualis Health, a private, not-for-profit healthcare consulting and quality improvement organization based in Washington State. Eric Jamoom PhD, a fellow at the National Center for Health Statistics will discuss the new national physician survey related to EHR implementation that will be entering the field in summer 2011. The new Physician Workflow Study represents a data collection initiative by ONC and NCHS to better understand physician experiences with EHR adoption and use. The study will follow 3 cohorts of physicians from the 2011 EMR Mail Supplement to the National Ambulatory Medical Care Survey (NAMCS) at various levels of EHR adoption over a 3 year period from 2011 to 2013. The main purpose of the study is to obtain information related to the costs, benefits, and barriers related to the use of electronic health records at various stages of adoption. This information will help ONC target and refine the strategies of its grantees, understand and communicate the
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Policy Roundtable Abstracts - AcademyHealth

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