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CareSpark: Working to improve health in the central Appalachian region through the collaborative use of health information
Presentation by Liesa Jenkins
Project Director
CareSpark
June 12, 2005

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Slide 1: CareSpark: Working to improve health in the central Appalachian region through the collaborative use of health information

 

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Slide 2: Tri-Cities TN / VA Regional Medical Service Area

Image: Map showing the Tri-Cities TN/VA Regional medical service area

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Slide 3: TN / VA Regional Health Problems

Image: National map showing the age-adjusted death rates by HSA, 1988-92

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Slide 4: TN / VA Regional Health Problems

Image:

1. Line graph showing all cancer mortality trends in the US in general and in the TN/VA Region

2. Line graph showing the diabetes mortality rates in the US in general and in the TN/VA Region

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Slide 5: Worst Health Status in U.S. : Drives Estimated $2,400 Cost PMPY

Image: Map showing the scores for the mental and physical health of veterans and non-veterans across the country, broken into regions.

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Slide 6: National Health Expenditures per Capita

Image:

1. Line graph showing the national health expenditures per capita.
Source: CMS

Caption:

1. Bedard [CEO Crown Laboratories] added that if he had known how unhealthy Johnson City was several years ago, he probably wouldn't have moved his company here."
Source: Johnson City Press

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Slide 7: Delivering Healthcare Value -The Whole Is Greater Than Any Part

Image:

1. A circle showing the different parts of healthcare: MD office, lab, ED, hospital, rehabilitation, pharmacy and home care.

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Slide 8: Delivering Healthcare Value -The Whole Is Greater Than Any Part

Image: Circle representing RHIO CareSpark within another circle representing zone of cooperation.

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Slide 9: What Is CareSpark?

CareSpark is a not for profit organization committed to better health in the central Appalachian region through collaboration, innovation, and wise use of health information.

  • 14 year history of health improvement projects
  • Regional leaders concluded major improvements require regional health information exchange (HIE)
  • 2 ½ years on current project; $600,000 raised in 9 mo
  • Formed as 501c3 not for profit organization
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Slide 10: Innovative Regional Cooperation To Improve Health

  • Active, representative membership, including
    • Eastman Chemical Company
    • Blue Cross Blue Shield, John Deere Health
    • Mountain States Health Alliance, Wellmont Health System, James H. Quillen VA, Medical Center, Johnston Memorial Hospital, Laughlin Memorial Hospital
    • Frontier Health
    • Holston Medical Group, Highlands Physicians, State of Franklin Healthcare Associates, Mountain Region Family Medicine, Clinch River Health Services
    • East TN State University and Medical School
    • Public health departments in TN and VA
    • Kingsport Tomorrow
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Slide 11: Strategic Planning Process

Image: A continuous improvement cycle continuum with core strategies followed by core tactics, strategic planning and implement.

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Slide 12: CareSpark

Mission: To improve the health of people in Northeast Tennessee and Southwest Virginia through the collaborative use of health information

Vision: To be a world-class, quality-driven, clinically integrated, efficient health and wellness system for the people of our region

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Slide 13: CareSpark

  • Values:
    • Regional Cooperation
    • Community Accountability
    • Privacy
    • Integrity
    • Continuous Improvement
    • Inclusiveness
    • Stakeholder Parity
  • Goals:
    • Improve clinical practice
    • Coordinate clinical care
    • Personalize care
    • Improve population health
    • Create an efficient health system
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Slide 14: Targeted health issues

We are targeting the health issues of greatest impact on quality of life and cost:

  1. Diabetes
  2. Hypertension / stroke
  3. Cardiovascular disease
  4. Lung disease / asthma
  5. Preventive immunizations / screenings
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Slide 15: Tactical plan

To address health issues, we propose to provide technical capability and encourage clinical process improvement in the following areas:

  1. Prescription Medication
  2. Diagnostic (lab, imaging) Services
  3. Preventive Medicine (immunizations / screenings)
  4. Chronic disease management
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Slide 16: Principles

  • Work for the good of the community
  • Enable clinicians to provide better outcomes
  • Assure cost-effective, coordinated care delivery
  • Provide necessary support through transition to an electronic health record system (EHR)
  • Engage all purchasers willing to cooperate
  • Engage all providers willing to cooperate (both large and small groups)
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Slide 17: Principles

  • Ensure ratio of investment and return is fair for all parties
  • Share savings through incentives for all participating stakeholders
  • Implement the full scope of project in a practical way
  • Sequence implementation by introducing new programs over time with coordination to insure functional and fiscal soundness
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Slide 18: CareSpark Facilitates Wise Use of Health Information

  • Provide health information on demand at the point of service
  • Encourage use of evidence-based guidelines defined by community consensus
  • Provide selected aggregate data for regional improvements
  • Enable individuals access to personal health information through a secure internet interface
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Slide 19: Health Information Exchange

Image: Showing the pathway of health information being exchanged between providers, hospitals, public health officials and other health organizations.

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Slide 20: Projected Tri-City TN-VA Health Expenditures

Image: Bar graph showing the projected Tri-City TN-VA Health Expenditures

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Slide 21: Regional Economic Impact

Image: Bar graph showing the financial impact of the CareSpark program on the TN-VA region.

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Slide 22: Medication and Diagnostic Services Improvement Savings Model Projections

Image: Bar graph showing the projected medication and diagnostic services improvement savings

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Slide 23: Opportunity: Programs Covered In This Model

  • Medication Improvement
    • 1st of several "layers"
    • 3-year cost: $12.6 M
    • Technology required
    • Web-based electronic health record with e-prescribing capabilities
    • Health Information Exchange not required
  • Diagnostic Services Improvement
    • 2nd of several "layers"
    • Small incremental cost: $2.7M
    • Technology
      • Physician Order Entry Module required
      • Health Information Exchange required
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Slide 24: Cost-Benefit Projections

Image:

1. Bar graph showing cost-benefit projections for 2005, 2006 and 2007

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Slide 25: Possible Investment and Reward Scenarios

  • There are multiple "investors" who can invest different resources in different proportions
  • "Investors" may invest effort, risk, and expense
  • Rewards should be shared equitably and proportionately
Scenario Purchasers/
Insurers
Physicians/
Health Systems
Others
A 67% 33%  
B 33% 67%  
C 50% 50%  
D 33% 33% 33%

 

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Slide 26: 3 Year Incentive Scenario Summary

Image: Table showing four scenarios for a three year incentive

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Slide 27: Progress to Date

  • Technical inventory and feasibility study completed
  • Strategic business plan developed
  • Non-profit organization formed, board of directors in place
  • Funding commitments of $75,000 (April 2005)
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Slide 28: Next Steps

  • Finalize partnership agreements (May - July 2005)
  • Secure $3M in funding for development and execution through June 2006
    ($600K by July 1, 2005; $2.4M by Sept 1, 2005)
  • Secure staffing for development and operations
    (Executive Director, administrative assistant, project manager) by May 15, 2005
  • Define technical specifications, conduct vendor selection process (July - Aug 2005)
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Slide 29: The Decade of Health Information Technology

Office of the National Coordinator for
Health Information Technology (ONCHIT)

http://www.hhs.gov/healthit/

  • Appointed as the first National Health Information Technology Coordinator on May 6, 2004
  • To execute the actions ordered by President George W. Bush in the Executive Order that he issued on April 27, 2004
  • Widespread deployment of health information technology within 10 years to help realize substantial improvements in safety and efficiency
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Slide 30: ONCHIT: Framework for Strategic Action

Four overarching goals
http://www.hhs.gov/healthit/frameworkchapters.html

Goal I: "Inform Clinical Practice." This goal centers around efforts to bring electronic health records directly into clinical practice. These tools will reduce medical errors and duplicative work, and enable clinicians to focus their efforts more directly on improved patient care.
Goal II: "Interconnect Clinicians." Interconnecting clinicians will allow information to be portable and to move with consumers from one point of care to another.
Goal III: "Personalize Care." To personalize consumer health care decision making, using Personal Health Records (PHRs) will be encouraged, providing for better information to assist with consumer choices will be promoted, and increasing the use of telehealth systems will all be strategies to personalize care.
Goal IV: "Improve Population Health." Population health improvement requires the collection of anonymous, timely and standardized clinical information that can support reporting for public health monitoring, bioweapon surveillance, post-market adverse event tracking and quality benchmarking.

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Slide 31: RHIO Characteristics

Criteria for a RHIO (Regional Health Information Organization)

  • Multi-stakeholder, trusted entity
  • "Harmonization of federal / state / local laws governing privacy, security
  • Ability to assure security, policies to enforce compliance among participants
  • Alignment of financial incentives
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Slide 32: Tennessee initiatives

  • Volunteer E-Health Initiative (Vanderbilt / Memphis)
    $5M federal, $5M state funding, $5M inkind hospital-based medications for TennCare
  • Shared Health (BlueCross BlueShield of TN)
    proposed central warehouse for all TennCare records
  • etHIN (Knoxville)
    Four hospitals sharing digital images through network
  • Initial meeting in Chattanooga
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Slide 33: Virginia initiatives

  • HIT Task Force appointed by Gov. Warner
  • Carillion pilot linking hospital / MD / public health
    $40K state funding for public health link
  • Pilot linking hospitals in Richmond
    $40K state funding
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Slide 34: Potential Policy Change

  • Standards for technology (open-source)
  • Clinical standards (evidence-based protocols)
  • Privacy (patient "opt-in" vs. opt-out)
  • Financial incentives for providers ("pay for use", "pay for performance", technology subsidies, RHIO funding)
  • Governance (RHIO structure)
  • Liability (among those sharing data)
  • Role of federal /state / local entities
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Slide 35: Get Involved!

For more information or to help

Visit our website at www.carespark.com

Contact Liesa Jenkins, project director
423-246-2017
ljenkins@carespark.com

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Slide 36: CareSpark

Image: Picture of the Appalachian mountains.

Caption: Together we can make a difference in the health of central Appalachia!