EMSAAC Health Care Reform and Its Impact on

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EMSAAC Health Care Reform and Its Impact on EMS: Volume to Value, Improving Population

EMSAAC Health Care Reform and Its Impact on EMS: Volume to Value, Improving Population Health and Other Paradigm Shifts

EMSAAC

EMSAAC

EMSAAC The “Triple Aim” Better care for individuals Hospitals Support the Triple Aim Better

EMSAAC The “Triple Aim” Better care for individuals Hospitals Support the Triple Aim Better care for populations Reducing per capita costs

EMSAAC ACA Overview of Key Provisions • • • Insurance Underwriting Changes Individual Mandate

EMSAAC ACA Overview of Key Provisions • • • Insurance Underwriting Changes Individual Mandate Employer Mandate Finance & Delivery Systems Redesign Cost Containment

EMSAAC CHBE Strategies • Price Leader: The CHBE as a Driver of Low Premiums

EMSAAC CHBE Strategies • Price Leader: The CHBE as a Driver of Low Premiums • Service Center: The CHBE as a Consumer Destination • Change Agent: The CHBE as a Catalyst of Finance and Delivery Reform • Public Partner: The CHBE Aligned with Medi-Cal

EMSAAC Opportunities for Health Care Cost Reduction Source: Harold D. Miller, Center for Health

EMSAAC Opportunities for Health Care Cost Reduction Source: Harold D. Miller, Center for Health Care Quality and Payment Reform Improved Inpatient Care Use of Processes lower-cost treatments Reduction in Hos Adverse Events pita ls an Reduction in d Sp Preventable ecia lists Readmissions re Pr Ca y r a im Improved Practice Prevention Efficiency and Early Diagnosis es c i t c Pra Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Improved Management Use of Lower. Cost Settings Of Complex And Providers Patients All Providers Lower Total Health Care Costs!

EMSAAC Opportunities for Health Care Cost Reduction Improved Inpatient Care Use of Processes lower-cost

EMSAAC Opportunities for Health Care Cost Reduction Improved Inpatient Care Use of Processes lower-cost treatments Reduction in Hos Adverse Events pita ls an Reduction in d Sp Preventable ecia lists Readmissions re Pr Ca y r a im Improved Practice Prevention Efficiency and Early Diagnosis es c i t c Pra Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Improved Management Use of Lower. Cost Settings Of Complex And Providers Patients All Providers MEDICAL HOME Lower Total Health Care Costs!

EMSAAC Opportunities for Health Care Cost Reduction Improved Inpatient Care Use of Processes lower-cost

EMSAAC Opportunities for Health Care Cost Reduction Improved Inpatient Care Use of Processes lower-cost treatments BUNDLING Reduction in Hos Adverse Events pita ls an Reduction in d Sp Preventable ecia lists Readmissions re Pr Ca y r a im Improved Practice Prevention Efficiency and Early Diagnosis es c i t c Pra Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Improved Management Use of Lower. Cost Settings Of Complex And Providers Patients All Providers Lower Total Health Care Costs!

EMSAAC Opportunities for Health Care Cost Reduction ACCOUNTABLE CARE ORGANIZATION Improved Inpatient Care Use

EMSAAC Opportunities for Health Care Cost Reduction ACCOUNTABLE CARE ORGANIZATION Improved Inpatient Care Use of Processes lower-cost treatments Reduction in Hos Adverse Events pita ls an Reduction in d Sp Preventable ecia lists Readmissions re Pr Ca y r a im Improved Practice Prevention Efficiency and Early Diagnosis es c i t c Pra Reduction in Unnecessary Tests and Referrals Reduction in Preventable ER Visits and Admissions Improved Management Use of Lower. Cost Settings Of Complex And Providers Patients All Providers Lower Total Health Care Costs!

EMSAAC • • • Concept Define the “region” THE GEOGRAPHY – Local communities within

EMSAAC • • • Concept Define the “region” THE GEOGRAPHY – Local communities within the region – Identify the healthcare needs and available resources Identify the vision for the region – Articulate goals: region and local communities Structure the “delivery model” the “Network of Care” Community Clinics MG Ambulatory Care Dr. Dept. of Public Health Dr. Facility PAC Facility MG Dr. MG The Camden Group Dr. CAH FQHC Dr.

AC Str O uc tur e EMSAAC Physicians Hospital n Infrastructure (Provided or Contracted

AC Str O uc tur e EMSAAC Physicians Hospital n Infrastructure (Provided or Contracted ACO Operations) SNF ACO Outpatient Clinics/ Centers < Information Technology EMR, CPOE, PACS Data warehouse Reporting HIE < Care Home Health Behavioral Medicine Rehab Pharmacy ACO responsible for: Clinical care management (clinical integration) Capture data for continuum of care Measure and monitor costs and quality Management Hospitalists and Intensivists CMO Disease management Clinical protocols Advanced analytics and modeling Call center Utilization management Knowledge management < Health Network Delivery network < Financial/Payment The Camden Group Systems

EMSAAC Strategic Issues for Caregivers: • Enhance efforts to improve quality • Increase clinical

EMSAAC Strategic Issues for Caregivers: • Enhance efforts to improve quality • Increase clinical and operational efficiencies • Increase efforts to improve patient satisfaction • Reduce avoidable readmissions • Assess and strengthen planning for HIT • Examine readiness for payment and care redesign • Foster physician alignment and clinical integration

EMSAAC

EMSAAC

EMSAAC

EMSAAC

EMSAAC

EMSAAC

EMSAAC Strategic Issues for EMS: • Continuation of below-Cost payment for Medi-Cal • Increase

EMSAAC Strategic Issues for EMS: • Continuation of below-Cost payment for Medi-Cal • Increase in use of EMS providers • Change in flow patterns • Engage in hospital integration plans • Educate/Prepare workforce

EMSAAC

EMSAAC

EMSAAC Jim Lott, Executive Vice President Hospital Association of Southern California 515 S. Figueroa

EMSAAC Jim Lott, Executive Vice President Hospital Association of Southern California 515 S. Figueroa St. , Suite 1300 Los Angeles, CA 90071 -3300 (213) 538 -0777 JLott@hasc. org www. hasc. org

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