ROCHESTER, Minn. — In a sustained effort to seek consensus-driven, patient-centered priorities that would build a high-value health care system, the Mayo Clinic Health Policy Center hosted a symposium Dec. 5–7 entitled “Achieving the Vision: Advancing High-Value Health Care,” which featured patients, providers, payers, and national policy experts.

“We need a collaborative approach to fixing the health care system,” said John Noseworthy, M.D., president and CEO of Mayo Clinic. “When people discuss the need to reform the system, it’s characterized in terms of ‘we.’ We have to do this together.” Dr. Noseworthy stressed Mayo Clinic’s commitment to patient-centered, high-value health care and invited participants to join together to build the mandate for higher-quality, lower-cost health care in the United States.

Among the panelists and speakers were Richard Gilfillan, M.D., acting director, Center for Medicare and Medicaid Innovation; Randall Krakauer, M.D., national medical director for Medicare, Aetna; Carolyn Clancy, director, Agency for Healthcare Research and Quality; Karen Ignagni, president and CEO, America’s Health Insurance Plans; and Susan Dentzer, editor-in-chief, Health Affairs.

Panelists and participants discussed many key issues, including payment reform, shared decision-making, Accountable Care Organizations (ACOs) and electronic health records.

Don Fisher, Ph.D., of the American Medical Group Association, said that care delivered to Medicare and Medicaid beneficiaries often is episodic and fragmented. He stressed new payment models must support integrated care. “Until we change the incentives, we won’t get there,” said Dr. Fisher. He added the system today is, “all about the money.”

Linda Fishman, senior vice president, Public Policy Analysis and Development, American Hospital Association, emphasized the importance of ACOs and care bundling, “Delivery system reform should go full-speed ahead,” she stressed.

At the completion of the panel sessions, participants made a series of recommendations based on health care goals and criteria. The highest ranked recommendations, based upon importance and urgency, include:

1. Change the reimbursement system to reward value
2. Incent interoperability of health care information technology systems
3. Drive practice reform with payment reform
4. Change incentives – clinical, financial and cultural – to allow patients to move through an individualized continuum of care across all settings

In the video below, Dr. Rob Nesse, co-host of the symposium, provides some closing thoughts on the event.

Moderator:

• Joanne Silberner, University of Washington and National Public Radio contributor

Panelists:

• Helen Darling, President, National Business Group on Health
• Shelia Burke, R.N., M.P.A., F.A.A.N., Faculty Research Fellow, Malcolm Wiener Center for Social Policy
• Linda Fishman, Senior Vice President, Public Policy Analysis and Development, American Hospital Association (AHA)
• Janet Corrigan, Ph.D., President and CEO, The National Quality Forum (NQF)
• Carolyn Clancy, M.D., Director, Agency for Healthcare Research and Quality (AHRQ)

Moderator Joanne Silberner asked the panelists to identify the most important issue now, considering the current political environment in Washington DC.  Janet Corrigan, Ph.D., NQF, said the focus must be on giving the right care at the right time.  Shelia Burke added that ensuring patients’ access and choice of health care providers is crucial.  Helen Darling said that there needs to be a focus on patient-centered safety and quality in health care delivery.  Carolyn Clancy, M.D., noted that the upstream cost of chronic disease must be addressed.  The AHA’s Linda Fishman recommended that providers achieve clinical coordination.

Silberner posed the controversial question of whether financial pressures will lead to health care rationing. “We already have rationing that is irrational,” noted Fishman. “We need to look at overuse, waste and misuse. It’s very costly, and we can change that.” 

Dr. Corrigan added that patients need to have some financial stake in their care.  She said that when patients are invested, costs go down, and suggested a broader communications effort to educate the public about the need for value in health care.  “Polls show the majority of the public don’t see overuse as a concern yet, but we can change that perception like we did with safety issues,” said Corrigan 

Asked about what will happen with implementation  of the Affordable Care Act (ACA), Fishman said that delivery system reform efforts — such as Accountable Care Organization, and bundling of care –  have bipartisan support and that these efforts should go full speed ahead.

Dr. Corrigan and Burke agreed that a lot of the tough decisions will be made at the state and regional levels.  Burke said the question will be how much freedom the Department of Health and Human Services gives to the states with health exchanges and the CMMI demonstration projects.

Below you will find video of four of the panelists as well as the moderator of the session on critical issues in future phases of health care reform:

Sheila Burke:

Carolyn Clancy:

Helen Darling:

Linda Fishman:

Joanne Silberner:

Moderator:
Tim Johnson, MD, ABC News

Panelists:

• Melissa Ortega
• Paul Llanes
• Carol Allred (president of WomenHeart)
• Kathi Hansen (patient advocate for American Cancer Society)

After Dr. Nesse introduced Dr. Tim Johnson and the panelists, the audience reviewed a video of patient perspectives about the American health care system:

After the video, each of the panelists provided their perspective.  Carol stated that patients must become educated about their own health care and rely on their providers’ medical expertise, but said they also have a role to be compliant.  Paul, who has lots of health care experience both as a patient and as a caregiver, feels that those who have a voice need to speak up for those who don’t – particularly for seniors. Melissa’s chronic condition has exposed her to insurance coverage issues as well as uncoordinated care.  She is pleased that the new law provides insurance for so many more people and prevents discrimination against pre-existing conditions. She also hopes that coordinated care and electronic medical records are adopted.  As a cancer survivor, Kathi is very pleased that routine screenings will no longer require co-pays, eliminating barriers to preventive care or early detection.

When posed with the question of how patients can make their voices heard, all of the panelists suggested that some sort of advocacy was necessary.  Carol spoke of the advocacy training that her organization provides to their members.  Paul talked about advocacy in the context of helping people get access to the right resources, encouraging them to ask questions and start talking to people.  Melissa also suggested that patients use their own circles to get the word out and to share information to educate.  Kathi echoed the desire and need for advocacy by saying that people need to speak up, write letters to the editor, attend events, and that personal stories are often the most powerful tools to get messages across.

Another question raised to the panel was how patients can be part of the solution. Carol continued with her theme of being an educated consumer, working with the physician and taking responsibility for one’s own health. Paul brought up the point that insurance does not pay for everything and that more education is needed on cost and necessity of all tests. Melissa made the point that there are many treatments and medicines available, but if resources are limited, who decides who gets the benefit of them?  Kathi wanted to make sure that the discussion didn’t shift to centering on money and that the focus should remain on the patient and the patient’s needs.  All patients have a voice and should be encouraged and supported to share that voice.

Questions from the audience concerned the level of patients’ obligation to be aware of costs, end of life issues and why chronic patients’ compliance wanes over time. Some important points related to these questions included a difference of opinion on patients’ behavior on choosing appropriate levels of care, a call for more effort by the provider community to engage patients in end-of-life discussions and decisions long before those decisions are imminent, and that the patients’ physical reactions to treatment will often dictate their compliance.

The video below is a compilation of thoughts from our panelists.

Moderator:
Susan Dentzer, Heath Affairs

Panelists:
Mike Critelli, Dossia
Don Fisher, Ph.D., American Medical Group Association (AMGA)
Randall Krakauer, M.D., Aetna
Robert Smoldt, Arizona State University Healthcare Delivery and Policy Program
Doug Wood, M.D., Mayo Clinic

Susan Dentzer, Health Affairs, and a diverse panel representing providers, employers, payers and academia discussed ways in which the private sector and the CMS Innovation Center (CMMI) can improve care outcomes and reduce costs in a variety of health care settings.

Drawing upon his previous experience with worksite clinical care programs as CEO of Pitney Bowes, Mike Critelli suggested three elements that create higher-value health care: convenient care locations (i.e. workplaces and schools); clinically competent, empathetic caregivers; and a business model that allows providers to spend adequate time with the patient.

Randall Krakauer, M.D., Aetna, stressed that teamwork, collaboration and integration change the nature of stakeholder relationships and can significantly increase value. He cited higher-quality, lower-cost results using a chronic care management model with Aetna’s Medicare Advantage population. “When we collaborate with provider groups, our results are dramatically better than when we do it by ourselves,” he said.

Don Fisher, Ph.D., AMGA, said that care delivered to Medicare and Medicaid beneficiaries often is episodic and fragmented. He suggested that the CMMI fund initiatives that move disaggregated providers into organized systems of accountable care. Dr. Fisher stressed that new payment models must support integrated care. “Until we change the incentives,” he said, “we won’t get there. It’s all about the money.”

Robert Smoldt, ASU, noted that the current payment system doesn’t reward providers who deliver higher-quality, lower-cost care, and proposed that private payers and providers work more closely together to redesign care and find simpler solutions that benefit all stakeholders. Doug Wood, M.D., Mayo Clinic, emphasized the importance of reducing the costs of health care to patients, doctors and hospitals, and ultimately government. The best way to accomplish this, he said, is to move away from fee-for-service payment and advocating for bipartisan support for strengthening efforts to pay for value.

Dentzer then asked participants to submit recommendations that address how the CMMI and the private sector can promote innovation that will enable beneficiaries to get the highest value in their health care. The top ranked items included:

• Accelerate payment reform to support changes in health care delivery.
• Incent interoperability of health care IT systems.
• Set the standards within which we can all share data.
• Develop a practical national definition of value that is acceptable to patients, care providers and payers.
• Focus on patients with multiple co-morbidities.

Below you will find video of three of the panelists value in health care delivery:

Mike Critelli, Dossia:

Don Fisher, Ph.D., American Medical Group Association

Randall Krakauer, M.D., Aetna:

Moderator:
Tim Johnson, M.D., Chief Medical Editor, ABC News

Panelists:
James Rohack, M.D., Immediate Past President, American Medical Association
Darrell Kirch, M.D., President and CEO, Association of American Medical Colleges
Mary Grealy, President, Healthcare Leadership Council
Karen Ignagni, President and CEO, America’s Health Insurance Plans
DeAnn Friedholm, Campaign Director, Health Care Reform, Consumers Union

Moderator Tim Johnson, M.D., began the discussion by asking the panelists to identify the single highest priority that will relieve patient concerns about the U.S. health care system, and whether the Affordable Care Act (ACA) addresses these concerns in any way.

Dr. Kirch commented that patients are often concerned about insurance-related issues, but there are still many other deep problems in health care that need to be addressed, such as the need to reward value rather than volume in the payment system. This culture shift must be led by health systems and providers, and a population health focus must be achieved. In addition to providing care, high-value health care systems can train providers in care models of the future and lead the way in patient-centered health care reform.

Karen Ignagni built on Dr. Kirch’s comments by adding that it is important for everyone to participate in the health care system as insurance reforms are implemented. Patients are anxious about rising costs, which is a concern that can be partially addressed by shrinking variation and incenting best practices. She also emphasized that the private sector must be engaged and take a leadership role in identifying priorities and ways to bend the cost curve—considering the difficulties in encouraging Congress to take effective action.

Mary Grealy agreed and added that one of the most important aspects of the ACA is the creation of the Center for Medicare and Medicaid Innovation (CMMI) to serve as a laboratory for new ideas in improving health care delivery. She acknowledged that there is concern that the results from the CMMI won’t be diffused rapidly enough, given the fact that over 30 million newly insured Americans will be added to the system by 2014. It is vital for CMMI to build upon delivery reform successes that are already taking place in the private sector and to diffuse results quickly.

Dr. Rohack noted that that the Medicare program drives how medicine is practiced and that a permanent solution to the Sustainable Growth Rate (SGR) formula is needed. Certain elements in the ACA are designed to incent high-value health care through the Medicare program, but these may be difficult if physician payments are cut because of SGR. He also emphasized that physicians need to be comfortable aligning with one another, and safe harbors need to be considered from a Federal Trade Commission perspective.

Finally, DeAnn Friedholm discussed that health care costs remain a top concern to patients. She also emphasized that patients need the appropriate number and type of providers tensure appropriate access. The panelists all agreed that people need to be empowered to be good decision-makers in their own personal health care experiences, but most patients don’t consider themselves active participants in the health care system. There is a need to build a mandate for high-value health care, but patients don’t currently understand what high-value health care is or what to expect from an effective system. The panelists were also in broad agreement that patients must be educated about high-value health care by showing how increases in value can have personal impacts on their lives.

Overall, the panelists agreed that the Affordable Care Act has elements that can further patient-centered health care, but much more needs to be done, particularly in diffusing private sector successes and engaging patients as consumers to advocate for high-value health care

After the panel concluded, attendees worked in small groups on two questions, submitted responses, and prioritized the responses as a large group. The questions and the top five responses follow:

How can we rapidly improve the experience of patients and make them more effective partners in making choices about their health care utilization?
1) Provision of care management is needed, particularly for chronic illness and elderly patients, to assist with communication and longitudinal care completion across the spectrum of providers.
2) Implement patient centered shared decision making with incentives to patients for compliance and adherence to the plan.
3) Make health care more user-friendly through virtual access, timely visits, patient education, and other initiatives.
4) Work toward a government-mandated and subsidized health care record (second vote after brief discussion)
5) Utilize patient-centered medical homes or other team approaches to enhance patient education levels and empowerment supported through new payment mechanisms. Improved reimbursement is necessary.

What delivery system changes can we make in the next two years to make health care more affordable and less burdensome to families?
1) Change incentives — clinical, financial and cultural — to allow patients to move through an individualized continuum of care across all settings.
2) Fill in the gaps to improve the efficiency of care.
3) Incentivize providers to join organized systems of care.
4) Provision of protocols and care management to target advanced illness.
5) Support better coordination of care through removal of legal barriers, improved health IT, alignment of reimbursement and medical homes.

Below you will find video of two of the panelists discussing the future of high-value, patient-centered health care:

• Mary Grealy, President, HealthCare Leadership Council
• DeAnn Friedholm, Campaign Director, Health Care Reform, Consumers Union
• James Rohack, M.D., Immediate Past President, American Medical Association

The purpose of the symposium is to:

1. Identify and prioritize the most critical issues in the next one to three years to ensure that patient-centered high-value health care delivery practices thrive and spread.
2. Formulate recommendations for the CMS Innovation Center by reviewing concrete examples of innovative health care delivery projects that improve outcomes and reduce costs.
3. Identify and prioritize key issues that will require attention in future phases of health care reform.

Join with national leaders to build consensus on the future of high-value health care delivery. An outstanding group of panelists and moderators will be gathered to identify the next steps necessary to advance high-value health care delivery in America. Your experiences and ideas will help influence and form the solutions.

Confirmed panelists and moderators include:

• Carolyn Clancy, M.D., Director, Agency for Healthcare Research and Quality
• Janet Corrigan, Ph.D., MBA, President and CEO, The National Quality Forum
• Helen Darling, President, National Business Group on Health
• Susan Dentzer, Editor-in-Chief, Health Affairs
• Donald W. Fisher, Ph.D., CAE, President and CEO, American Medical Group Association
• Linda Fishman, Senior Vice President, Public Policy Analysis and Development, American Hospital Association
• Richard J. Gilfillan, M.D., Acting Director of the Center for Medicare and Medicaid Innovation
• Mary R. Grealy, President, Healthcare Leadership Council
• Karen Ignagni, President and CEO, America’s Health Insurance Plans
• Timothy Johnson, M.D., Chief Medical Editor, ABC News
• Darrell G. Kirch, M.D., President and CEO, Association of American Medical Colleges
• J. James Rohack, M.D., Past President, American Medical Association
• Joanne Silberner, Artist in Residence, University of Washington

For more information and to register:
www.mayoclinic.org/healthpolicycenter/

Join with national leaders to build consensus on the future of high-value health care delivery.  Susan Dentzer, Editor-in-chief of Health Affairs, Dr. Richard Gilfillan, Acting Director of the new Center for Medicare and Medicaid Innovation (CMI) at the Centers for Medicare and Medicaid Services (CMS), and an outstanding group of panelists and moderators will be gathered to identify the next steps necessary to advance high-value health care delivery in America.  The program aims to identify immediate issues to ensure the spread of high-value health care practices, formulate recommendations of innovative projects for the CMI and look to future phases of health care reform. Your experiences and ideas will help influence and form the solutions. 

Register online or download the program brochure (PDF).

Health reform legislation is the law of the land.  How do we use this opportunity as a burning platform to further meaningful health care delivery reform?  What are the most critical issues in the next one to three years to ensure that patient-centered, high-value health care delivery practices thrive and spread?

Opening Session Panelists:
Mary Grealy, President, Healthcare Leadership Council
James Guest, President and CEO, Consumers Union (invited)
Karen Ignagni, President and CEO, America’s Health Insurance Plans
Darrell Kirch, MD, Presdient and CEO, Association of American Medical Colleges
J. James Rohack, MD, Past President, American Medcial Association

Moderator:  Timothy Johnson, MD, Chief Medical Editor, ABC News

Register now to join with national leaders and build consensus on the future of high-value health care delivery.     Register online. 

View or download the Program brochure (PDF).

The Mayo Clinic Shared Decision Making National Resource Center will benefit from Mayo Clinic’s expertise in effective patient-physician relationships. Building on existing Mayo Clinic resources and working with key partners, the Center will seek to help implement shared decision making provisions in the Affordable Care Act by developing, implementing and assessing patient decision aids and shared decision making techniques while focusing its efforts on a very important group of patients: those with chronic conditions, such as diabetes and heart disease.

Please visit the Center’s Web site for more details and regular updates.

Mayo Clinic committed to advancing high-value care

The Patient Protection and Affordable Care Act (ACA) changed the nation’s health care landscape.  As Mayo Clinic continues to prepare for the new environment, we remain steadfast in our mission of delivering high-value, patient-centered care.    As it did during the legislative process, the Mayo Clinic Health Policy Center will continue to convene health care thought leaders and patients, offer expertise and knowledge to policy makers, and advocate for policies and regulations that promote the principles of high-value, cost-effective and coordinated patient care. 

The ACA includes provisions that promote paying for value in health care, which we define as outcomes, safety and service divided by cost over time.  These provisions are good, first steps to begin efforts to advance high-value health care.   However, we believe much more needs to be done.   In this effort, we are committed to working with you and other stakeholders to ensure that the ACA is implemented consistent with our four principles of high-value care, coordinated care, payment reform and insurance for all. 

Specifically, we will offer our ideas and expertise to rapidly diffuse best practices in the following areas:

• High-Value Care:  Ideas that improve patient outcomes and satisfaction, and decrease medical costs and waste;
• Coordinated Care:  How best to use IT and other tools to promote health care delivery integration; and
• Payment Reform:  Change the ways providers are paid in order to incent value in health care.

In this periodic communication, we intend to highlight care and payment models both within and outside of the new law’s provisions to improve value, access and excellence in patient care for all Americans.

Patient-focused care models highlighted on HHS Secretary visit

This summer, U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius visited Mayo Clinic in Rochester, MN and observed several patient-focused health care models that Mayo employs to ensure affordable, quality care for its patients. 

“Initiatives like the Beacon Community Health IT pilot project, and Mayo’s coordinated care model to bring down costs and improve health, show providers across the country what is possible. The Affordable Care Act will help to spread high-quality, low-cost models like these throughout the country to create the kind of quality, cost-effective health system that every American deserves,” said Sebelius.

Featured below is more information about programs highlighted during Secretary Sebelius’ visit.

Studies to develop best practices of health information technology

Mayo Clinic will participate in two HHS funded projects that will develop and test delivery models designed to promote the use of Health Information Technology (HIT) to improve patient care.

The first project is a collaboration between Mayo Clinic and several Southeastern Minnesota organizations to demonstrate how HIT can help providers develop innovative care models that lead to sustainable and measurable health and efficiency improvements.  The collaborative, one of 17 projects awarded a grant from HHS’ Beacon Community Cooperative Agreement Program, will bring together organizations in an 11-county region of Southeast Minnesota to adopt meaningful-use HIT standards to securely exchange information on diabetes and childhood asthma.  In addition to Mayo Clinic, the collaborative includes other area doctors and hospitals, public health departments, the Bureau of Prisons, Veteran’s Administration Clinic and the Prairie Island Indian Reservation. 

The second project, funded by HHS’ Strategic Health IT Advanced Research Projects (SHARP) program, will research and advance methods for using electronic medical records (EMRs) for medical research, while also maintaining privacy and security. Specifically, the project will:

• Create a framework of open-source services that dynamically configure to transform EHR data into information that is comparable and conforms to standards for large-scale analysis, inference and integration;
• Apply these services in medical centers and population-based settings; and
• Examine data quality and repair strategies.

We will provide updates on these projects as they move forward. 

Austin, Minnesota [pop. 22,000] model for patient centered medical home

In 2009, Austin Medical Center and Mayo Clinic’s Center for Innovation began a project in the Southern Minnesota city of Austin to develop a Patient-Centered Medical Home model that will ultimately serve as a model of patient-centered medical home care for the United States.

The medical home concept brings together schools, churches, employers, hospitals and other local groups to better care for and prevent chronic diseases like diabetes and heart failure.  With a population of 22,000 people, including 13 percent seniors and 15 percent Hispanic, the demographics of the Southern Minnesota community mirrors many small American cities across the U.S. 

The goal of the project is to improve the experience and health of the individual, improve the overall health of the community and reduce the per capita costs of providing healthcare.

2010 Symposium: Achieving the Vision — Advancing High-Value Health Care

You are invited to join the conversation and help define the next steps to advance high-value health care delivery in America by attending the 2010 Mayo Clinic Health Policy Center Symposium, “Achieving the Vision: Advancing High-Value Health Care.” The event is being held Dec. 5-7, 2010, at the Bethesda North Marriott Hotel & Conference Center in Bethesda, MD.

With passage of the new health care law, the stage is set to define the next steps necessary to advance high-value health care delivery in America. The symposium will determine key priorities to further the evolution to a high-value health system. The purpose of the symposium is to:

• Identify and prioritize the most critical issues in the next one to three years to ensure that patient-centered high-value health care delivery practices thrive and spread.
• Formulate recommendations for the Centers for Medicare and Medicaid Services (CMS) Innovation Center by reviewing concrete examples of innovative health care delivery projects that improve outcomes and reduce costs.
• Identify and prioritize key issues that will require attention in future phases of health care reform.

Join with other national leaders to build consensus on the future of high-value health care delivery. Nationally recognized health care experts will facilitate discussions at this highly participatory event. Your experiences and ideas will influence future priorities.

Register online and watch the Mayo Clinic Health Policy Center Health Policy Blog for updates on speakers and panelists.

This perspective is written by Jeffrey O. Korsmo, Executive Director, Mayo Clinic Health Policy Center; and Bruce Kelly, Director of Government Relations, Mayo Clinic.  For more information about the issues or projects discussed in this publication, please contact Randy Schubring at schubring.randy@mayo.edu.