Peter Person
description
Transcript of Peter Person
Medical Technology Leadership Forum
“The Role of Integrated Systems ……Combining Technology and
Structure…to Improve Value”
Peter E. Person, M.D.Chief Executive Officer
October 15, 2007
Overview
1. Introduction…Where has the Arms Race taken us?
2. Critical Elements of/to Successful Integrated Care
3. Overview St. Mary’s/Duluth Clinic Health System (SMDC)
4. Role of Structure/Technology and Collaborative Practice Teams to bring Value
5. Example(s) of Value Creation
6. Future Direction
Current U.S. Health Care Reality…
PatientPatient
Fragmented U.S. System…Non System
OrthopedistCardiologist
Dermatologist
Gynecologist
Gastroenterologist
Chest pain
Pap Test
Rash
Stomach Ache
Knee
ache
Health Care Costs, 2002 (in US $s)
$2,930
$2,820
$2,740
$2,520
$2,160
$2,080
$5,270U.S.
Canada
Germany
France
Sweden
U.K.
Japan
$ Per CapitaOECD, 2004
Best care in the world?
Rank of 13 industrialized nationsRank of 13 industrialized nationsLow birth weight %
Infant mortality
Years of potential life lost
Age adjusted mortality
Life expectancy @ 1 yr
Life expectancy @ 40 yrs
Life expectancy @ 65 yrs
Life expectancy @ 80 yrs
Average for all indicators
BestPoorest
(U.S. in Red)
WHO ranks US 3737thth out of 191 out of 191 countries in overall health measures
… With A Dysfunctional Value Proposition
“Our current reimbursement system rewards the wrong behavior……….the worst physicians get paid the
most because they see the patient more often”…Joe
Bianco, M.D. (10-8-07)
Our Belief…..Seven Critical Elements To Successful Integrated Care
(Systems of Care)
1. Mission/Vision
2. Structure
3. Strategy
4. People
5. Support/Technology
6. Incentives
7. Culture
St. Mary’s Duluth Clinic Health System (SMDC) was formed from a
partnership between St. Mary’s Medical Center and The Duluth
Clinic, Ltd in 1997
December 19, 1996
St. Mary’s Duluth Clinic Health System (SMDC)Duluth, MN (2007)
• 4 hospitals with a total of 555 beds
• 18 regional clinics• 450+ employed physicians• 6,000 employees• 850,000 annual
encounters• 40,000 emergency care
and trauma center visits• 22,000 surgeries• 9,700 cardiac procedures
• Non-profit healthcare organization serving a region of 450,000 residents
SMDC Health SystemReflecting the heritage and continuing partnership of the Health Care Ministry of the Benedictine Sisters of
St. Mary’s Medical Center and the physicians of the Duluth Clinic
MissionSMDC brings the soul and science of healing to the people we serve.
VisionSMDC, as a world-class organization, will be the best place to receive care
and the best place to work.
ValuesRespect – We regard all persons with dignity and respect.
Innovation and Excellence – We are committed to innovation and excellence in medical care, education and research.
Teamwork – Our strength is in our people, working together.Stewardship - We wisely and responsibly manage all resources.
SMDC’s Healthcare Network..A Model for Rural Health Care?
TertiaryHospital
Primary Care
Critical AccessHospitals
SpecialtyHospitals
Nursing Services
Nurse On Line
Regional Clinics
SpecialtyPhysicians
PATIENT&
RESIDENT
SMDC Integrated Vision…Bringing Technology, People, and Structure
Together to Provide Value
Building a Health Care Strategy Structured Around The IOM Six Aims
Institute of Medicine Six Aims of Quality Care:
Safe Effective Patient-Centered Timely Efficient Equitable
Internal ProcessesTo satisfy our customers, at which operational & quality processes must we excel?
FinancialTo financially sustain our Mission, on what must we focus?
Vision: SMDC, as a world-class organization, will be the best place to receive care and the best place to work
CustomerTo achieve our focus on Service, Clinical & Operational ExcellenceHow should we appearTo our internal & external customers?
Strategy Defining Value…..SMDC’s Balanced Scorecard/Strategy Map
Copyright © 2008 by St. Mary’s/Duluth Clinic Health System
Service Excellence Clinical Excellence
Operational Excellence
Learning & GrowthHow will we sustain our ability to change and improve as a system?
Mission: SMDC brings the soul and science of healing to the people we serve
We will pursue our mission and vision through a focus on Service, Clinical and Operational Excellence
C1 Quality Relationships• Patient-centered Care • Timely Care• Equitable Care
C2 Clinical Expertise• Effective Care• Safe Care
C3 Customer Value• Efficient Care
P2 Provide easy, timely, coordinated access to health care services
P1 Right patient, right care, right process, best outcome
P6 Optimize physician & staff productivity
P5 Design & implement coordinated care models to effectively manage disease
processes through teamsP7 Excel in efficient & effective operations
P4 Consistentlydemonstrate
personalized, caring,attentive interactions
P3 Investment emphasis to support clinical & financial outcomes
L3 Recruit, develop & retain talented people to outstanding levels of performance to support the Mission
L4 Engage physician leaders & managers as partners in success
L2 Grow & excel in research & education
F3 Optimize system investments F4 Be provider of choice in the Twin Ports
F2 Grow key specialty services, programs & strategic
partnershipsF5 Achieve negotiated increasing
amounts of financial risks for “covered lives”
*Cancer, Cardiovascular, Digestive, Surgery, Children’s Specialty
L1 Develop a high performance culture that delivers world-class care through innovation
F1 Achieve a 3% Operating Margin to sustain our Mission and achieve our Vision
SMDC Organizational Chart…Integrating
Physicians to Create Value
Interdisciplinary Teams At The Core of Value Delivery
Clinic VP Hospital COO
EVP Clinic Division
Physician Division
Chief
EVP HospitalDivision
Section ChairDirector orManager
Nursing Director
or Managers
Accountability- Quality- Service- P&L
Administrative Level
Care LevelAccountability- Quality- Service
Collaborative Practice Teams
Collaborative Practice Teams
• Interdisciplinary groups formed to determine best practice for an assigned patient population
• Responsible for development of tools & care processes that improve clinical quality & customer value
SMDC Collaborative Practice Teams
• Cardiology
• Cardiothorasic Surgery
• Critical Care
• General Surgery
• Medicine
• Neonatalogy
• Neuroscience
• Obstetrics
• Oncology
• Orthopedics
• Pediatrics
CardiologySMDC Heart Failure Program
• Racing to Value with Technology…(with Caveats)
• Approximately 5 million Americans have Heart Failure
• 550,000 new cases annually• Incidence of 10/1000 > 65 years of age• Estimated direct and indirect costs in U.S.
$27.9 billion• Single largest expense for Medicare
(1999-$3.6 billion)• High 1-year mortality rate with 1 in 5 dying
Heart FailureIncidence and Prevalence…
AHA. 2005 Heart and Stroke Statistical Update.
SMDC Heart Failure Program Profile
• Heart Failure outpatient services first introduced in 1999
• Program managed by nurse practitioners in collaboration with cardiologists from the SMDC Heart Center
• Model expanded to Ashland, WI in 2004; Spooner/Hayward, WI in 2005; Virginia, MN in 2007
• Currently the program coordinates care for 989 patients
Why Change Care Delivery?…Value Proposition
• Program born out of honest desire to improve care to this complicated, fragile population
• Traditional medical model did not allow time for coordination of care required of this population
• Traditional model inefficient• Maximizing the use of technology and people.
SMDC Heart Failure ProgramIntegrated Team
• Medical Director - Cardiologist oversight of program, clinical leadership
• Cardiologists-accurate diagnosis, accurate treatment plan
• Nurse Practitioners/Physician Assistant – Disease management, medication management, referral for device therapy, oversight of telescale data
• Registered Nurses- Continual patient education, management of telescale data, phone triage
SMDC Heart Failure ProgramSupporting Roles
• Primary Care Physicians
• Nurse On Line
• Emergency Room Physicians and Staff
• Pharmacy Staff
• Social Workers
• Information Services
• EPIC
SMDC Heart Failure Program Growth
1999• Initial Staff
– 1 Nurse Practitioner (NP)
– 1 Physician (MD)
– 1 Registered Nurse (RN)
– 1 Certified Medical Assistant (CMA)
• 100 Patients Served
2007• Current Staff
– 6 NPs/PAs
– 2 MDs (Directors)
– 6 RNs
– 6 CMAs3 teams in Duluth
3 teams in regional sites
• 989 Patients Served
SMDC Heart Failure Program
• Patients have a cardiology consult prior to entering the program
• 7- 10 office visits with a nurse practitioner in first year (0, 2, 4, 6 weeks; 3, 6, 9 months)
• 4 office visits annually thereafter with an NP
• AT LEAST an annual office visit with a cardiologist and their primary care physician
SMDC Heart Failure Program
• Structured educational content
• Team approach to clinic visits
• Quality of life, functional status and depression screening
• In home scale tele-monitoring program for vigilance between office visits
SMDC Heart Failure ProgramCommunity Outreach
• Quarterly Heart Failure Support Group/Educational Sessions
– Designed by Heart Failure Focus Group
– 100+ attendees, patients and relatives
– Various clinical presentations /clinicians
• Quarterly Heart Failure Newsletter – 2000 copies printed
SMDC Heart Failure Program
• Tele-monitoring (Telescales)• Home based electronic scales. Patients send
daily weights and survey data to Heart Failure staff
• 175 scales in use. Assigned to the most frail patients
• Staff calls patients when triggers occur• Hold patients accountable for their own care
plan
SMDC Heart Failure Program
• RN calls patient – Completes the following:– Nursing assessment – Medication list review– Dietary adherence– Educational needs– Follows diuretic protocol as indicated/or talks with
NP– Makes followup recommendations– Initiates office visit or primary care referral– Care plan monitoring; hospitalization initiation
SMDC Heart Failure Program
• Tele-monitoring advantages– Facilitates early intervention and minimizes ER visits
and re-hospitalizations– Improves patient adherence with care plan– Patients get immediate feedback on life style choices– Provides high patient satisfaction– Provides family reassurance– Provides additional opportunity to educate patients– Builds trust between patient and provider
Type of Care Pre-Program6 months
Post-Program6 months
Percent Change
Inpatient $1,149,080 $185,134 -84%
Outpatient $124,884 $125,498 0%
ER $379,852 $66,318 -83%
Prof. Fees $674,428 $706,298 5%
Lab/Radiol $138,781 $118,064 -15%
Pharmacy $124,229 $137,312 11%
Total $2,591,254 $1,338,624 -48%
SMDC Heart Failure ProgramFinancial Outcomes
Pilot with payer N=29 patients $1.25M cost savings
SMDC Heart Failure ProgramFinancial Outcomes
Tele-Monitoring makes financial sense:
• Yearly charges for a remote scale– Rental + Professional Fees
$2,820/year– Compared to 1 hospitalization for heart failure
$6,000/admission
–CONCLUSION: Paying for preventive care and wellness reduces downstream hospital charges and payer costs. Resources are used more efficiently.
SMDC Heart Failure ProgramClinical Outcomes
Sample Study in 200025 patients in the Heart Failure Program
• 82% Reduction in Heart Failure hospitalizations
• 81% Decrease in Length of Stay
• 88% Decrease in ER Visits
SMDC Heart Failure ProgramClinical Outcomes
2006 Data (Currently 815 Patients)
• 7% Yearly Admission Rate
• 2.8% 6-month Re-admission Rate
National 6 month Re-admission Rate is 40-50%
SMDC Heart Failure Program Total Uncompensated Services (n=800)
• Staff $781,750• Research 15,000• Community Outreach 10,000• Telescales 398,800
Total Direct Cost $1,205,550
…The Caveat
Payor “Savings” (n=29 patients) $1,250,000
Total Unreimbursed Costs (n=800 patients)
• Staff $781,750• Research 15,000• Community Outreach 10,000• Telescales 398,800
Total Direct Cost $1,205,550
TertiaryHospital
Primary Care
Critical AccessHospitals
SpecialtyHospitals
Nursing Services
Nurse On Line
Regional Clinics
SpecialtyPhysicians
PATIENT&
RESIDENT
SMDC Future Vision
Questions???