Shark Tank: Costs of Care Edition - IHI Home...
Transcript of Shark Tank: Costs of Care Edition - IHI Home...
12/6/2015
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© Copyright. All Rights Reserved. Costs of Care.
Shark Tank: Costs of Care Edition
Neel Shah, MD, MPP, Executive Director (Harvard Medical School)
Jordan Harmon, MHA, Advocacy Director (Hospital for Special Surgery)
September Wallingford, RN, MSN, Operations Director (Brigham & Women’s Hospital)
Chris Moriates, MD, Implementation Director (UCSF)
Helping clinicians provide better care at lower cost
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Disclosures
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Objectives
• Learn how to identify and prioritize institutional
opportunities to provide better care at lower
cost
• Review our “COST” framework for developing
collaborative value-improvement projects that
are most likely to meet performance targets
• Design a value improvement project that could
be adapted to the context of your own
institution
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Agenda
• The Landscape in 2016
• The Role of Administrators & Health System Leaders
• The Inter-professional Team
• Putting Ideas into Practice
• “COST” Framework
• Shark Tank
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Helping clinicians provide better care at lower cost
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Advocate
Educate
Implement
Costs of Care
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Value-based healthcare
Outcome/safety AffordabilityPatient
experience
Defining Value
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Landscape 2016: Improving Value
Neel Shah, MD
Executive Director, Costs of Care
Helping clinicians provide better care at lower cost
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Helping clinicians provide better care at lower cost
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Patients
transparency
Policymakers
accountability
Changing Landscape
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Costs of Care Essay Contest
© Copyright. All Rights Reserved. Cost of Care. 12Graham JD, Potyk D, Raimi E. Hospitalists' awareness of patient charges associated with
inpatient care. J Hosp Med. 2010 May-Jun;5(5):295-7.
Illustration by Peter Arkle, Bloomberg.com 7/11/11
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$800 billion low value health care spending X
20% variable costs X
70% clinician-driven component =
How Much Can We Save?
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Clinicians are trained to take care of the patient in front of us
The Point of Care
Policies and Systems
… not to assume responsibility for populations and systems
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The Role of Administrators and Health System Leaders
Jordan Harmon, MHA
Advocacy Director, Costs of Care
Helping clinicians provide better care at lower cost
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High Performing Healthcare Organizations
clinical
operational
financial
Coordinating Delivery System Efforts
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No Longer a Focus
• Private Physician Practice Silos
• Optimizing Fee for Service Reimbursement
• Increase in In-patient Volume
• Paper Chart Documentation
High Focus Areas
• Financial Re-Design
• New Care Management Models
• Process Improvement
/Operational Efficiency
• Electronic Health Records
Issues in the Environment
• Reimbursement changes
• Population health and episodes
of care
• Shift from in-patient to out-
patient procedures
• Need for improved efficiency
• Greater need for data
1
2
3
4
The New Focus for Health Leaders
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Four Areas of Focus for Health Leaders
▪ Enhance clinical networks
through physician contracts
▪ Optimize new bundle
payment methodology
▪ Reduce patient financial
burden
▪ Focus on driving evidence-
based clinical outcomes
▪ Improve clinical
communication to patients
▪ Use of data to drive patient
care models
Financial Re-Design Care Management Models
▪ Implement best practice
▪ Reduce waste across
health systems
▪ Support clinicians in
providing efficient care
▪ Provide a new set of “big
data”
▪ Expansion of coordination
with care management team
▪ Patient medical information
centrally located
Operational Efficiency Electronic Health Records
High Performing
Organizations
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Patient
Satisfaction
Efficient Care
Delivery
Value Created
High Quality
Outcomes
High Performance Care
Delivery System
Patient
High Performing Organizations Create Value
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Most Organizations
Learning from leaders.
Preparing for changes but
no real advanced
foresight.
Low
Performing
High
Performing
Laggards
Slow to Change. Lack
resources to focus on
efficiency and new
advancements in care
management
Leader Organizations
Integrated care at the
lowest cost using data
and analytics to optimize
patient experience
Spectrum of Healthcare Organizations
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Building Clinical – Administrative Partnerships
Yale New Haven Health System
Helping clinicians provide better care at lower cost
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The Inter-professional Team
September Wallingford, RN, MSN
Operations Director, Costs of Care
Helping clinicians provide better care at lower cost
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Inter-professional Team
Communication Teamwork
Evidence-Based Practice High-Value Healthcare
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Time
Lack of knowledge
Cultural hierarchies
Misguided perception that we cannot affect
change
Inter-professional Barriers
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Nurses Can Make a Difference
• 3.1 million
nurses
• Largest group
of healthcare
professionals
• Most “trusted”
professional for
the last 15 out
of 16 years
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Nurses Can Make a Difference
*3.1 Million
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At the Point of Care
Professional Communication
and Collaboration
Knowledge and Skills
Meaningful Patient and
Family Relationships
Pragmatic
Opportunities
“Does this add value to
this patient’s care?”
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At the Point of Care
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At the Point of Care
Individualized plan for the patient:
nursing to monitor nasogastric tube for proper positioning
Ileus, nasogastric tube,
gastrointestinal assessment
Improvement in patient’s condition,
feelings of exhaustion
Abdominal
x-ray
“Does this add value to
this patient’s care?”
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Inter-professional Communication
“…draw on individual and collective skills and experience
…allows each person to practice at a higher level
…better patient outcomes, including higher levels of patient satisfaction”
Susan Hassmiller, PhD, RN, FAAN
Senior Adviser for Nursing, RWJF
Helping clinicians provide better care at lower cost
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Putting Ideas into Practice
Chris Moriates, MD
Implementation Director, Costs of Care
Helping clinicians provide better care at lower cost
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Important… but
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Culture is all around us, yet can be hard to perceive from
within
Culture forms behaviors
(Behaviors that reflect)
Culture can be measured
Culture can be changed
This Is Your Culture
Culture
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Key Elements for Successful High-Value Care Campaign
PLUS an implementation strategy that includes:
Culture change Oversight Systems Change Training
Data, data, data
Champions on the ground
Lessons Learned
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An organized process for
engaging and supporting
frontline clinicians in efforts to
remove unnecessary costs from
health care delivery systems.
Caring Wisely
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Management
Frontline Staff
Caring Wisely
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• Two strategies:
• Restrictive threshold (<8 g/dL)
• Favored approach
• Liberal threshold
Goal: Improve adherence to restrictive strategy
Slide by Alvin Rajkomar, MD (UCSF)
“Caring Wisely” - Project
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Date of TransfusionClinical
ServiceAttending Physician Hemoglobin Prior to Transfusion
…23 other variables
7/1/2013Hospital
MedicineAlvin Rajkomar 7
…
7/2/2013Hospital
MedicineAlvin Rajkomar 7.1
…
7/3/2013Hospital
MedicineAlvin Rajkomar 12
…
7/4/2013Hospital
MedicineAlvin Rajkomar 6.5
…
7/5/2013Hospital
MedicineAlvin Rajkomar 4.3
…
7/6/2013Hospital
MedicineAlvin Rajkomar 7.2
…
7/7/2013Hospital
MedicineAlvin Rajkomar 6.9
…
7/8/2013Hospital
MedicineAlvin Rajkomar 6.5
…
7/9/2013Hospital
MedicineAlvin Rajkomar 7.8
…
7/10/2013Hospital
MedicineAlvin Rajkomar 5.9
…
Hemoglobin
Threshold
Clinical
Service
Liberal
threshold
Restrictive
threshold
Slide and Data Analyses by Alvin Rajkomar, MD (UCSF)
The Dataset
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© Copyright. All Rights Reserved. Cost of Care. 45Slide and Data Analyses by Alvin Rajkomar, MD (UCSF)
© Copyright. All Rights Reserved. Cost of Care. 46Slide and Data Analyses by Alvin Rajkomar, MD (UCSF)
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© Copyright. All Rights Reserved. Cost of Care. 47Slide and Data Analyses by Alvin Rajkomar, MD (UCSF)
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“CaringWisely”atUCSF:NebsNoMoreA er24
andBloodU liza onStewardship
ChristopherMoriates,MDAssistantClinicalProfessor
Twi er:@ChrisMoriates
“Caring Wisely” at UCSF
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Caring Wisely InitiativeLEVERAGING ACADEMIC MEDICINE TO
REDUCE COST, INCREASE VALUE, AND ENABLE INNOVATION
HEALTHVALUE.UCSF.EDU
PICTURED ABOVE:
From left: Vedat Deviren (Orthopaedic Surgery), Kevin Bozic (Orthopaedic Surgery), Christopher Ames (Neurological Surgery), Richard O’Donnell (Orthopaedic Surgery)
Nebs No More After 24: Improving Use of Appropriate Respiratory Therapies In collaboration with Hospital Medicine and Respiratory Therapy
Transfuse Just One First: Improving Blood Utilization StewardshipIn collaboration with Med-Surg Nursing and Transfusion Service
Caring Wisely Initiative
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Caring Wisely
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An implementation strategy that includes:
Culture change
Oversight
Systems Change
Training
“COST” framework described in: Levy, et al. Acad Med, 2014
Implementation Strategy
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Mourning the Morning Lab
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The SHM Choosing Wisely list challenges us to not
“perform repetitive CBC and chemistry testing in the
face of clinical and lab stability.”
Choosing Wisely
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Think Twice, Stick Once
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Intervention Description Example
C Culture Valuing cost-consciousness and
resource stewardship at the individual
and team level
Hospital-wide campaign
led by peer-champions
to reduce lab tests
overuse
O Oversight Requiring accountability for cost-
conscious decision-making at both a
peer and organizational level
Requiring attending to
review labs residents
order to reduce overuse
S Systems
Change
Creating systems to make cost-
conscious decisions using institutional
policy, decision-support tools, and
clinical guidelines
EHR displays cost of lab
tests next to order for
specific tests
T Training Providing knowledge & skills clinicians
need to make cost-conscious decisions
Lecture or workshop on
ordering of lab tests
“COST” Framework
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• At your tables, you’ll have 30 minutes to:
• Pick an area in need of high-value improvement
• Use “COST” Worksheet to develop your “pitch”
• Select a “pitch” person
• Ok to be creative!
• Present to the Sharks!
• 5 minute pitch per table
Let’s Shark Tank!
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Costs of Care Value Challenge 2016
Submit Your Bright Idea or Innovation
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“The book is a masterful primer for all
clinicians—especially those of us hoping to
navigate the transition from volume-based
healthcare to value-based healthcare without
running aground.”
Atul Gawande, MD
Professor of Surgery, Harvard Medical School,
author of Being Mortal and The Checklist
Manifesto
“This book is an instant classic. It
masterfully gives front-line clinicians and
other health care leaders a raft of practical
ideas to help make care dramatically safer,
more patient-focused, and more affordable.”
Donald Berwick, MD
President Emeritus and Senior Fellow, Institute
for Healthcare Improvement
summarizes and makes accessible a mountain of
relevant health care delivery research. And it gives
front-line clinicians and other health care leaders a
raft of practical ideas to help make care
dramatically safer, more patient-focused, and more
affordable."
Donald Berwick, MD
President Emeritus and Senior Fellow, Institute for
Healthcare Improvement
Understanding Value-Based Healthcare
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Stay Connected
www.costsofcare.org
@CostsOfCare
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summarizes and makes accessible a mountain of
relevant health care delivery research. And it gives
front-line clinicians and other health care leaders a
raft of practical ideas to help make care
dramatically safer, more patient-focused, and more
affordable."
Donald Berwick, MD
President Emeritus and Senior Fellow, Institute for
Healthcare Improvement
© Copyright 2015
• This publication is the property of Cost of Care, Inc. No part of
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• Some or all of the information contained herein may be protected
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• All other trademarks are owned by their respective owners