Symposium on Delivery Science:Evolution & Application

A focus on:• The boundaries of Delivery Science• Tools and expertise for success in patient care in the reformed health system• The role of supply chain in new models of innovation• Meeting the dual demands for clinical and economic integration

A panel from academia, practice, and the supplier community including:• Amol Navathe, M.D., Ph.D., Co-Editor, Health Care: The Journal of Delivery Science and Innovation• Keith Lindor, M.D., Executive Vice Provost and Dean, College of Health Solutions, ASU• Terry Loftus, M.D., MBA, Medical Director of Surgical Services and Clinical Resources, Banner

Health• Michael Nagel, MBA, President and CEO, Vomaris Innovations• Natalia Wilson, M.D., MPH, Co-Director Health Sector Supply Chain Research Consortium, ASU

The Science of Healthcare Delivery:Moving Beyond Theory

Terry Loftus, MD, MBA, FACSMedical Director

Surgical Services & Clinical ResourcesBanner Health, Phoenix, Arizona

Agenda

• Challenges– Volume to Value– Transition from High Cost to Low Cost Centers– The Great Migration

• Approaches– Contracting– Utilization– Physician Support– Clinical Practice– Patient Safety

CHALLENGES

Volume to Value

Qua

lity

of L

ifeComfortable setting

Chronic Disease Management

Cost Effective

Independent, Healthy Living

$1 $10 $100

Home Care

Assisted Living

Skilled Nursing Facility

Residential Care

ICU

Community Hospital

Specialty Clinic

Acute Care

Cost of Care / Day

Source: IBM ‘Connected Health’ Solution, 2011

$10,000$1000

High Cost to Low Cost Centers

The Great Migration

2010 2011 2012 2013 20140.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0% 61.4% 60.8%

51.9% 48.9% 46.7%

Inpatient Surgery CasesAcute Care Facilities

VALUE ANALYSIS PROGRAMContracting

VAP: EVAR/ELGs

Vendor A Vendor B Vendor C Vendor D

Value Analysis Teams

• EVAR/ELGs*• Synthetic Mesh*• Biological Mesh*

– Hernia & Breast Reconstruction• Spinal Implants• Ortho-biologics• Heart Valves• Urinary Incontinence

Value Analysis Savings

1 2 3

$556,990 $556,990 $556,990

$203,392 $203,392

$106,617

2013 Value AnalysisEVAR Synthetic Mesh Biological Mesh

$867K Total Savings

ORAL RINSE IN THE ICUUtilization

CHG Oral Care Case Study

• Critical Care Discipline Team identified a variance in supply usage (Q2 vs Q4)

• Worked with Supply Chain to reviewed literature to identify best practice (Q4)

• Team standardized practice across system and reduced costs

• System savings $129K (cut in half)

REPROCESSINGUtilization

Reprocessing

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec $-

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

Reprocessing SavingsPerioperative + Surgery Centers

20122013

45.4% increase from 2012 to 2013 -> $ 2M Savings

(All -> $4.9M Savings)

ALL HANDS ON DECKUtilization

Aligning Strategies

Preventing new non-value added spend just as critical as reducing current non-value added spend

Daily CHG Patient Hygiene Case Study

• Care Management and Supply Chain teamed with Infection Prevention– Care Mgt narrowed scope of patient population– Supply Chain lower cost alternative identified and

contracted

• Potential $1M+ spend down to $300K

ENERGY DEVICEADHESION BARRIER

Physician Support

Ortho CCG Recommendation

$255,570 Savings

OB/Gyn CCG: Adhesion Barriers

--OB Clinical Practice* changed to eliminate adhesion barriers

--Supply cost was reduced by nearly $1 million annually

*Edwards RK, et al. Obstet Gynecol. 2014; 123: 919,923-928.

BOWEL SURGERYTOTAL KNEE ARTHROPLASTY

Clinical Practice

• Bowel Surgery– Key Process Steps:

• Early & frequent activity: ambulating 3 or more times on POD #1• Early alimentation: a minimum of 200cc of liquids on POD #1

• Total Knee Arthroplasty– Key Process Steps:

• Early activity: mobilizing patient out of the bed, either to a chair, standing at the bedside or ambulating any distance on POD #0

• Avoidance of continuous urinary catheter: no use of a continuous urinary catheter during their hospital stay

Clinical Practice Metrics

Accelerating Adoption & Sustaining the Gains

OutcomesBowel Surgery Outcomes* Reduction

Complications -27.8%

Gastrointestinal -30.2%

Ileus -29.8%

Pulmonary -34.4%

30-day Readmission -17.5%

TKA Outcomes** Reduction

Complications -10.5%

Cost ($1000) mean -9.7%

30-day Readmission -18.8%

LOS -7.6%

* Loftus T, Stelton S, Efaw BW, Bloomstone J. A system wide care pathway for enhanced recovery after bowel surgery focusing on alimentation and ambulation reduces complications and readmissions. J. Healthcare Quality. 2014 Feb 20 (Epub ahead of print).** Loftus T, Agee C, Jaffe R, Tao J, Jacofsky D. A simplified pathway for total knee arthroplasty improves outcomes J. Knee Surg. 2013 Nov 14 (Epub ahead of print).

$3M Savings

SAFE SURGERY PROGRAM

Patient Safety

Patient Safety & SRE

• Safe Surgery Program– Implemented in 22 acute and 8 ASC OR’s– Results

• Increase in days between SRE:121%

• Reduction in SRE:52%

• Est. 10 year cost avoidance:$5,565,523

Questions