The High Value Healthcare Collaborative (HVHC) Model for Driving

Innovation/Spread in Care & Payment Reform

Lucy Savitz, Ph.D., MBA

Director of Research and Education

Institute for Health Care Delivery Research

Intermountain Healthcare

The High Value Healthcare Collaborative (HVHC) is a collaborative of provider organizations who’s mission is to:

• improve healthcare value – defined as quality and outcomes over costs, across time – for its service population in the U.S.

• Serve as a model for national healthcare reform.

Sustainable Health System, Provider-driven

HVHC delivers on its mission by: – identifying best-practice care models – testing value-based payment models– accelerating adoption of these models through:

• collaborative improvement efforts• a common information infrastructure• tools to support care delivery

Resulting in:

1)Improved Population Health,

2)Value-Based Care, and 3)Reduced Costs.

Sustainable Health System, Provider-driven

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20 Members and Growing 31 states; patients in every state

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70,000 PHYSICIANS300,000 STAFF

20 MEMBERS

70,000,000 PATIENTS

30,000 BEDS200 HOSPITALS

31 STATES

Working together, we can really make a difference

Founding Partners

Mayo ClinicIntermountain HealthcareDartmouth Hitchcock Medical Center (The Dartmouth Institute (TDI) – data center, convener)

Denver Health

Partners

Baylor Health Care SystemScott & White HealthcareUniversity of Iowa Health CareBeaumont Health SystemNorth Shore-Long Island Jewish Health SystemMaineHealthProvidence Health & Services (affiliate)UCLA Medical CenterVirginia Mason Medical CenterBeth Israel Deaconess Medical Center

More Partners

Hawaii Pacific HealthSinai Health SystemNYUBoston Children’sDept of Defense Tricare (MCA signed)

All are integrated delivery systems(+/- insurance – ownership vs. partnership)

Other systems showing active interest

Core funding: Annual member paymentssupplemented by grants

Core Activities

MCA – Master Collaborative Agreement: establishes principles by which we work together and share data

Criteria for Membership

“All in” collaborative projects –• Total knee (e.g., HA article)• Diabetes mellitus• Heart failure (just starting)• Episodic bundled payment (focus: total knee)• Medicare data base analysis

Core Activities (continued)

Voluntary collaborative projects –oCMMI Innovation Challenge - ~$120 million

• Shared Decision Making – hip, knee, spine, diabetes, HF

• Sepsis• 3 QI projects in complex chronically ill

patients

oOther

Shared Learning

3 levels of deployment:

• Directly participate in a project• Adopt a success from another subgroup

(direct access to front-line, hands-on expertise)

• Transparently Publish

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HVHC Organization Structure

HVHC Program

HVHC Data Trust & Collaborative Tools

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HVHC TKR patients, every state

Addressing Unwarranted Variation in Health Care: Can Better Care Cost Less?

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Cost = cost per episode x # of episodes

Variation in cost per episode: Cost of TKRs across HVHC sites

Variation in # of episodes: # of TKRs across HVHC sites

Sample: % TKR Patients Discharged to Self-care

Site E higher due to lack of insurance Site G higher due to intentional process HVHC is now testing

Sample: TKR Length of Stay (LOS) Improvement

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Average Length of Stay (in days)

Site C has reduced its Length of Stay for TKRs by almost a day

Early results of change

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CMMI Innovation Challenge Award

The goals of this initiative are to:

1. Improve quality, outcomes, and cost of care by advancing

best practice care models for patients considering hip, knee,

or spine surgery and patients with diabetes, congestive heart

failure, or sepsis

2. Improve patient experience and reduce utilization and total

cost by implementing:

a. Shared decision making (SDM) interventions for preference-

based decisions (hips, knees, spine surgery)

b. Patient engagement interventions (e.g., decision tools,

motivational interviewing, patient management) for complex

patients with diabetes or CHF

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35,000 Knee Patients55,000 Knee

SurgeryPatient Data Cohorts385,000 Diabetes Patients

40,000 Sepsis39 Million CMS

Beneficiaries

Patient Data: identify best practices, assess impact of change, support research