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10/29/2019
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The Changing Face of Health Care: How does CentraCare Respond and
What is the Role of Nursing?
Nursing Impact Day -- November 1, 2019Ken Holmen, MD
CentraCare President/CEO
My mother WWII Nursing Uniform
Thank you
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Ptolemy---Copernicus Healthcare Yesterday – Healthcare Today
Nurses / Physicians
/ Clinics
Nurses / Hospitals / Procedures
Who ate my green eggs and moved my ham – Where’s my cheese?
Profound Disruption
Understanding the Driver’s of Disruption
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QUADRUPLE AIM
• Improve the health of the community
• Enhance the patient experience
• Reduce the cost of care
• Improve provider and staff well-being
Continuing Paperwork
Best Practice
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Not consumer centric
Other stakeholders
INCONVENIENT
SILOED
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Not Wholistic Nor Preventative
Who Pays?
The Strategic Challenge / Opportunity for HealthCare Leaders
THE GREAT ONE:
“Skate to the where the puck is going, Not where it has been.”
Wayne Gretzky
The Strategic Challenge / Opportunity for Health Care Leaders
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Where is the puck going to be?
Cost Aging population
Fewer workers (tax payors)
Role of government as payer
COST
Data Driven
Best Practice
Results Oriented
Standardization with Customization
Data Driven
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Team Based Models
Right Care – Right Place – Right Way
– Lowest Cost
Team Based Models
Right Care – Right Place – Right Way-
Lowest Cost
TechnologyElectronic
Health RecordArtificial
Intelligence
Big Data Highly Integrated
Technology
Significant Demand
Aging
Innovation
Competition
SignificantDemand
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ConsumerismIncreased used of transparency and consumer navigation tools to guide choices
Importance of consumer experience to providers and plans, both in terms of patient acquisition, retention and loyalty, as well as patient satisfaction
Ever higher expectations of service industries driven by their positive experience with high-technology-enabled consumer offerings
Consumers need to be more proactive and engaged in their own health and wellness
Rising out-of-pocket cost burden
Consumerism
The MN Puck Examples…
The Shift to Outpatient
2007 2017 % of Change
Inpatient Gross Revenue Charges
60.8% 50.2% -17%
Outpatient Gross Revenue Charges
39.2% 49.8% 27%
Source: MHA and MedTrend, Inc
The Shift to Outpatient
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Growth Came From Outpatient SurgeriesMN Hospitals Total Change in Volumes 2007-2017
Source: MHA and MedTrend, Inc
Growth Came From Outpatient SurgeriesMN Hospitals Total Change in Volumes 2007-2017
CentraCare’s Response –MN Hospitals Now Majority Government Payment MN Hospitals Total Payer Mix Based on Charges
2007 2017 % of Change
Medicare 32% 43% 34%
Medicaid 8% 17% 112%
Government Total 40% 60% 50%
Commercial 42% 34% -19%
Source: MHA and MedTrend, Inc
MN Hospitals Now Majority Government PaymentMN Hospitals Total Payer Mix Based on Charges
The Strategic Challenge / Opportunity for HealthCare Leaders
THE GREAT ONE:
“Skate to the where the puck is going, Not where it has been.”
Wayne Gretzky
The Strategic Challenge / Opportunity for Health Care Leaders
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CostSkate
Hearts and MindsNuts and Bolts
IceDisruptors
ModelsGovernment
PuckReflects other market
forces / dynamics
Role of Nursing
Cost People (tools, training, efficiency, compensation/benefits)
Stuff (supply chain, standardization, customization
Cost
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Clinical Data Base
Benchmarking
Pay for Performance
Quadruple Aim
Best Practice
Data Driven
Team Based Models
Right Care – Right Place – Right Way
– Lowest Cost
Staffing Models Care Delivery Models When/How Services Provided
TechnologyElectronic Health
RecordArtificial
Intelligence Big Data
Integrated Systems (including financial, decision support)
Telehealth
Technology
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Significant Demand
Aging (more complex, fewer inpatient beds)
Ambulatory / Outpatients
Competition
Growth
Significant Demand
ConsumerismIncreased used of transparency and consumer navigation tools to guide choices
Importance of consumer experience to providers and plans, both in terms of patient acquisition, retention and loyalty, as well as patient satisfaction
Ever higher expectations of service industries driven by their positive experience with high-technology-enabled consumer offerings
Consumers need to be more proactive and engaged in their own health and wellness
Rising out-of-pocket cost burden
Brand / Culture /Purpose
High Tech or High Touch
Disruption
App’s
Consumerism
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Strategy / TacticsNURSING
LEADERSHIP
Significant Investments
AMBULATORY TECHNOLOGY HEALTH PLANS (MEDICARE
ADVANTAGE)
Significant Investments
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Margin versus Mission
INSURER CARE DELIVERY
VENDORS
Margin versusMission
Consumer Trends
Particular bond to doctor’s matter, but overall declining in importance
Lessons Learns from Amazon, Walmart and Sears
Patient loyalty is low
Consumer Trends
Consumer Trends
Changing Generations
Diversity
Their Way
Culture
Purpose
Brand
Consumer Trends
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Business Model
REVENUE CHALLENGE
(GOVERNMENT)
COST (PEOPLE AND STUFF)
CONTINUED VALUE (RISK
BASED)
CONTINUED COLLABORATION /
MERGERS AND ACQUISITIONS
Business Model
Care Model Team Based
Top of License
Care Model
Technology (Disruptors)
INTEGRATION – ELECTRONIC MEDICAL RECORD (EMR)
BIG DATA
VIRTUAL HEALTH
ARTIFICIAL INTELLIGENCE
Technology (Disruptors)
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Role of Leadership Help define where the
puck will be
Help your colleague (yourself ?) skate there (tools)
Role of Leadership
WHAT IT REALLY LOOKS LIKE
WHAT PEOPLE THINKIT LOOKS LIKE
SUCCESS SUCCESS
CentraCare’s Journey Quadruple Aim
Culture
Purpose
Leadership Development
– Continuous Performance Improvement (Change Management)
– Key Performance Indicators
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Role of Leadership = UncomfortablenessWinning Friends and Influencing People
You have to do the hard things
You have to make the call you’re afraid to make
You have to get up earlier than you want to get up
You have to give more than you get in return right away
You have to care more about others than they care about you
You have to fight when you are already injured, bloody and sore
You have to feel unsure and insecure when playing if safe seems smarter
You have to lead when no one else is following you yet
You have to do the hard things (continued)
You have to invest in yourself even though no one else is
You have to look like a fool while you’re looking for answers you don’t’ have
You have to grind out the details when it’s easier to shrug them off
You have to deliver results when making excuses is an option
You have to search for your own explanations even when you’re told to accept the “facts”
You have to make mistakes and look like an idiot
You have to try and fail and try again
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You have to do the hard things (continued)
You have to run faster even though you’re out of breath
You have to be kind to people who have been cruel to you
You have to meet deadlines that are unreasonable and deliver results that are unparalleled
You have to be accountable for your actions even when things go wrong
You have to keep moving towards where you want to be no matter what’s in front of you
You have to do the hard things. The things that no else is doing. The things that scare you. The things that make you wonder how much longer you can hold on.
You have to do the hard things (continued)
Those are the things that define you. Those are the things that make the difference between living a life of mediocrity or outrageous success. The hard things are the easiest things to avoid. To excuse away. To pretend like they don’t apply to you. The simple truth about how ordinary people accomplish outrageous feats of success is that they do the hard things that smarter, wealthier, more qualified people don’t have the courage – or desperation – to do.
Do the hard things. You might be surprised at how amazing you really are.
-Todd Steinke
Thank youKen Holmen, MD, CentraCare Health President/CEO
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