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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