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Proprietary & Confidential 1 HIMSS 2015 Chicago Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician- Directed Transformation Ricardo Martinez, MD, FACEP Chief Medical Officer Donna Houlne, RN,BSN,MHA,MHRM Clinical Transformation Lead

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Page 1: North highland himss_hardwiringclinicalfinancialperformance_041315

Proprietary & Confidential 1

HIMSS 2015

Chicago

Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician-Directed Transformation

Ricardo Martinez, MD, FACEP

Chief Medical Officer

Donna Houlne, RN,BSN,MHA,MHRM

Clinical Transformation Lead

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Opportunity Knocks

• Are we leveraging or drowning in data?

• Are the right HIT systems being used by the right

people?

• How do you maintain clinical quality and cut costs?

• What is the role of the physician and the patient in the

transformation to value-based care?

• How do you increase adoption and use of HIT by

physicians?

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• Market Drivers for Value-Based Care

• Clinical Transformation

• Physician Engagement

• Patient Activation and Engagement

• Key Takeaways for Healthcare IT

Today’s Agenda

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Market Drivers

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Market Drivers of Value-Based Care

Drivers of

Healthcare Trends Current Future

• Responds with

patient need

arises

• Centered around

provider practice

& schedules

• Volume-based

• High utilization =

revenue

• Margins

dependent upon

reimbursement

Financial

Technology

Social Healthcare

Reform

• Identifies unmet

needs &

responds

proactively

• Centered around

patient needs &

schedules

• Value-based

• Utilization =

costs

• Margins

dependent upon

costs

Activity-Based

Care Fading Away

Value-Based Care

Emerging

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Change is Coming

Payment reforms will affect

financial viability

Preserve or improve margins

Reduce unnecessary

utilization

Compete in new risk-based

payment models

Clinical and quality

performance will drive contracting

Based on measurable outcomes

Data-driven decision making

Market forces are squeezing margins

Larger players expanding

market share

Geographic expansion may be needed to create

clinically integrated network

Change must be sustained

Transformationto value-based

delivery

Rapid adoption of “best” practice

patterns and processes

Evolving roles and relationships

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Designing &

Implementing

New Care Models

Changing Provider &

Patient Roles

Optimizing Care Value

and

Quantifying Risk

Addressing these items greatly increases the likelihood of success during the transition to High Performance Healthcare

Key Issues Affecting Clients

How do we evaluate the financial impact of these

changes?

What changes are we making to the delivery model?

How do we decrease cost without sacrificing quality?

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Patient-centered, physician-directed teams

Value-driven: high quality at lowest cost

Delivers measurable quality healthcare with the use of meaningful metrics, dashboards, etc.

Data-driven performance integrating Business Intelligence and is constantly learning

Connected and integrated, bothculturally and digitally

Essential Changes

The Road to High Performance Healthcare

Organizational

Transformation

Financial

Transformation

Clinical

Transformation

Digital

Transformation

Our Vision

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Clinical Transformation

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What is Clinical Transformation?

• A comprehensive, interdisciplinary approach to redesign care delivery to achieve clinical excellence and better value throughout the care continuum

Reduce

total cost of

care

Enhance

operational

efficiency

Align clinical

delivery

across

settings &

providers

Improve

financial and

clinical

performance

Data Analytics & Clinical Information TechnologyBI, Data Analytics & Clinical Information Technology

Data Analytics & Clinical Information TechnologyProvider Engagement/Patient Activation

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Clinical Transformation: Core Components

• Meaningful metrics

• Enterprise dashboards

• Gain insights & make decisions

• Monitor/manage costs per unit of service

BI/Analytics

• Care redesign driven by value over efficiency

• Physician-directed, team-powered design, implementation and oversight

• Dyad governance structure

Value-Based Care Design

• Optimize efficiency and minimize variation in process

• Strengthen handoffs & transitions across settings

• Patient activation & engagement to improve care

Care Management

Across Settings

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Decreasing Costs of Care Delivery

• Provider substitution

• Diagnostic/treatment substitution

• Setting substitution

• Process redesign:

Eliminate steps and processes

Add missing steps and processes

Re-engineer process

• Offload costs to patient and family

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Physician Engagement

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Physician Decisions Directly Affect Organizational Health

• Physicians influence the majority of decisions regarding

healthcare utilization

• Physician practice variation accounts for almost one third of

wasted cost in the healthcare industry (Institute of Medicine

2011)

• Research shows that evidenced based clinical pathways are

associated with improved outcomes at lower costs, i.e. stroke

and STEMI

• Only 36% of practicing physicians believe they have a major

responsibility for reducing healthcare costs (JAMA)

• Organizations with high physician engagement demonstrate

higher productivity and profitability (Gallup)

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Key Factors Affecting Physician Satisfaction

Source: RAND/AMA

Quality of CareElectronic Health

Records

Practice Leadership

Work Content, Quantity and Pace

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Physician Integration is not Physician Engagement

• Market segmentation / service line selection

• Business models / structures

• Contracting

• Offerings and client targets

• Recruiting, credentialing, and scheduling

• Onboarding and retention

• Physician services

Physician Integration Strategies include:

• Physician governance

• Physician leadership

• Physician alignment

• Physician adoption

Physician Engagement Strategies focus on:

Physician Engagement Drives Change

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The Difference Between Physicians vs. Non-PhysiciansUnderstanding physicians requires understanding how physicians think

Logical Reasoning

Use of Science

Evidence-Based

Thinking

Deduction

Focus on Observation

Detail Oriented

Sherlock Holmes

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Physician Engagement Methodology

Adoption CSFs

How does this help

my patients?

Where is the

evidence that

this helps?

Is this

supported by

our senior

physicians?

How does this fit

into my workflow?

Will it slow me

down?

How do I get help?

• Institute physician governance

and communication program

• Establish visible, involved

physician champion

• Frame in clinical context, with

clear examples and/or data, e.g.

• Support clinical workflow

• Highlight a clear migration

path to success

• Make training time-sensitive

with consistent readily-

available support

• Provide feedback and data to

measure success

Concerns

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What Physicians Value

Meaningful metrics and information

Data analytics with clinical insights

Tools that enhance collaboration/care

Remote access to needed information

HIT properly embedded into workflow

User-designed interfaces

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Example: Benefits of EMR Redesign By Clinical Team

Improved workflow

~41% more efficient

Saved 23.9 hours a day of

staff time

Decreased “cognitive distraction”;

interface time; clicks

Improved staff satisfaction

ROI in 50 days

1

2

3

4

5

6

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Patient Activation & Engagement

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Increasing Recognition of Patient Role in Outcomes

50% of patients with chronic

disease don’t take their

medication

~30% of newly diagnosed

patients don’t get their medication

filled

Increasing number of

patients with preventable

diseases related to obesity and

unhealthy habits

Behavioral and social factors

attribute to ~ 50% of outcomes

variance

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Empowering Patients

Patient Activation & Engagement

“By empowering patients to understand that providers are not merely professionals

to see when one gets “sick”, but valuable partners that can help provide advice

and tools for individuals to take charge and achieve health outside the clinical

setting. To realize the value this partnership can bring we first need to understand

how to activate and maintain our engagement. That’s the hardest part of all.”

- Holly Korda, Ph.D.

“To move from a health care system that primarily treats the sick in America to one

that actively promotes wellness in America…first listen to patients….They will be

our guides in designing a health care system that supports meaningful patient

partnerships and true patient-centered care.”

- Susan Frampton, PhD, President Planetree

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Activation is developmental

Patient Activation – A Patient Assessment

Consists of 13 self-reported questions, that build upon one another. Correlates with

patient outcomes, experience and costs.

Level 1: Starting to take a role

• Patients do not yet grasp that they must play an active role in their own health; they are being disposed to being passive recipients of care

Level 2: Building knowledge & confidence

• Patients lack the basic health-related facts or have not yet connected these facts into larger understanding of their health or recommended health regimen

Level 3: Taking action

• Patients have the key facts and are beginning to take action but may lack the confidence and the skill to support their behaviors

Level 4: Maintaining behaviors

• Patients have adopted new behaviors but may not be able to maintain them in the face of stress or health crises

Increasing Level of Activation

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Optimizing Clinical, Operational and Financial

Virtual or Group

Support

Associate Provider

Active Coaching

Physician-Nurse Team

High Patient Activation

Low Patient Activation

Low Care Burden High Care Burden

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Health Affairs, 2013

What is Patient- and Family-Engagement?

“Patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system – direct care, organizational design and governance, and policy making – to improve health and healthcare.”

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Patients are asked

about their

preferences in

treatment plan

Framework for Engagement

Direct Care

Organizational

Design and

Governance

Policy Making

Factors Influencing Engagement:• Patient (beliefs about patient role, health literacy, education)

• Organization (policies and practices, culture)

• Society (social norms, regulations, policy

Treatment decisions

are made based on

patients’ preferences,

medical evidence,

and clinical judgment

Patients receive

information about a

diagnosis

Organization surveys

patients about their

care experiences

Hospital involves

patients as advisers

or advisory council

members

Patients co-lead

hospital safety and

quality improvement

committees

Patients have equal

representation on

agency committee

that makes decisions

about how to allocate

resources to health

programs

Patients’

recommendations

about research

priorities are used by

public agency to

make funding

decisions

Public agency

conducts focus

groups with patients

to ask opinions about

a healthcare issue

Levels of

EngagementConsultation Involvement

Partnership and

shared leadership

Continuum of Engagement

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Outcomes of Patient Engagement and Activation

Patient starts to take a role

Patient builds confidence and knowledge

Patient takes action

Patient maintains behaviors

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Key Takeaways for Health IT

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Healthcare Data Supply & Demand is ExplodingIn These Settings…

• Hospitals

• Nursing Homes

• Clinics

• Patient Homes

• On-the-go

Are Data Creators…

• Physicians

• Nurses

• Specialists (RTs, etc.)

• Patients

• Care / Case Managers

• Pharmacists

• Medical Devices

• Labs

Creating Information…

• Patient Demographics

• Symptoms

• Diagnoses

• Procedures

• Medications

• Metrics / Parameters

• Lab Results

• Radiology / Scans

In These Destinations…

• Clinical Applications / EMR

• Data Warehouse

• Decision Support Systems

• Patient Portals

• Claims Recipients

For These Data Consumers

• Physicians

• Nurses

• Specialists (RTs, etc.)

• Patients

• Family Members

• Hospital Executives

• Care / Case Managers

• Employers

• Pharmacists

• State Governments

• Federal Government

• Insurers / Payers

• Nursing Home Executives

• Clinic Executives

• Pharmaceutical Companies

• PBMs

• Medical Device Companies

Managing Both Effectively Is Critical

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Leveraging Data Effectively Means…

• Deliver the right

information

• To the right person

• In the context of their

daily workflow

• That allows them to

make the best

possible decision

Step 1

Step 2

Right Info

Step 3

Step 4

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What Success Looks Like

• Data spans the clinical, operational and financial spectrums

• Tied together to help people understand how levers in one area impact another

• Customized for the user

• Relevant – tied to metrics that are meaningful to the role they play

• Intuitive – user involved in the design

• Real-time or near real time

• Interactive (abilityto answer “why” questions on their own)

INTEGRATED PERSONALIZED ACTIVE

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Progressive Strategies Enabled by Healthcare IT

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The Patient-Centered, Physician-Led Transformation will Create…

1

2

3

A Shared View of Performance

Sustainable, Measurable Change

A Structure for Continuous Improvement

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Q&A

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Thank you!

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