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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
Proprietary & Confidential 2
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?
• Market Drivers for Value-Based Care
• Clinical Transformation
• Physician Engagement
• Patient Activation and Engagement
• Key Takeaways for Healthcare IT
Today’s Agenda
Market Drivers
Proprietary & Confidential 5
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
Proprietary & Confidential 6
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
Proprietary & Confidential 7
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?
Proprietary & Confidential 8
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
Clinical Transformation
Proprietary & Confidential 10
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
Proprietary & Confidential 11
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
Proprietary & Confidential 12
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
Physician Engagement
Proprietary & Confidential 14
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)
Proprietary & Confidential 15
Key Factors Affecting Physician Satisfaction
Source: RAND/AMA
Quality of CareElectronic Health
Records
Practice Leadership
Work Content, Quantity and Pace
Proprietary & Confidential 16
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
Proprietary & Confidential 17
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
Proprietary & Confidential 18
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
Proprietary & Confidential 19
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
Proprietary & Confidential 20
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
Patient Activation & Engagement
Proprietary & Confidential 22
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
Proprietary & Confidential 23
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
Proprietary & Confidential 24
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
Proprietary & Confidential 25
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
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.”
Proprietary & Confidential 27
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
Proprietary & Confidential 28
Outcomes of Patient Engagement and Activation
Patient starts to take a role
Patient builds confidence and knowledge
Patient takes action
Patient maintains behaviors
Key Takeaways for Health IT
Proprietary & Confidential 30
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
Proprietary & Confidential 31
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
Proprietary & Confidential 32
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
Proprietary & Confidential 33
Progressive Strategies Enabled by Healthcare IT
Proprietary & Confidential 34
The Patient-Centered, Physician-Led Transformation will Create…
1
2
3
A Shared View of Performance
Sustainable, Measurable Change
A Structure for Continuous Improvement
Q&A
Thank you!
Come visit us at the Clinical & Business Pavilion – Booth 5484, Kiosk # 5. Bring your voucher to receive your free giveaway!