Transforming Service Lines and Institutes to Achieve Success In a Value Based Era
Brian Sweeney, RN, MBA, FACHE Vice President for Clinical and Support Services Thomas Jefferson University Hospitals Philadelphia, PA
Becker’s Hospital Review – May 4, 2015
Objectives
• Describe how service lines and institutes must evolve to align with value based care
• Identify methods to align key stakeholders and achieve results with service line initiatives
Agenda
I. Old model II. New model III. Transformational tactics IV. Evidence these tactics work
Nomenclature Varies in Healthcare Systems
Service Line Institute
Center of Excellence
Key Purpose: Organize Services and Care Delivery
Old Model
Led By Business People
Focused Mostly on Growth
Admissions
Surgeries
Office Visits
ED Visits
Hospital at Core of Model – Provider Centric
Virtual Integration
Develop New Programs to Drive More Procedures
More Marketing Please…
Old Model is Not Aligned with IHI Triple Aim
New Model
Physician Led; Administrator Managed
Focus on Outcomes…Which Positions You for Growth
HCAHPS
Cost/Case
Days to 1st Appointment
Readmissions
Mortality
Include the Whole Continuum of Care – Consumer Centric
Achieve True Integration and Alignment
Develop Programs to Keep Patients Out Of Hospital
Transformational Tactics
Executive Sponsors: Richard Webster, Mitchell Harris, Anne Docimo, MD
Champion: Brian Sweeney Mitchell Conn, MD
Financial Analyst: Vincent Sborlini
Physicians:
Cataldo Doria, MD, David Tichansky, MD, Jerry McCauley, MD, Gary Rosato, MD, David Kastenberg, MD, David Sass, MD, Scott Goldstein, MD, Serge Jabbour, MD, George Francos, MD, Thomas Kowalski, MD
Administration: Maria Neff, Barbara Clancy-Sweeney, Gloria Rosado, Chad Gorn, Dianne MacRae, Joyce Hartman, Mellissa Panagiotidis, Vicki Jones
Nursing: Eleanor Gates, RN, MSN
Performance Improvement: Jenny Bosley, RN, MSN
Marketing and PR: Allison Benton, Katie Krauss
Assure You Have the Right Team
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Embed Performance Improvement Leaders in Model
Conduct value stream mapping Assess current PI process
Lean educa7on
Gemba walks
Iden7fy projects and priori7ze
Educate and engage team members
Specify performance metrics
Design and launch new PI program
Implement changes
Sustain performance
Roadmap for the Future
Recognize You May Need to Enhance Their Skills
Invest in Physician Leadership Development, Including Coaching
Engage Physicians
• Strategic planning • Budget and P&L statements • Performance improvement projects
Assure Strategic Plans Extend Beyond Growth
Loss of P4P Dollars
Payor 1 $ 30,000.00 Payor 2 $ 190,000.00 Payor 3 $ 76,250.00 Payor 4 $ 176,000.00 Payor 5 $ 80,000.00 Payor 6 $ 37,000.00 TOTAL $ 589,250.00
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MEASURES
-‐ Diabetes Annual HbA1c Level TesKng -‐ Diabetes Annual Lipid Level TesKng -‐ Diabetes Annual ReKnal Exam -‐ Diabetes Annual HbA1c Management -‐ PaKent Centered Medical Home -‐ RecogniKon
Need to invest in diabetes educators, nutritional counselors, and care coordinators to capture this P4P revenue and achieve system cost reductions
Minimize Clinical Variation
Adjust Marketing Campaigns to Include Outcomes
Clinically Integrate and Align
• Incentive compensation • Clinically integrated network • Co-management agreements • Network agreements
Change Dashboard Metrics from Fee For Service Measures to Value Measures
• Outmigration • Episode expense • Evidence based care compliance • Access
Assure Accountability and Results
Evidence These Tactics Work
Example # 1 – Improved GI Access in Physician Practice by Reducing Days to First Appointment
• Action plan • Lean training • Process mapping/brainstormed solutions • Incentive compensation plan • Operator model • Text appointment reminders • Endoscopy SOP
26% 28% 28%
33% 32% 30%
43%
48%
52% 51%
56% 55%
50%
0%
10%
20%
30%
40%
50%
60%
Mar '14 April '14 May '14 June '14 July '14 Aug '14 Sept '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15
G.I. % of New Patients Scheduled within Threshold (<14 Days)
Example # 2: Improved Stroke Care through Telehealth
• Action plan • Telestroke network – 28 hospitals • Stroke education • Patients remain at lower cost site • Stroke centers established
Results • Consults: 6,000+ • PaKents Remaining in Community: 85.3% • tPA Treatment Rate: 16% • Mean Response Time: 12 minutes • Cost avoidance for healthcare system
Example # 3: Align Physicians Through Orthopedic Co-Management Agreement
• Action plan • Co-management agreement • Hip fracture performance improvement project • Multidisciplinary team • Pathway
Results
• LOS: 8.86 daysà 6.64 days (statistically significant reduction of 1.72 days)
• Time from admission à OR decreased by 31.68 hours • 50% reduction in number of cardiac testing units per patient
Post Becker’s Self Assessment for Your Organization
Do you have the right members on your team? Are they focused on quality/cost initiatives…in addition to growth? Is your integration and alignment strategy optimized? Have you modernized your measures? Have you prepped your team for healthcare transformation?
Contact Information: Brian Sweeney, RN, MBA, FACHE [email protected] (215) 955-7937