When the Going Gets Tough, the Tough When the Going Gets Tough, the Tough Get Data: SCAMPsGet Data: SCAMPs

James E. Lock, MDJames E. Lock, MDDepartment of CardiologyDepartment of Cardiology

Boston Children’s HospitalBoston Children’s Hospital

Harvard Medical SchoolHarvard Medical SchoolSupported by Hinden Foundation, Boston Children’s Heart Foundation,Supported by Hinden Foundation, Boston Children’s Heart Foundation,

Boston Children’s Program for Patient Safety and Quality, and the major insurers of MassachusettsBoston Children’s Program for Patient Safety and Quality, and the major insurers of Massachusetts

Pediatric Patient Safety SymposiumPediatric Patient Safety Symposium

Hospital for Sick Children – TorontoHospital for Sick Children – Toronto

June 13th, 2013June 13th, 2013

Declaration of DisclosureDeclaration of Disclosure

Boston Children’s Hospital is a member of the not-for-Boston Children’s Hospital is a member of the not-for-profit entity Institute for Relevant Clinical Data Analytics. profit entity Institute for Relevant Clinical Data Analytics. The Institute has created a multi-institutional network to The Institute has created a multi-institutional network to create and develop standardized clinical assessment create and develop standardized clinical assessment and management plans (SCAMPs) around the country, and management plans (SCAMPs) around the country, and plans to license SCAMPs and related technology and plans to license SCAMPs and related technology and services. It is possible that, in the future, Boston and services. It is possible that, in the future, Boston Children’s Hospital and SCAMP authors will receive Children’s Hospital and SCAMP authors will receive royalties from SCAMPs.royalties from SCAMPs.

James E. Lock, MD.James E. Lock, MD.

Learning ObjectivesLearning Objectives

1.1. To understand the novel components To understand the novel components behind the SCAMP processbehind the SCAMP process

2.2. To understand how the iterative SCAMP To understand how the iterative SCAMP process can lead to improved clinical process can lead to improved clinical outcomes while identifying unnecessary outcomes while identifying unnecessary resource utilizationresource utilization

3.3. To show how SCAMPs are similar and, To show how SCAMPs are similar and, more importantly, different than more importantly, different than retrospective studies, clinical practice retrospective studies, clinical practice guidelines and prospective trialsguidelines and prospective trials

Why is this Important?Why is this Important?

• The increase in medical expenditures seems to The increase in medical expenditures seems to be outstripping both the health benefits and the be outstripping both the health benefits and the nation’s financial underpinning to paynation’s financial underpinning to pay

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

15%

16%

17%

18%

19%

20%

21%

22%

National Health Care Spending

Gross Domestic Product

Data from the Centers for Medicare and Medicaid ServicesData from the Centers for Medicare and Medicaid Services

Cos

t (in

bi

llion

s)P

ercentag

e of G

DP

spen

t on

Health

C

are

Health Care in 2018:Health Care in 2018:• $4.4 Trillion in spending$4.4 Trillion in spending• >20% of the GDP>20% of the GDP

Why is this Important Now?Why is this Important Now?

• What are the options for reducing What are the options for reducing medical expenditures?medical expenditures?

1. Reduce salaries1. Reduce salaries

2. Improve efficiency for necessary care2. Improve efficiency for necessary care

3. Reduce unnecessary utilization3. Reduce unnecessary utilization

4. Ration health care4. Ration health care

What do we currently use in clinical medicine to What do we currently use in clinical medicine to standardize and improve care?standardize and improve care?

1. Best clinical judgment

2. Clinical Practice Guidelines: a care plan created by experts, intended to be followed until further notice

3. Registries or Retrospective Studies: careful look backwards

4. Prospective Randomized Controlled Trials: Meant to provide a definitive and final answer

Current PracticeCurrent Practice• 10 Cardiologists (7 different fields) were shadowed with every 10 Cardiologists (7 different fields) were shadowed with every

significant clinical decision recorded and classifiedsignificant clinical decision recorded and classified

Results – All DecisionsResults – All Decisions(n = 1188, ~170 decisions/person/day)(n = 1188, ~170 decisions/person/day)

# Decisions % of Total# Decisions % of Total

• Experience or anecdoteExperience or anecdote 441441 37.1%37.1%

• Arbitrary or instinctArbitrary or instinct 175 175 14.7%14.7%

• Trained to do itTrained to do it 173173 14.6%14.6%

• First principlesFirst principles 146146 12.3%12.3%

• General research studyGeneral research study 146146 12.3%12.3%

• Limited research studyLimited research study 6161 5.1%5.1%

• Specific research studySpecific research study 3434 2.9%2.9%

• Parental preferenceParental preference 66 0.5%0.5%

• For researchFor research 44 0.3%0.3%

• Avoid a lawsuitAvoid a lawsuit 22 0.2%0.2%

• Despite the “limited” nature of decision-making in pediatric cardiology, over Despite the “limited” nature of decision-making in pediatric cardiology, over 18 years, death from 4 “common” defects fell 2.5 fold18 years, death from 4 “common” defects fell 2.5 fold

Deficiencies of Clinical Practice GuidelinesDeficiencies of Clinical Practice Guidelines

• Mandated CPGs that have been shown to be Mandated CPGs that have been shown to be “wrong” by subsequent data“wrong” by subsequent data11

– Tight control of glucose in ICUTight control of glucose in ICU

– Normal glucose levels in outpatientsNormal glucose levels in outpatients

– Recommendations for hip & knee replacementsRecommendations for hip & knee replacements

– Best practices in treatment of congestive heart failureBest practices in treatment of congestive heart failure

– Statins in renal failure patients on dialysisStatins in renal failure patients on dialysis

– Outpatient treatment of asthma and hypertensionOutpatient treatment of asthma and hypertension

– Antibiotics within 4 hours of ER visit for pneumoniaAntibiotics within 4 hours of ER visit for pneumonia

• Adherence to a pediatric asthma CPG was Adherence to a pediatric asthma CPG was between 39% and 53%between 39% and 53%22 1Groopman, The New York Review, January 2010

2Cabana, Arch Pediatr Adolesc Med, Sept 2001

Conflicts of Interest for Guideline Authors

Overall

Research Grants

(industry)

Non-industry research support

Speaker Honoraria

Expert Witness

Ownership Interest

Consultant/ Advisory

Board

Percent with disclosures

82.4%

55.9%

29.4%

20.6% 5.9% 5.9% 50%

Percent with significant financial relationship

17.6%

14.7%

5.9%

2.9% 0% 2.9% 8.8%

Percent with no financial benefit, or benefit is not industry related

17.6%

44.1%

100%

79.4% 79.4% 94.1% 50%

This table shows the percentages and breakdown of financial relationships for guideline committee members who participated in writing ACCF/AHA clinical guidelines in 2010

Source: CardioSource WorldNews

Randomized Controlled TrialsRandomized Controlled Trials

Outcome 2Outcome 2

Superior Intervention

Generalization

of Results?

?

?

?Outcome 3

(Not measured)Outcome 3

(Not measured)

UnnecessaryResourceUtilization

UnnecessaryResourceUtilization

?

?

StandardizedEntry Criteria,Assessment,

& Management

StandardizedEntry Criteria,Assessment,

& Management

Management1

Management1

Management 2

Management 2

Outcome 1(Preferredoutcome)

Outcome 1(Preferredoutcome)

RCT’s only provide answer RCT’s only provide answer for a few patients and for only for a few patients and for only

1 or 2 outcomes during a 1 or 2 outcomes during a short time period. Even then short time period. Even then

are they correct?are they correct?

What About the What About the Gold Standard?Gold Standard?

Shojania et al. Ann Internal Med 2007

Summary of the Status QuoSummary of the Status Quo

•We make most medical decisions based on instinct, We make most medical decisions based on instinct, anecdotes, first principles, or traininganecdotes, first principles, or training

•Current tools are demonstrably inadequate to handle the Current tools are demonstrably inadequate to handle the fact that fact that medicine is changing constantlymedicine is changing constantly

, usually new RCTs

of RCTs

Duration of RCT “Validity”Duration of RCT “Validity”

3. Data collection should be targeted based on prior 3. Data collection should be targeted based on prior probabilities… probabilities…

but not but not soso narrowly that important, unplanned narrowly that important, unplanned consequences are missed. consequences are missed.

First Principles for SCAMPsFirst Principles for SCAMPs::

4. Diversions are permitted…4. Diversions are permitted…

but the reasons must be recorded. but the reasons must be recorded.

These diversions will accelerate improvement.These diversions will accelerate improvement.

SStandardized tandardized CClinical linical AAssessment and ssessment and MManagement anagement PPlans: lans: SCAMPsSCAMPs

1. There is no such thing as “best” practice…1. There is no such thing as “best” practice…

only sound practice that is constantly changing.only sound practice that is constantly changing.

2. Very few decisions are informed by 2. Very few decisions are informed by conclusive data… conclusive data…

which are hard to acquire and often incorrect. which are hard to acquire and often incorrect. Changes should be made on persuasive data.Changes should be made on persuasive data.

Unlike a CPG, a SCAMP is a care plan created by clinicians intended Unlike a CPG, a SCAMP is a care plan created by clinicians intended to continuously improve and promote innovationto continuously improve and promote innovation

“Evidence” Based Standard Assessment &Management

“Evidence” Based Standard Assessment &Management

SCAMPsSCAMPs

Selected Information Captured In

All Categories

Data analysis and frequent (q 6 month)

literature review allows for SCAMP modification and

improvement

Knowledge orInnovation

BasedDiversion

Knowledge orInnovation

BasedDiversion

PredictedOutcomePredictedOutcome

UnnecessaryResourceUtilization

UnnecessaryResourceUtilization

UnexpectedOutcome

UnexpectedOutcome

SCAMPs HistorySCAMPs History

• 2006: Effort begun to establish CPGs for outpatient 2006: Effort begun to establish CPGs for outpatient assessment and management of several conditionsassessment and management of several conditions

• 2007: Realization that nearly all recommendations for 2007: Realization that nearly all recommendations for the CPG would be arbitrary or anecdotalthe CPG would be arbitrary or anecdotal

• 2008: Recognition that SCAMP-like activities have 2008: Recognition that SCAMP-like activities have been very successful in past improvements in care, been very successful in past improvements in care, creation, and modification of SCAMP prototypescreation, and modification of SCAMP prototypes

• 2009: Finalization of the SCAMP approach, creation 2009: Finalization of the SCAMP approach, creation of 7 SCAMPs, development of data collection tools, at of 7 SCAMPs, development of data collection tools, at Boston Children’s Hospital. First patient enrolled in Boston Children’s Hospital. First patient enrolled in March 2009March 2009

• 2010: First analysis of SCAMP data with subsequent 2010: First analysis of SCAMP data with subsequent SCAMP improvementSCAMP improvement

• 2011: Spread of SCAMPs to multiple sites, including 2011: Spread of SCAMPs to multiple sites, including BWHBWH

SCAMPs and ResearchSCAMPs and Research

• The care plan is carefully crafted to be within the boundaries of The care plan is carefully crafted to be within the boundaries of "standard of care" and only data relevant to clinical care are "standard of care" and only data relevant to clinical care are captured captured

• Analysis conducted with the Analysis conducted with the intentintent of informing, improving, and of informing, improving, and streamlining the health care delivery process and therefore streamlining the health care delivery process and therefore qualifies as quality improvement qualifies as quality improvement

• Retrospective data analysis with the Retrospective data analysis with the intentintent of producing of producing generalizable knowledge comprises human subject research generalizable knowledge comprises human subject research and therefore requires IRB approval when undertakenand therefore requires IRB approval when undertaken

Adult Acute Kidney Injury SCAMP AlgorithmAdult Acute Kidney Injury SCAMP Algorithm

Pediatric SCAMPs in Current UsePediatric SCAMPs in Current UseTotal number of pediatric SCAMPs: 43Total number of pediatric SCAMPs: 43

•Airway Disorders•Aortic Regurgitation•Aortic Stenosis•AS for Cath Lab•Arterial Switch Operation•Aspiration Pneumonia•Blood Ordering/Cell Salvage•Chest Pain•Coarctation•Cognitive and Headache Management•Critical Asthma•Cytomegalovirus Prevention•Dilated Aorta•Distal Radius Fracture•ECMO Anticoagulation •Fever of Unknown Origin•Food Challenge•Hypertrophic Cardiomyopathy•Hyperparathyroidism •Immune Thrombocytopenia•Interstage Single Ventricle•Lipid Management

• Lipid PCP• Lymphatic Malformations• MS/AA• Myocarditis• Neonatal PDA• Nutrition• Operative Management of TOF/PS• Orthodontic Retention• Papilledema• PICC Line Placement• Polycystic Ovarian Syndrome• PPHN• Pressure Ulcer • Sedated Echo • Sedation and Analgesia for Ventilated Pts• Skin Abscess• Small PDA• Somatoform disorders• Syncope• Ureterocele• Wolff–Parkinson–White syndrome

Adult SCAMPs in Current UseAdult SCAMPs in Current Use

• Total number of adult SCAMPs: 6Total number of adult SCAMPs: 6

• Examples include:Examples include:– Distal radius fractureDistal radius fracture

– Acute kidney injuryAcute kidney injury

– Breast reconstruction post mastectomyBreast reconstruction post mastectomy

– Inpatient management of low probability of Inpatient management of low probability of acute coronary syndromeacute coronary syndrome

– Lumbar spine fusionLumbar spine fusion

– Discharge management of CHF Discharge management of CHF exacerbationsexacerbations

Total Patient Encounters at Boston Children’sTotal Patient Encounters at Boston Children’s

Total of 30,922 encounters (on 11,732 patients)

as of 5/1/2013

The First SCAMP The First SCAMP (March 2009)(March 2009)

Transposition of the great arteries after Transposition of the great arteries after an arterial switch operation (ASO)an arterial switch operation (ASO)

• Background Background – ASO is now the preferred operation for ASO is now the preferred operation for

TGA. Remaining issues include lung and TGA. Remaining issues include lung and coronary obstruction, a large aorta, and coronary obstruction, a large aorta, and weakened heart muscle. Sound weakened heart muscle. Sound assessment and management is unclear.assessment and management is unclear.

• Plausible Findings make us collect Plausible Findings make us collect relevant data on those 4 areas of relevant data on those 4 areas of concernconcern

SCAMP Analytics and Actions: ASOSCAMP Analytics and Actions: ASO

First review (n=86)First review (n=86)– OO22 saturations were invariably normal saturations were invariably normal Eliminated Eliminated

– Cardiac MRI at 12 years (n=15) yielded no new relevant clinical data Cardiac MRI at 12 years (n=15) yielded no new relevant clinical data Continuing to follow Continuing to follow

– Poor compliance with 6 year lipid assessment Poor compliance with 6 year lipid assessment Continuing to follow Continuing to follow

Second review (n=173)Second review (n=173)– Cardiac MRI at 12 years (n=34) yielded no new relevant clinical data Cardiac MRI at 12 years (n=34) yielded no new relevant clinical data

Use MRI for high risk patients only Use MRI for high risk patients only

– Continued poor compliance with 6 year lipid assessment Continued poor compliance with 6 year lipid assessment Eliminate Eliminate

– Sedated echo at 2 years (n=20) unhelpful Sedated echo at 2 years (n=20) unhelpful Eliminate Eliminate

Third review (n=227)Third review (n=227)– No new significant cardiac findings after 6 years of age No new significant cardiac findings after 6 years of age Reduce Reduce

surveillance testing by 50%surveillance testing by 50%

How often are SCAMPs followed?How often are SCAMPs followed?

Chest Pain SCAMP Compliance with TestingChest Pain SCAMP Compliance with Testing

Testing Modality CHB NECCA* Total

ECG Recommended 357/357 (100%) 99/99 (100%) 456/456 (100%)

Echo Recommended 138/177 (78%) 34/41 (83%) 171/218 (78%)

Echo Not Recommended 161/180 (89%) 44/58 (76%) 205/238 (86%)

CXR Recommended 0/1 (0%) 0/0 0/1 (0%)

CXR Not Recommended 338/356 (95%) 89/99 (90%) 427/455 (94%)

Total Compliance 93% 90% 92%

**NECCANECCA includes Mass General Hospital, Connecticut Children’s, Baystate, includes Mass General Hospital, Connecticut Children’s, Baystate, Vermont Children's, Dartmouth, Harvard Vanguard, University of Vermont Children's, Dartmouth, Harvard Vanguard, University of Massachusetts, Maine Medical Center and CHA (Worcester)Massachusetts, Maine Medical Center and CHA (Worcester)

SCAMP Diversion AnalysisSCAMP Diversion Analysis

What is a “Justifiable” Diversion?What is a “Justifiable” Diversion?Example: A 1 year old presents to clinic with a PDA that is too Example: A 1 year old presents to clinic with a PDA that is too

small (diameter 1.8 mm, normal LV size) to recommend small (diameter 1.8 mm, normal LV size) to recommend cath lab closure according to the PDA SCAMP. Patient is cath lab closure according to the PDA SCAMP. Patient is nonetheless referred to the cath lab for closure.nonetheless referred to the cath lab for closure.

I. I. Reasons for diversion:Reasons for diversion:

- Abnormal Q wave in V6 suggests significant LV volume - Abnormal Q wave in V6 suggests significant LV volume loadload

- LV and LA look considerably larger than RV and RA on - LV and LA look considerably larger than RV and RA on echo.echo.

II. II. Findings at Cath: Findings at Cath:

- Moderate (3 mm) PDA with significant shunt.- Moderate (3 mm) PDA with significant shunt.

II. II. Changes to the SCAMP:Changes to the SCAMP:

- Consider new plausible finding: LV/RV volume ratio is a - Consider new plausible finding: LV/RV volume ratio is a better of predictor of PDA size than absolute LV sizebetter of predictor of PDA size than absolute LV size

SCAMPs and Comorbidities

• Aortic Stenosis and Aortic Regurgitation SCAMPs recommend no exercise restrictions

• Largest diversion category for both AS and AR were providers restricting exercise (no weightlifting). Almost all cases were due to co-morbidity of dilated aorta.

• Important and unidentified management issues related to co-morbidities are recognized through diversion analysis and are included in revised version of SCAMPs

SCAMPs Provider Experience SurveySCAMPs Provider Experience Survey2011 Results

2%6%

13%

41%37%

0%

10%

20%

30%

40%

50%

60%

VeryNegative

Negative Neutral Positive VeryPositive

How positive or negative is your opinion of SCAMPs?

2010 Results

0%

10%

27%

48%

15%

0%

10%

20%

30%

40%

50%

60%

VeryNegative

Negative Neutral Positive VeryPositive

Which evidence-based method do you prefer?

2010 Results

30%

11% 13%

46%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

CPG Care Pathway ClinicalProtocol

SCAMP Other

Patient Experience Survey (Nov 2011)

Claims data from a Massachusetts Insurance CompanyClaims data from a Massachusetts Insurance Company

Baseline EvaluationΔ Standardized Billed Medical

Charges *N F/U Time (mo) N F/U Time (mo)

AR 8 69.85 5 37.01 -50%

AS 6 46.74 5 32.26 11%

ASO 21 133.92 14 94.03 -25%

DA 24 173.68 24 152.3 -63%

HCM 14 80.09 23 134.66 -28%

* Per member per month* Per member per month

Chest Pain SCAMP: Reducing UtilizationChest Pain SCAMP: Reducing Utilization

• An echo is “indicated” only with chest pain on exerciseAn echo is “indicated” only with chest pain on exercise

• Mean patient actual care charges pre-SCAMP = $2,506/ptMean patient actual care charges pre-SCAMP = $2,506/pt

• Mean patient actual care charges with SCAMP = $2,068/ptMean patient actual care charges with SCAMP = $2,068/pt

• Chest Pain SCAMP has lead to ~20% reduction in actual Chest Pain SCAMP has lead to ~20% reduction in actual patient care chargespatient care charges

% of patients with exertional CP who did not have an echo

17%

33%

0%

10%

20%

30%

40%

50%

His toric al C ontrol (n= 406) S C AMP P atients (n= 457)

% of patients with CP exclusively at rest who had an echo

29%

14%

0%

10%

20%

30%

40%

50%

Historical Control (n=406) SCAMP Patients (n=457)

Catch Lab Aortic Valvuloplasty SCAMP: Improving Catch Lab Aortic Valvuloplasty SCAMP: Improving OutcomesOutcomes

Ideal (AS <35 mm Hg, 0 – trace AR)Adequate (AS <35 mm Hg, mild AR)Inadequate (AS ≥ 35 mm Hg or ≥

moderate AR)

Brown et al, JACC 2011.

Freedom from AVR at 10 years: - Ideal: ~95% - Adequate: ~80% - Inadequate: ~65%

Freedom from AVR at 10 years: - Ideal: ~95% - Adequate: ~80% - Inadequate: ~65%

Catch Lab Aortic Valvuloplasty SCAMP: Improving Catch Lab Aortic Valvuloplasty SCAMP: Improving OutcomesOutcomes

Ideal = AS <35 mm Hg, 0 – trace ARAdequate = AS <35 mm Hg, mild AR)Inadequate = AS ≥ 35 mm Hg or ≥

moderate AR)

SCAMP Benefits (to whom)SCAMP Benefits (to whom)

• Cardiology exampleCardiology example

– 6 SCAMPs have saved $726,000 in avoided 6 SCAMPs have saved $726,000 in avoided testing coststesting costs

– Testing costs were estimatedTesting costs were estimated

• 6 Cardiology SCAMPs6 Cardiology SCAMPs

– Direct costs savings of $510,000Direct costs savings of $510,000

• Return on investment if 42%Return on investment if 42%

SCAMPs Benefits for PayorSCAMPs Benefits for Payor

• 2 SCAMPs with actual single payor cost data2 SCAMPs with actual single payor cost data

– ASO SCAMP: 37% reduction (vs 11% projected)ASO SCAMP: 37% reduction (vs 11% projected)

– Hypertrophic cardiomyopathy SCAMP: 29% Hypertrophic cardiomyopathy SCAMP: 29% reduction (vs 20% projected)reduction (vs 20% projected)

• Payor savings on these 2 SCAMPs: $149,000 Payor savings on these 2 SCAMPs: $149,000 (not statistically robust)(not statistically robust)

• Assume this payor has a 20% market share, Assume this payor has a 20% market share, then BCH saves payors $745,000 on two then BCH saves payors $745,000 on two SCAMPsSCAMPs

– Are there savings from factors other than testings?Are there savings from factors other than testings?

• Return on investment if 338% (this is a major Return on investment if 338% (this is a major effect!)effect!)

Pediatric SCAMPs NetworkPediatric SCAMPs Network• Boston Children’s Hospital Boston Children’s Hospital

• New England Congenital Cardiology Association (NECCA) New England Congenital Cardiology Association (NECCA) – Harvard Vanguard Harvard Vanguard

– Baystate Medical Center Baystate Medical Center

– Connecticut Children’s MC Connecticut Children’s MC

– Vermont Children’s Hospital Vermont Children’s Hospital

– Dartmouth Hitchcock Dartmouth Hitchcock

• Children’s Hospital of Wisconsin Children’s Hospital of Wisconsin

• Children’s National Medical Center (Washington, DC) Children’s National Medical Center (Washington, DC)

• University of California San Francisco University of California San Francisco

• StanfordStanford

• Pediatric Endocrine SocietyPediatric Endocrine Society

• Hospital for Sick Kids (Toronto, Canada)Hospital for Sick Kids (Toronto, Canada)

• Great Ormond Street (London, United Kingdom)Great Ormond Street (London, United Kingdom)

– Hasbro Children’s Hasbro Children’s

– University of Mass University of Mass

– Mass General Hospital Mass General Hospital

– Maine Medical Center Maine Medical Center

– CHA (Worcester, MA) CHA (Worcester, MA)

Adult SCAMPs NetworkAdult SCAMPs Network

• Brigham Women’s Hospital Brigham Women’s Hospital

• Lancaster General HospitalLancaster General Hospital

How Will SCAMPS Become an Ongoing, Integral Part of Medical Care?

1. Institute for Relevant Clinical Data Analytics established as 501c3 non-profit in 2010

2. Formal Members: Boston Children’s Hospital, Brigham and Women’s Hospital, Children’s Hospital of Wisconsin, Children’s National Medical Center (Washington D.C.), Lancaster General Hospital, Pediatric Endocrine Society, NECCA, Toronto Sick Kids

3. Institutions reviewing contract: Stanford, Sydney Children’s Hospital (Australia)

How Will SCAMPS Become an Ongoing, Integral Part of Medical Care?

4. Products:

a. SCAMP content itself

b. Consulting services to help others write and implement SCAMPs

c. Data generated from SCAMP and modifications based on that data

d. Software programs

e. Data related to but not directly derived from SCAMPs (i.e., diversion analyses)

f. Use of SCAMPs for MOC credit

Current Finances of SCAMPsCurrent Finances of SCAMPs

Impact on Benefit Impact on Benefit Creators (Provider Creators (Provider

Institutions / Doctors)Institutions / Doctors)

1.1.Reduced revenue from Reduced revenue from reduced unnecessary carereduced unnecessary care

2.2.Increased costs to collect Increased costs to collect and analyze data to further and analyze data to further reduce unnecessary carereduce unnecessary care

3.3.Decreased margin, Decreased margin, because unnecessary care because unnecessary care is the most profitable careis the most profitable care

Impact on Benefit Impact on Benefit RecipientsRecipients

1.1.PayersPayers

2.2.PatientsPatients– Better careBetter care

– Reduced co-paysReduced co-pays

– Less time waiting for Less time waiting for unnecessary careunnecessary care

3.3.EmployersEmployers– Healthier workersHealthier workers

– Reduced premiumsReduced premiums

$ $ $

Conclusions and Next StepsConclusions and Next Steps

• SCAMPs have successfully and repeatedly, in a SCAMPs have successfully and repeatedly, in a variety of conditions and locations:variety of conditions and locations:

– Reduced practice variationReduced practice variation

– Iteratively optimized careIteratively optimized care

– Reduced unnecessary utilizationReduced unnecessary utilization

• SCAMPs build on key principles well-known to SCAMPs build on key principles well-known to clinicians, permit diversions, and use data to improve clinicians, permit diversions, and use data to improve care deliverycare delivery

• SCAMPs create natural networks to rapidly and SCAMPs create natural networks to rapidly and collaboratively improve care deliverycollaboratively improve care delivery

• Expansion of SCAMPs IT support and network is Expansion of SCAMPs IT support and network is rapid and inevitable, but will require careful planningrapid and inevitable, but will require careful planning