North highland himss_hardwiringclinicalfinancialperformance_041315
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North Highland's Ricardo Martinez and Donna Houlne's presentation on "Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician-Directed Transformation"
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North highland himss_hardwiringclinicalfinancialperformance_041315
- 1. Proprietary & Confidential1 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
- 2. Proprietary & Confidential2 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?
- 3. • Market Drivers for Value-Based Care • Clinical Transformation • Physician Engagement • Patient Activation and Engagement • Key Takeaways for Healthcare IT Today’s Agenda
- 5. Proprietary & Confidential5 Market Drivers of Value-Based Care Drivers of Healthcare TrendsCurrent 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
- 6. Proprietary & Confidential6 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 Transformation to value-based delivery Rapid adoption of “best” practice patterns and processes Evolving roles and relationships
- 7. Proprietary & Confidential7 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?
- 8. Proprietary & Confidential8 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, both culturally and digitally Essential Changes The Road to High Performance Healthcare Organizational Transformation Financial Transformation Clinical Transformation Digital Transformation Our Vision
- 10. Proprietary & Confidential10 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
- 11. Proprietary & Confidential11 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
- 12. Proprietary & Confidential12 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
- 14. Proprietary & Confidential14 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)
- 15. Proprietary & Confidential15 Key Factors Affecting Physician Satisfaction Source: RAND/AMA Quality of Care Electronic Health Records Practice Leadership Work Content, Quantity and Pace
- 16. Proprietary & Confidential16 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
- 17. Proprietary & Confidential17 The Difference Between Physicians vs. Non- Physicians Understanding physicians requires understanding how physicians think Logical Reasoning Use of Science Evidence- Based Thinking Deduction Focus on Observation Detail Oriented Sherlock Holmes
- 18. Proprietary & Confidential18 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
- 19. Proprietary & Confidential19 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
- 20. Proprietary & Confidential20 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
- 21. Patient Activation & Engagement
- 22. Proprietary & Confidential22 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
- 23. Proprietary & Confidential23 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
- 24. Proprietary & Confidential24 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
- 25. Proprietary & Confidential25 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
- 26. 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.”
- 27. Proprietary & Confidential27 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 Engagement Consultation Involvement Partnership and shared leadership Continuum of Engagement
- 28. Proprietary & Confidential28 Outcomes of Patient Engagement and Activation Patient starts to take a role Patient builds confidence and knowledge Patient takes action Patient maintains behaviors
- 29. Key Takeaways for Health IT
- 30. Proprietary & Confidential30 Healthcare Data Supply & Demand is Exploding In 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
- 31. Proprietary & Confidential31 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
- 32. Proprietary & Confidential32 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 (ability to answer “why” questions on their own) INTEGRATED PERSONALIZED ACTIVE
- 33. Proprietary & Confidential33 Progressive Strategies Enabled by Healthcare IT
- 34. Proprietary & Confidential34 The Patient-Centered, Physician-Led Transformation will Create… 1 2 3 A Shared View of Performance Sustainable, Measurable Change A Structure for Continuous Improvement
- 35. Q&A
- 36. Thank you! Come visit us at the Clinical & Business Pavilion – Booth 5484, Kiosk # 5. Bring your voucher to receive your free giveaway!