clinical strategic plan & community best citizen …expanding quality beyond our traditional...

Clinical Strategic Plan &Community Best Citizen…expanding quality beyond our traditional definitionsPresented by: Randy Axelrod, MD

The objectives for today include…

• Provide an overview of the new Clinical Strategic Plan and our evolving environment

• Explore the focus on becoming the “Community Best Citizen”

• Discuss governance implications and opportunities

Providence Health & Services | GOVERNANCE CONFERENCE

“The significant problems of our time cannot be solved by the same level of thinking that created them.”

Albert Einstein

Providence Health & Services | 2014 GOVERNANCE CONFERENCE

As we assume more “accountability” and risk increases, the “reward band” widens substantially – we must be creative

Full Risk(Total popula-

tion)

Defined Risk Population

Com-prehen-

sive Bundle

DefinedEpisode

(DRG)Expanded Episode (DRG with penalty)

PercentCharges

Risk

Rew

ard

Low Unit Costs

Optimized Care

Variation Management

Clinical & Contractual Alignment

Advanced Informatics

Population orientation

High Unit Costs

High Variation

No Clinical Alignment

Poor Quality

No Continuum of Care


Shifting “Event Orientation” to “Community Needs” is the underpinning of our clinical transformation If Quality is defined as “the degree to which health services for individuals and

populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” and…

Unit Cost x Utilization = Total Cost of Care and… Latency inversely related to experience then…

= Value of Care

Our main focus should be the delivery of a refined and enriched value proposition to our patients and customers through the improvement of the total cost of care while maintaining or improving access and quality

5

This is NOT possible without clinical leadership, clinical and financial information, careful strategic planning and community engagement. The world of healthcare is changing – we can choose to be the architects or merely the dwellers.

There was a great deal of developmental work by a broad audience


As our commitments transform so must our responses – broadening beyond Quality Strategic Framework

• Our commitment to “Create Healthier Communities, Together” demands a new approach

• Era of healthcare accountability requires full continuum involvement

• Quality and safety focus and all it entails must become embedded in everything we do

• Broader organizational engagement will be required to support success in clinical arenaProvidence Health & Services | GOVERNANCE CONFERENCE

Our new Clinical Strategic Plan is comprehensive, including both direct care improvement and innovation efforts as well as enabling factors to support our mission

Leader in Chronic Care

Steward of Care Resources

OptimizeAcute Care

CareCoordinationAcross theContinuum

Design & DeployHigh Reliability

Care

Develop Teams, Clinicians &

Leaders

BestCommunity Citizen

PromoteWellness &Prevention

Optimize Healthcare Informatics & Intelligence

Leverage Research, Technology &

Innovation

STRATEGIESInspire and develop

our people

Build enduring relationships with

consumers

Create alignment with clinicians & care teams

Develop and thrive under new care delivery

& economic models

Grow by optimizing expert to expert

capabilities

SYSTEMWIDE

TACTICS

Recognizing inspired employees are the foundation for providing high-quality care and innovative solutions to our communities, Providence will hold steadfast to our Mission and values and will concentrate on the ongoing development of our people, their health and workplace culture.

Providence will actively engage with the communities we serve to understand their needs and develop an exceptional consumer-centered experience that improves the delivery of high quality, innovative services and fosters lasting partnerships in improving the health of our communities.

Providence will build strong partnerships with clinicians and care teams across the continuum of care, including employed and aligned providers, to create a seamless care delivery system focused on improving quality and safety and working collectively to build healthier communities.

Providence will adopt greater accountability for the overall health of the community, joining with our clinicians, care teams and other partners to develop innovative care delivery and economic models that focus on population health, utilization management, and pioneering technology resulting in improved health care value.

Providence will continue to grow by serving as a valued partner in creating healthier communities by not only offering excellent clinical, operational and administrative services but also by acting as a catalyst to build collaboration, identify and share best practices, and develop innovative partnership approaches.

Creating healthier communities, together

The alignment with overall system Strategic Plan is important as our clinical experience spans all the strategies


Our traditional quality measures have been narrowly focused

Measured in… Influenced by…

Mortality Acute Acute


Our new Annual Clinical Excellence Index spans multiple settings and incorporates a broad range of indicators

Measured in… Influenced by…

Mortality (AMI, Pneumonia, HF)Acute Medical Group Acute Medical Group

Continuing Care Health Plan Continuing Care Health Plan

Providence Patient Safety IndexAcute Medical Group Acute Medical Group


Cancer Screening IndexAcute Medical Group Acute Medical Group


Readmission Process ImprovementAcute Medical Group Acute Medical Group


CPS Resource StandardizationAcute Medical Group Acute Medical Group



The “behind the scenes”

detail outlines strategic

initiatives beneath

each operating

imperative

Our remaining focus for today’s

session is on the

operating imperative

“Community Best Citizen”


Community Health Needs Assessments are routinely performed and have been comprehensive and inclusive


We think about the “Community Best Citizen” work in three different areas

• Determinants of Health

• Community & Social Partnerships

• Community Education & Activation


Determinants of Health Our focus on the specific characteristics we must address to create healthier communities


Defined… Assess major issues, needs and drivers of health in the community and prioritize, plan and implement targeted efforts

Examples… Primary care capacity…tuition repayment incentive program in the family medicine residencyPrimary care access…leading a community forum with providers to revise structure for patients arriving in the emergency department without an assigned primary care provider. Alcohol and substance abuse…development of client-centered, team-driven and evidence-based approaches to treatment and prevention.Transportation…Telehealth, hot-spots, social gathering

Health Field Conceptual Model Influence Factors on Health Status

Mark Lelonde, Canadian Health Ministry

Lifestyle Behavior

50%

Human Biology

20%

Envi-ron-

ment20%

Medical Care10%


Tobacco Use Diet/Activity Alcohol Use Other

19%

14%

5%

12%

Risk factors and the cause of death – personal choices

Heart Disease

Cancers

Diabetes

Infant Deaths

Heart Disease

Cancers

Diabetes

Infant Deaths Heart DiseaseCancers

All InjuriesInfant Deaths

Heart DiseaseCancers

All InjuriesInfant Deaths

Heart DiseaseCancersDiabetes

All InjuriesRespiratory Disease

HIV/AIDSInfant Deaths

Heart DiseaseCancersDiabetes

All InjuriesRespiratory Disease

HIV/AIDSInfant Deaths

Heart Disease

Cancers

Respiratory Disease

Infant Deaths

Heart Disease

Cancers

Respiratory Disease

Infant Deaths


Blood PressureIn Finland, a comprehensive national strategy that

combined prevention, community-based health promotion and access to treatment was associated with a 60% decline in mortality rates from CV diseases over a 25-year period.

Improved Dietary Habits• Approximately 58% of diabetes mellitius

globally, 21% of ischemic heart disease and 8–42% of certain cancers were attributable to BMI above 21

• Low intake of fruit and vegetables is estimated to cause about 19% of GI cancer, about 31% of ischemic heart disease and 11% of stroke worldwide

• Living in super-sized worldProvidence Health & Services | GOVERNANCE CONFERENCE

Disease burden is derived from clinical and socioeconomic challenges

0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

All Comm Asthma Diabetes Male Comm Male MedcdRandy C. Axelrod, MD Copyright @ 2003

Providence Health & Services | 2014 GOVERNANCE CONFERENCE

Decreasing disease burden within any population should focus on risk factor reduction


Community & Social PartnershipsWho we partner with becomes more critical as our focus becomes more expansive


Defined… Create and leverage both traditional and novel collaborations with community & social partners to address shared goals for improved community health

Examples… Team-Up Montana – broad collaboration of community sponsors organized by St. Patrick Hospital to raise funds for cancer prevention & detection efforts, and to provide financial support to cancer patients in need

Providence Northeast Washington (NEW) Hunger Coalition – twenty-five community groups brought together to end poverty-induced hunger in Stevens County

Pharmacy Bridge – Providence Health Plan, in partnership with others, created this program to provide access to needed medications for uninsured and underinsured in Portland and surrounding areas

Community Education & Activation Achieving healthier communities will demand a greater level of community activation


Defined… Activate community members to be a catalyst for change in their own health as well as the health of others in their community

Examples… Global to Local – Partnership led by Swedish to build on the expertise of global health institutions to bring strategies that have proven effective in developing countries to underserved communities in Washington state

Get Out and Live (GOAL) – Outreach program led by Providence Little Company of Mary Medical Centers San Pedro and Torrance supporting underserved community members with diabetes – overall decreases in A1c levels and high retention rate

“Get Movin” program in Everett designed to promote physical activity for kids

Our panelists bring additional perspective to “Best Community Citizen”

• June Altaras– SVP Operations Swedish Seattle and CNO Swedish System

• Elaine Couture– Regional Chief Executive, PHC

• Chris Dyke MD– Chair of the Alaska Community Ministry Board


Governance implications and opportunities abound

• Vast and exciting opportunity to truly involve and activate our communities

• Begins with each of you:– Local engagement– System level engagement


clinical strategic plan & community best citizen …expanding quality beyond our traditional...

Documents

acute care care coordination

highquality care

md slide

mission slide

high reliability care

new clinical strategic

clinicians care teams

clinical leadership