dr david rankin - medibank private - advancing private healthcare sustainability through closer...

ADVANCING PRIVATE HEALTHCARE SUSTAINABILITY

THROUGH CLOSER COLLABORATION

Health Insurance SummitJuly 29 2016

Dr David RankinClinical Director - Medibank

HEALTH SYSTEM CHALLENGES

A sustainable healthcare system is driven to innovate and deliver efficiencies to offset these growing cost pressures

131220142

Growing and Aging

Population

Increasing

Prevalence of

Chronic Disease

New

Technologies

Consume 35 of all

hospital and medical

expenditure

HIGHER COST DOESNrsquoT EQUAL QUALITY

SOURCE Medibank claims data showing of total FY2013 admissions A comparison of 11 major Sydney

Hospitals with more than 100 beds and ICU

3

Hospital Acquired Complications

052

080074

049

149

072

112

047

151

091

138

Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Hospital 6 Hospital 7 Hospital 8 Most ExpensiveHospital

Hospital 10 Hospital 11

VALUE BASED HEALTHCARE

bull Outcomes are the health results that matter

for a patientrsquos condition over the care cycle

bull Costs are the total costs of care for a

patientrsquos condition over the care cycle

bull Bundled payments

4

Health Outcomes

Cost of Delivering the OutcomesValue =

Source lsquoThe Strategy That Will Fix Health Carersquo Michael Porter Thomas Lee HBR October 2013

lsquoValue Based Health Carersquo Michael Porter Robert Kaplan HBS Webinar 2015

lsquoHow to Pay for Healthcarersquo Michael Porter Robert Kaplan HBR JulyAugust 2016

MEDIBANKrsquoS TRIPLE AIM

Outcome

bull Safe - treatment that results in the fewest injuries or complications

bull Appropriate - treatment that is delivered in an appropriate location by qualified professionals

bull Effective - the best treatment choice based on scientific evidence

Experience

bull Patient Centred - treatment that is responsive to the individual memberrsquos needs

bull Timely - treatment that will avoid potentially harmful delays

bull Informed - treatment about which our members have been appropriately informed both clinically and

financially

Affordability

bull Efficient - treatment that is provided in a way that avoids or reduces waste

bull Economical - treatment that is delivered on the number of occasions necessary

To Improve the outcome of patient care

Improve the memberrsquos experience of care and

Improve the affordability of health care

TRANSFORMING HEALTH CARE

6

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise

ChangeKey variance areas

Drivers of variance

Barriers to change

Industry motivation

Level of Evidence

Identify LeversRecognition

Payment

Censure

Set targets

Engage providersMeasure

OutcomesEvaluate success

Report trends

Celebrate and reward

Identify PartnersEngage sector

representatives

Agree objectives

Establish relationship (MoU)

Agree MeasuresClinical Indicators

ProceduresConditions

Units and specifications

Risk AdjustmentDistribute

ReportsIdentify target

audience

Distribution

Media engagement

Implement

ChangeReport on evidence

Identify best practice

Set targets

Set timeframes

Activate levers

Engage providers


7

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

CORE PRINCIPLES

8

Criteria Explanation

Relevant to Medibank bull A direct and significant impact on Medibank Triple Aim

Outcome Focusedbull Focused on the memberrsquos health outcome (rather than the process of

delivering care)

Contributorybull Not readily available to the provider from internal data collection

bull Avoid duplicating existing reported measures

Motivational bull Must address something the provider perceives as important to motivate

change

Remediable bull Performance must be able to be changed with focused effort

Industry Accepted bull Indicators need to be accepted as valid and appropriate by providers

Benchmarkedbull Able to compare performance against comparable peers

bull Ideally there should be evidence based best practice targets for comparison

IMPLEMENTATION PRINCIPLES

9

Criteria Explanation Compliant

Examples

Non-compliant

Examples

Sufficient

volumeStatistically significant incident rate

ICU admission rate

Rehab referral rateDeath rate

TimelyData needs to be available in a timely manner to

encourage improvement and track changeAnnual volumes

5 yr re-operation

rate

Transparent Clearly defined indicatorsLength of stay

Day case rate

OR time (lack of

clear definition)

ObjectiveData should not be subject to local interpretation

or manipulationLength of stay Hand hygiene rate

Available

Data must be readily available to Medibank

Collection should not pose an additional burden

on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission

ComparableIndicators need to be risk adjustable to ensure

valid inter-provider comparisons

LoS for single

procedure or DRGService wide LoS

Discrete

Measures should not be subject to care

substitution change in coding practice or patient

selection

Patient comorbidity

Patient age

DRG complexity

coding

IDENTIFYING APPROPRIATE INDICATORS

gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical

specsSelect specific

metrics

1 3 4 5 62

MEDIBANK CLINICAL INDICATORS

11

AffordabilityOutcomes Experience

Length of stay

Same day rate Total episode cost

Prostheses cost30 day readmission

6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items

Procedure specific(operative cholangiogram)

Medibank Triple Aim

Patient Experience

Inpatient Rehabilitation

Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age

bull Volume of procedures

undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

What Hospitals Believe

We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions

HOSPITAL VARIANCE REPORT

14

HOSPITAL BENCHMARK REPORT

331615

Hospital Group

Hospital A

16

x Hospital is performing outside expectations on this clinical indicator

y Hospital is a high performer on this clinical indicator

x Hospital is a significant outlier and Medibank has concerns

y This Hospital appears to be a significant high performer

Hospital Mix Vol LoS TLoS Rehab ICU Complex TransferSame

DayComments

Hospital A x y y y y Relatively few hip replacements

Hospital B x x x x x Only 3 HJR 100 rehab no day hernia

Hospital C y y y y y x x X 2 Whipples Chole transfers no day hernia

Hospital D x y x y X

Hospital E x x y y x y Only 5 THJR 5 Spinal fusion

Hospital F y y y X Low day colonoscopy rate

Hospital G y y y y x Only 2 Whipples

Hospital H x x y x x Low hernia day rate

June ndash July 2014 June ndash July 2015 Comment

Length of stay for hips and knees Hips - 58 Knees ndash 583 Hips 57 Knees 56 Reducing LoS

rehab for hips knees spine Hips 32 Knees 37 Spine 19 20 24 24 Significant reduction

ICU Hips 6 Knees 4 Spine 39 4 5 32 Reduction in spine

day stay Colonoscopy Hernia Eye 95 11 92 97 10 92 Stable

Trends (Jul ndash Jun 14 compared to Oct ndash Sep 15)

ldquoSamplerdquo Health Care Group ndash Clinical Indicator ReportClinical Report Oct 14 ndash Sep 2015

IDENTIFIED COMPLICATIONSMedibank Identified Complications are

bull likely to occur in an acute private hospital setting

bull frequently (gt0) occur on Medibankrsquos claims history and

bull evidence shows they can be reduced or avoided if clinical guidelines are followed

17

bull 5 Groups

bull 12 Categories

bull 82 CodesIdentified

Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)

bull 4000+ CodesCHADx

Pressure

Injury

Falls Infection Surgical

Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE

Complication rate is independent of group size or case mix

18

Hospital Reaction

Itrsquos too

much too

soon

Few prepared to respond

to clinical quality

focused commercial

negotIations

Letrsquos work together

on data collection

but come to an

agreement in ldquosay

12 monthsrdquo

Lots of lsquoplaying the

manrsquo and lsquolooking

for weedsrsquo

Hospitals are only hotels

where surgeons operate

Talk to the surgeons

This is contract

related letrsquos not

tell the surgeons

SURGICAL VARIANCE REPORTS

20

Released Pending

General Surgery Urology ENT Vascular Surgery Orthopaedics

Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp

bull wrsquoout polyp

Cystoscopy

bull with resection

bull wrsquoout resection

Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair

SAME DAY HERNIA REPAIR RATES

21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight

Surgeons by separation volume

US rate = 90

Australian rate = 20

Average SD hernia cost = $2160

Average Inpatient hernia cost = $3100

INPATIENT REHABILITATION REFERRAL RATES ndash KNEE REPLACEMENT

bull Inpatient Rehabilitation adds $10000 to the cost of a hip replacement

bull Growing evidence that inpatient rehabilitation does not improve patientsrsquo outcomes following joint replacements

22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation


Ontario referral rate = 10

Medibank rate = 35

Significant variation

between surgeon hospital

and state

See Stolee 2011 Mahomed et al 2008 Buhagiar et al 2013 Stolee 2011 Mahomed et al 2008 Buhagiar et al 2013Loacutepez-Liria et al 2015 Kauppila et al 2010

OUT OF POCKET CHARGE BY PRINCIPAL SURGEON

23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e


Cystoscopy with resection


24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

IDENTIFICATION OF PRIORITY FOCUS AREAS

25

Barr

iers

to C

hange

Clinician Ability to InfluenceLower Higher

Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)

IDENTIFYING FOCUS AREAS

26

00

100

200

300

400

500

600

700

800

Rehab Transfer Rate RAPT Rehab Rate

LEARNINGS

27

CHALLENGES

bull Terminologyminus Clear definition of the clinical indicators

minus Implication of mistake avoidable preventable

bull Limitations and utility of administrative data

bull Role of Medibank

bull Variance in ldquoClinical Governancerdquo systems

bull Recording and reporting ldquominorrdquo and ldquoinevitablerdquo complications

bull Definition of Guidelines and best practice

bull Clinical expert review

bull Communicating the detailminus Contracted providers stakeholders interest groups

bull Speed of implementation

bull Fractured sector response

Engagement with our providerspartners is at the heart of changeMedibank cannot change the sector on its own

28

EARLY INDICATORS OF SUCCESS

Enhanced engagement

bull hospital and insurer

bull hospitals and surgeons

bull surgeon and anaesthetist

Exploration of what is best practice

Hospitals and surgeons are actively engaged in discussion about

bull Reducing inpatient rehabilitation referral rates

bull ICU utilisation rates

bull Inter-clinician variation

bull Low volume surgery

bull Complication rates

bull Out-of-Pocket charges

Outlier hospitals are clearly moving towards the mean

29

HOSPITAL SURVEYPositives

bull All hospitals welcomed the reports and appreciated the initiative

bull All hospital executives found the presentation simple and clear and the data easy to

interpret

bull Reports are very useful particularly in highlighting inter-hospital comparisons

bull Hospitals are optimistic that as the reports evolve the hospitals will share the good news

with their clinicians

Opportunities for Improvement

bull Reports only capture a subset of hospitalrsquos activity - would welcome wider scope of

reports

bull Seldom shared with clinicians ndash unless there was a particular area of concern

bull Concern that some measures (rehab referral rate) did not relate to quality and safety

Hospital Attitude to Medibank Reports Amongst Eight Major Hospital Groups Dr Anand Ponniraivan July 2016

30

TO CHANGE BEHAVIOR PROVIDERS MUST -

bull First be engaged

bull Be informedbull Providers seldom understand how they compare

bull Accept the data as valid

bull Acknowledge there is a problem

bull Be motivated to change

bull Accept that they can changebull Ability to overcome barriers and resistance

bull Grasp their opportunities

31

ldquoData Sharing is Just the Start of a Relationshiprdquo

Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change

ldquoTHE TRANSFORMATION IS

GOING TO HAPPEN ndash IT HAS TO

AND WE KNOW IT WORKSrdquo

MICHAEL PORTER ICHOM CONFERENCE MAY 2016

32

HEALTH SYSTEM CHALLENGES

A sustainable healthcare system is driven to innovate and deliver efficiencies to offset these growing cost pressures

131220142

Growing and Aging

Population

Increasing

Prevalence of

Chronic Disease

New

Technologies

Consume 35 of all


expenditure




3


052

080074

049

149

072

112

047

151

091

138









4

Health Outcomes






Outcome




Experience




financially

Affordability







6

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


7

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

CORE PRINCIPLES

8




delivering care)




change






9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32

Consume 35 of all


expenditure




3


052

080074

049

149

072

112

047

151

091

138









4

Health Outcomes






Outcome




Experience




financially

Affordability







6

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


7

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

CORE PRINCIPLES

8




delivering care)




change






9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32







4

Health Outcomes






Outcome




Experience




financially

Affordability







6

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


7

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

CORE PRINCIPLES

8




delivering care)




change






9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


Outcome




Experience




financially

Affordability







6

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


7

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

CORE PRINCIPLES

8




delivering care)




change






9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


6

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


7

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

CORE PRINCIPLES

8




delivering care)




change






9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


7

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers

CORE PRINCIPLES

8




delivering care)




change






9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32

CORE PRINCIPLES

8




delivering care)




change






9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


9


Examples

Non-compliant

Examples

Sufficient


ICU admission rate




5 yr re-operation

rate


Day case rate

OR time (lack of

clear definition)



Available



on the provider

HCP data

Hand hygiene rate

SAB rate

ldquoAvoidablerdquo

admission



LoS for single


Discrete



selection

Patient comorbidity

Patient age

DRG complexity

coding


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


gt 1200 14

Catalogue

International

metrices

Determine

Available Data

Set

Apply Core

Criteria

Apply

Implementation

Criteria

Build technical


metrics

1 3 4 5 62


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


11


Length of stay



6 month reoperation

Hospital Acquired

Complication rate

ICU admission rate

Member OOPs

Multiple MBS items


Medibank Triple Aim

Patient Experience


Rate

Patient Reported

Outcome Measures

Modifiers

bull Patient Age


undertaken


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


12

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


We believe

in quality

We have the

best doctors

We have the

sickest frailest

and most at risk

patients

We are

quality

champions


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


14


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


331615

Hospital Group

Hospital A

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32

16






DayComments




















17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32





17

bull 5 Groups

bull 12 Categories


Complications

bull 15 Groups

bull 39 Categories

bull 400+ Codes


(ACSQHC)


Pressure

Injury


Complications

VTE of PWO

Separations

38 43 997 3309 10 19

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32

COMPLICATION RATE


18

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32

Hospital Reaction

Itrsquos too

much too

soon


to clinical quality

focused commercial

negotIations


on data collection

but come to an


12 monthsrdquo



for weedsrsquo




This is contract


tell the surgeons


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


20

Released Pending


Lap Chole

Gastric banding

Gastric sleeve

Hernia

Bowel resection

Gastroscopy

Colonoscopy

bull with polyp


Cystoscopy

bull with resection


Prostatectomy

bull Endoscopic

bull Radical

Sinus surgery

Tonsils and

adenoids

Myringotomy

Varicose veins

Endarterectomy

Hip replacement

Knee replacement

ACL repair


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


21

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70

Perc

enta

ge o

f patient

that

sta

yed in h

ospital

overn

ight


US rate = 90







22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32




22

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80

Perc

enta

ge o

f patients

tra

nsfe

rred to inpatient

rehabili

tation



Medibank rate = 35



and state



23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


23

$0

$200

$400

$600

$800

$1000

$1200

$1400

$1600

0 10 20 30 40 50 60 70

Avera

ge s

urg

eon O

OP

charg

e




24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


24

Develop

ReportsExtract data

Analyse data

Validate data

Format data

Partner Endorsement

Print reports

Prioritise


Drivers of variance

Barriers to change

Industry motivation

Level of Evidence


Payment

Censure

Set targets



Report trends



representatives

Agree objectives







audience

Distribution

Media engagement

Implement



Set targets

Set timeframes

Activate levers

Engage providers


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


25

Barr

iers

to C

hange


Low

er

Hig

her

Same Day rate

LOS

Sep cost

Rehab rate

Prosthesis

cost

Surgeon OOP

Reoperation

s

30 day

Readmissions

ICU

Complications

Multiple MBS

High Low

Impact

(Outcome Experience

Affordability)


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


26

00

100

200

300

400

500

600

700

800


LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32

LEARNINGS

27

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32

CHALLENGES













28


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32


Enhanced engagement













29




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32




interpret






reports




30









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32









31


Develop

Reports

Prioritise

Change

Identify

Levers

Measure

Outcome

s

Identify

Partners Agree

Measures

Distribute

Reports

Implement

Change





32





32

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