outcomes: the key to delivering high-value...

OUTCOMES: THE KEY TO DELIVERING HIGH-VALUE HEALTH CARE

APHA 36th National CongressMarch 21, 2017

20150701 Standard Presentation 2Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.

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http://upload.wikimedia.org/wikipedia/commons/4/4c/Flag_of_Sweden.svg

/upload.wikimedia.org/wikipedia/commons/a/a4/Flag_of_the_United_States.svg

3Copyright © 2017 by the International Consortium for Health Outcomes Measurement. All rights reserved.

Variation in health outcomes is a worldwide problem

variation in 30-day mortality rate from heart attack in US hospitals

variation in bypass surgery mortality in the UK hospitals

Variation of major obstetrical complications among US hospitals

variation in complication rates from radical prostatectomies in the Dutch hospitals

variation in reoperation rates after hip surgery in German hospitals

variation in mortality after colon cancer surgery in Swedish hospitals

variation in capsule complications after cataract surgery in Swedish hospitals

4x

9x

18x

20x

36x

2x

5x


Value for the patient must be the overarching goal

Value =Health outcomes that matter to patients

Costs of delivering the outcomes


Toward an interdependent and mutually reinforcing system

The Legacy System

1. Siloed around speciality departments, with private-practice physicians

2. Measures process compliance and charges

3. Fee-for-service payments based on volume of services delivered

4. Loose confederations of largely standalone units that often duplicate services

5. Providers limited to serving their immediate geographic area

6. Information technology for documenting care

The Value Agenda

1. Integrated practice units (IPUs) organized around the patient’s medical condition

2. Measures outcomes and costs for every patient

3. Move to bundled payments for the full cycle of care

4. Integrate care delivery systems to eliminate fragmentation and duplication of care

5. Expand geographic reach (hub and spoke or affiliate model)

6. Information technology for optimizing care


5 reasons why outcome measurement is essential

Outcomes define the goal of the organization and set direction for its differentiation

Outcomes inform the composition of integrated care teams

Outcomes motivate clinicians to compare their performance and learn from each other

Outcomes highlight value-enhancing cost reductions

Outcomes enable payment to shift from volume to results

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Value-based health care in action

“I wanted to use the outcomes to challenge the status quo, to adjust old methods and

uncover better ones”

- Prof Dr Hartwig Huland


The Martini Klinik Team


Rapid adopted of the FFLU technique by the Martini Klinik staff

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Urinary ContinenceOne Week After Catheter Removal

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r 24

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urs

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Source: Schlomm, Thorsten, Oliver Engel, Thomas Steuber, Hans Heinzer, Alexander Haese, Georg Salomon, Hartwig Huland, and Markus Graefen. "Full Functional Length Urethral Sphincter Preservation During Open Radical Prostatectomy." The Journal of Urology 183.4 (2010): 320-29.

Surgeon B


The impact of focus and teamwork

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1-year Severe Erectile Dysfunction

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5-year Survival

95,094,0

Source: BARMER GEK Hospital Report 2012, Martini-Klinik database

Martini Klinik

Germany (average)

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Martini Klinik’s institutional learning curve over time

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Accumulated Case Experience

1-Year Urinary Continence

Source: Martini Klinik company documents


As a result, Martini Klinik’s case volume has increased rapidly

2,225

1,973

1,759

1,542

1,336

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789679

562547486382320

230195142120819469

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Source: Martini Klinik quality report

Martini Klinik

University of Hamburg


Prostatectomy Case Volume in German Urological Departments

2,225

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Percentile (n=393)

Mayo Clinic (1,250/yr)

John’s Hopkins (1,000/yr)

Note: Based on 2011 data


Michigan’s Collaborative Quality Initiatives provide a strong template for collaborating to drive improvement

Why Michigan?

Michigan (population ~10 million) is a national hub for automobile manufacturing

Rising health care costs was making firms less competitive globally

Blue Cross Blue Shield, largest commercial payor in the state, faced increasing pressure to lower the cost of care while maintainig or improving quality

Image: St. Clair County Economic Development Alliance. Accessed at http://www.edascc.com/site-selection/target-industries/automotive-supply-chain


Funder pays for infrastructure (data collection and analysis) and contributes administrative data for longitudinal follow-up

Funder

ProvidersCoordinating

CenterCoordinating Center (Univ. of Michigan) analyzes data from clinical registries and reports back to providers

Providers set improvement goals and meet regularly to share practices in how to improve

Source: Arora J, Aisenbrey J. Aligning payers and providers around value: Blue Cross Blue Shield of Michigan’s Collaborative Quality Initiatives. Cambridge, MA: International Consortium for Health Outcomes Measurement (ICHOM), June 2015.

The Collaborative Quality Initiatives (CQI) model


Use of IVC filters in bariatric surgery demonstrates how best practices disseminate

Bariatric surgery patients at high risk of deep venous thromboses (DVTs)

Inferior Vena Cava (IVC) Filters developed to catch clots in highest risk patients


Use of IVC filters in bariatric surgery demonstrates how best practices disseminate

Source: Blue Cross Blue Shield of Michigan Collaborative Quality Initiatives (CQI) – A model for Collaboration and Quality Improvement: Program Introduction & Overview. September 2014

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Use of IVF Filter in 20 Michigan Hospitals participating in BMSC

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The dissemination of this and other best practices allowed Michigan to aggressively lower its surgical mortality rate

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30-day Mortality After Bariatric Surgery

Source: David A. Share et al. Health Aff 2011;30:636-645. ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

Non-Michigan Hospitals

Michigan Hospitals

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Bariatric SurgeryCardiac SurgeryGeneral Surgery

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~$600M

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Collaborative discussions around outcomes measurement have also led to dramatic state-wide cost savings


ICHOM was formed as a non-profit catalyst to drive the industry towards value-based health care

Our Mission:

Unlock the potential of value-based health care by defining global Standard Sets of outcome measures that really matter to patients and by driving adoption and reporting of these measures worldwide


ICHOM organizes Working Groups to define minimum outcomes sets that we recommend all care providers track

ICHOM facilitates a process with international clinical and registry leaders and patient

representatives to develop a global Standard Set of outcomes that really matter to patients,

along with corresponding case-mix factors


International leaders from eight countries helped develop ICHOM’s Localized Prostate Cancer Standard Set

Adam Glaser, St James’ Institute of Oncology; NHSJim Catto, University of Sheffield, European Urology

Kim Moretti, South Australian Prostate Cancer Clinical Outcome CollaborativeMark Frydenberg, Prostate Cancer Registry of VictoriaIan Roos*, Cancer Voices Victoria

Frank SullivanProstate Cancer InstituteJohn Fitzpatrick, Irish Cancer Society

Hartwig Hulandⱡ and Markus Graefen, Martini KlinikMichael Froehner, Günter Feick*, BundesverbandProstatakrebs Selbsthilfe (BPS); Europa UOMOThomas Wiegel, University Hospital Ulm

C.H. Bangma, Erasmus Medical Center

Anna Bill-Axelson, Swedish Prostate Cancer Registry

Francesco Montorsi, European Urology Editor in ChiefAlberto Briganti, Vita-Salute San Raffaele University Hospital, Milan

Jacob Ramon, Sheba Medical Center

Steven Jay Frank, MD AndersonDavid Swanson, MD AndersonAndrew Vickers, MSKCCAdam Kibel, Dana Farber/BWHMichael O’Leary, Dana Farber/BWHAnthony D’Amico, Dana Farber/BWHNeil Martin, Dana Farber/BWHMichael Blute, MGHHoward Sandler, Cedars-SinaiRonald Chen, University of North CarolinaDan Hamstra, University of MichiganAsh Tewari, Weill Cornell Medical College

*Patient representative; ⱡWorking Group lead


ICHOM Standard Set for Localized Prostate Cancer: Outcomes

Treatment approaches covered

▪ Watchful waiting▪ Active surveillance▪ Prostatectomy▪ External beam radiation therapy ▪ Brachytherapy▪ Androgen Deprivation Treatment▪ Other

Sponsored by:


We have completed 21 Standard Sets covering 45 percent of the disease burden in high-income countries, with more under development

Our current 21 Standard Sets In Progress / Ramping Up

1. Adult Overall Health2. Atrial Fibrillation3. Chronic Kidney Disease4. Oral Health5. Pediatric Overall Health6. Inflammatory Arthritis7. Congenital Hand Malformations8. Facial palsy9. Hypertension*10. Type II Diabetes

*Focused on low and middle income countries

Anticipated

1. Mental health package2. Pediatric Epilepsy3. Multiple Sclerosis4. COPD5. Morbid Obesity


If you’d like to learn more about ICHOM and what’s happening here in Australia, please join us in Sydney on May 4th

www.ichomforum.com.au

1 Day Forum

25+ Speakers

6 overarching plenaries from international experts

2 breakout sessions highlighting local examples and perspectives

Networking reception

http://www.ichomforum.com.au/

THANK YOU

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