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Medical Technology Leadership Forum
The Role of Integrated Systems Combining Technology and Structureto Improve ValuePeter E. Person, M.D.Chief Executive OfficerOctober 15, 2007
OverviewIntroductionWhere has the Arms Race taken us?Critical Elements of/to Successful Integrated CareOverview St. Marys/Duluth Clinic Health System (SMDC)Role of Structure/Technology and Collaborative Practice Teams to bring ValueExample(s) of Value Creation Future Direction
Current U.S. Health Care Reality
PatientFragmented U.S. SystemNon SystemOrthopedistCardiologistDermatologistGynecologistGastroenterologistChest painPap TestRashStomach AcheKnee ache
Health Care Costs, 2002 (in US $s)OECD, 2004
Best care in the world?WHO ranks US 37th out of 191 countries in overall health measures
With A Dysfunctional Value Proposition
Our current reimbursement system rewards the wrong behavior.the worst physicians get paid the most because they see the patient more oftenJoe Bianco, M.D. (10-8-07)
Our Belief..Seven Critical Elements To Successful Integrated Care (Systems of Care)Mission/VisionStructureStrategyPeopleSupport/TechnologyIncentivesCulture
St. Marys Duluth Clinic Health System (SMDC) was formed from a partnership between St. Marys Medical Center and The Duluth Clinic, Ltd in 1997December 19, 1996
St. Marys Duluth Clinic Health System (SMDC)Duluth, MN (2007)4 hospitals with a total of 555 beds18 regional clinics450+ employed physicians6,000 employees850,000 annual encounters40,000 emergency care and trauma center visits22,000 surgeries9,700 cardiac proceduresNon-profit healthcare organization serving a region of 450,000 residents
SMDC Health SystemReflecting the heritage and continuing partnership of the Health Care Ministry of the Benedictine Sisters of St. Marys Medical Center and the physicians of the Duluth Clinic
MissionSMDC brings the soul and science of healing to the people we serve.
VisionSMDC, as a world-class organization, will be the best place to receive care and the best place to work.
ValuesRespect We regard all persons with dignity and respect.Innovation and Excellence We are committed to innovation and excellence in medical care, education and research.Teamwork Our strength is in our people, working together.Stewardship - We wisely and responsibly manage all resources.
SMDCs Healthcare Network..A Model for Rural Health Care?
SMDC Integrated VisionBringing Technology, People, and Structure Together to Provide Value
Building a Health Care Strategy Structured Around The IOM Six AimsInstitute of Medicine Six Aims of Quality Care: SafeEffectivePatient-CenteredTimelyEfficientEquitable
Internal ProcessesTo satisfy our customers, at which operational & quality processes must we excel?FinancialTo financially sustain our Mission, on what must we focus?Vision: SMDC, as a world-class organization, will be the best place to receive care and the best place to workCustomerTo achieve our focus on Service, Clinical & Operational ExcellenceHow should we appearTo our internal & external customers?Strategy Defining Value..SMDCs Balanced Scorecard/Strategy MapCopyright 2008 by St. Marys/Duluth Clinic Health System
Service ExcellenceClinical ExcellenceOperational ExcellenceLearning & GrowthHow will we sustain our ability to change and improve as a system?Mission: SMDC brings the soul and science of healing to the people we serveWe will pursue our mission and vision through a focus on Service, Clinical and Operational ExcellenceC1 Quality Relationships Patient-centered Care Timely Care Equitable CareC2 Clinical Expertise Effective Care Safe CareC3 Customer Value Efficient CareP2 Provide easy, timely, coordinated access to health care servicesP1 Right patient, right care, right process, best outcomeP6 Optimize physician & staff productivityP5 Design & implement coordinated care models to effectively manage disease processes through teamsP7 Excel in efficient & effective operations P4 Consistentlydemonstratepersonalized, caring,attentive interactionsP3 Investment emphasis to support clinical & financial outcomesL3 Recruit, develop & retain talented people to outstanding levels of performance to support the MissionL4 Engage physician leaders & managers as partners in success L2 Grow & excel in research & educationF3 Optimize system investments F4 Be provider of choice in the Twin PortsF2 Grow key specialty services, programs & strategic partnershipsF5 Achieve negotiated increasing amounts of financial risks for covered lives*Cancer, Cardiovascular, Digestive, Surgery, Childrens SpecialtyL1 Develop a high performance culture that delivers world-class care through innovationF1 Achieve a 3% Operating Margin to sustain our Mission and achieve our Vision
SMDC Organizational ChartIntegrating Physicians to Create Value
Interdisciplinary Teams At The Core of Value DeliveryClinic VP Hospital COOEVP Clinic DivisionPhysician DivisionChiefEVP HospitalDivision
Section ChairDirector orManager Nursing Director or ManagersAccountability Quality Service P&LAdministrative LevelCare LevelAccountability Quality ServiceCollaborative Practice Teams
Collaborative Practice TeamsInterdisciplinary groups formed to determine best practice for an assigned patient populationResponsible for development of tools & care processes that improve clinical quality & customer value
SMDC Collaborative Practice TeamsCardiologyCardiothorasic SurgeryCritical CareGeneral SurgeryMedicineNeonatalogyNeuroscienceObstetricsOncologyOrthopedicsPediatrics
CardiologySMDC Heart Failure ProgramRacing to Value with Technology(with Caveats)
Heart FailureIncidence and PrevalenceApproximately 5 million Americans have Heart Failure 550,000 new cases annuallyIncidence of 10/1000 > 65 years of ageEstimated direct and indirect costs in U.S. $27.9 billionSingle largest expense for Medicare (1999-$3.6 billion)High 1-year mortality rate with 1 in 5 dyingAHA. 2005 Heart and Stroke Statistical Update.
SMDC Heart Failure Program ProfileHeart Failure outpatient services first introduced in 1999Program managed by nurse practitioners in collaboration with cardiologists from the SMDC Heart CenterModel expanded to Ashland, WI in 2004; Spooner/Hayward, WI in 2005; Virginia, MN in 2007Currently the program coordinates care for 989 patients
Why Change Care Delivery?Value PropositionProgram born out of honest desire to improve care to this complicated, fragile populationTraditional medical model did not allow time for coordination of care required of this populationTraditional model inefficientMaximizing the use of technology and people.
SMDC Heart Failure ProgramIntegrated TeamMedical Director - Cardiologist oversight of program, clinical leadershipCardiologists-accurate diagnosis, accurate treatment planNurse Practitioners/Physician Assistant Disease management, medication management, referral for device therapy, oversight of telescale dataRegistered Nurses- Continual patient education, management of telescale data, phone triage
SMDC Heart Failure ProgramSupporting RolesPrimary Care PhysiciansNurse On LineEmergency Room Physicians and StaffPharmacy StaffSocial WorkersInformation ServicesEPIC
SMDC Heart Failure Program Growth1999Initial Staff1 Nurse Practitioner (NP)1 Physician (MD)1 Registered Nurse (RN)1 Certified Medical Assistant (CMA)100 Patients Served2007Current Staff6 NPs/PAs2 MDs (Directors)6 RNs6 CMAs3 teams in Duluth3 teams in regional sites989 Patients Served
SMDC Heart Failure ProgramPatients have a cardiology consult prior to entering the program7- 10 office visits with a nurse practitioner in first year (0, 2, 4, 6 weeks; 3, 6, 9 months)4 office visits annually thereafter with an NPAT LEAST an annual office visit with a cardiologist and their primary care physician
SMDC Heart Failure ProgramStructured educational contentTeam approach to clinic visitsQuality of life, functional status and depression screeningIn home scale tele-monitoring program for vigilance between office visits
SMDC Heart Failure ProgramCommunity OutreachQuarterly Heart Failure Support Group/Educational SessionsDesigned by Heart Failure Focus Group100+ attendees, patients and relativesVarious clinical presentations /cliniciansQuarterly Heart Failure Newsletter 2000 copies printed
SMDC Heart Failure Program
Tele-monitoring (Telescales)Home based electronic scales. Patients send daily weights and survey data to Heart Failure staff175 scales in use. Assigned to the most frail patientsStaff calls patients when triggers occurHold patients accountable for their own care plan
SMDC Heart Failure Program
RN calls patient Completes the following:Nursing assessment Medication list reviewDietary adherenceEducational needsFollows diuretic protocol as indicated/or talks with NPMakes followup recommendationsInitiates office visit or primary care referralCare plan monitoring; hospitalization initiation
SMDC Heart Failure Program
Tele-monitoring advantagesFacilitates early intervention and minimizes ER visits and re-hospitalizationsImproves patient adherence with care planPatients get immediate feedback on life style choicesProvides high patient satisfactionProvides family reassuranceProvides additional opportunity to educate patientsBuilds trust between patient and provider
SMDC Heart Failure ProgramFinancial OutcomesPilot with payer N=29 patients $1.25M cost savings
Type of CarePre-Progr