session #20 leveraging data and strong partnerships to ...€¦ · thrive in the land between...

SESSION #20

Leveraging Data and Strong Partnerships to

Thrive in the Land Between Volume and Value

Craig StraussCardiologist, Medical Director,

Minneapolis Institute for Healthcare

Delivery Innovation

Leveraging Data And Strong Partnerships To Thrive In The Land Between Volume And Value

Craig Strauss MD, MPH

OBJECTIVES

• To describe the collaborative partnership between the hospital, health system, and cardiology group.

• To explain the value and rationale for investing in an enterprise data warehouse (EDW).

• To highlight the development of the Minneapolis Heart Institute (MHI) Center for Healthcare Delivery Innovation as a framework to transition from volume to value.

• To demonstrate, through specific case examples, the value of strong partnerships and an EDW in driving meaningful change in cardiovascular (CV) quality and outcomes.

KEY POINTS

• Healthcare market forces are driving an increased need for complex data analytics to improve value.

• Allina Health has developed an Enterprise Data Warehouse (EDW) that provides leading data analytic capabilities.

• A relentless focus on improving quality drives lower costs.

• Success requires 3 components:

Physician Leadership

Strong care team collaboration (MDs, RNs, Administrators)

An EDW with access to accurate data analytic resources

ALLINA: REGION’S LARGEST HEALTH CARE ORGANIZATIONAllina Health is dedicated to the prevention and treatment of illness and enhancing the greater

health of individuals, families and communities throughout Minnesota and western Wisconsin.

Allina Health

• 13 Hospitals

• 82 Clinic sites

• 3 Ambulatory care centers

• Pharmacy, hospice, home care, medical equipment

• 26,000 employees

• 5,000 physicians

• 2.8 million+ clinic visits

• 110,000+ inpatient hospital admissions

• 1,658 staffed beds

• 3.4B in revenue

• 32% Twin Cities market share

LAND BETWEEN VOLUME AND VALUE

The mixed world is here to stay.

Likely to move to value dominant systems:

MedicareAdvantage | Fee-For-

Service

Medicaid Less CertainFully Insured Commercial

Least CertainSelf-Insured Commercial

LAND BETWEEN VOLUME AND VALUE

We will need strategies that

work in a hybrid world.

Hospitals and high-end

programs are volume

sensitive and will become

more so rather than less.

POWER OF PARTNERSHIP: MINNEAPOLIS HEART INSTITUTE (MHI) AND ALLINA

Common vision.

Aligned interests.

Supportive infrastructure.

Platform to allow

ongoing investment.

Trust.

POWER OF PARTNERSHIP: MHI AND ALLINA

Support of three types of innovation.

• Device/drug.‒ Structural Heart Program.

» 500 transcatheter aortic valve replacement (TAVR).

» 30% increase in open heart volume.

» First in human transcatheter mitral valve.

• Care model to enhance experience.

» Cardiology curbside.

» Metro hubs.

• Increase value through better outcomes at a lower cost.

» MHI Center for Healthcare Delivery Innovation.

US HEALTHCARE SPENDINGU.S. Health spending—larger than the gross domestic product

(GDP) of most nations

• If all of that activity was separated

into its own sovereign nation, it

would constitute the fifth largest

economy in the world, behind only

the United States, China, Japan,

and Germany.

$2.7 TRILLIONU.S. HEALTH SPENDING in 2011

RETURN ON INVESTMENT

Source: OECD Data 2011

Life expectancy in the U.S. does not compare favorably to other

countries which spend less per capita.

0

1000

2000

3000

4000

5000

6000

7000

8000

70

72

74

76

78

80

82

84

Per

Capit

a S

pendin

g

Avera

ge L

ife E

xpecta

ncy

Life Expectancy Per Capita Spending (International Dollars)

HEALTHCARE SPENDING IN MINNESOTA

Total healthcare spending in Minnesota

was $40 billion in 2012; expected to

grow 6.5% per year.

FORECASTING THE FUTURE OF CV DISEASE

Source: Heidenreich, P. A., Trogdon, J. G., Khavjou, O. A., Butler, J., Dracup, K. … Woo, Y. J. (2011). Forecasting the future of

cardiovascular disease in the United States: A policy statement from the American Heart Association. Circulation, 123, 933-944.

A policy statement from the American Heart Association

CV Costs

Reach

$ 818 Billion

in 2030

COSTS AND VARIATION AMONG CV CONDITIONS

PAYMENT REFORM PRESSURES

Target percentage of Medicare fee-for-service (FFS) payments

linked to quality and alternative payment models in 2016 and 2018.

All Medicare FFS (Categories 1-4)

2016

All Medicare FFS

30%

85%

FFS linked to quality (Categories 2-4) Alternative payment models (Categories 3-4)

2018

All Medicare FFS

50%

90%

CMS PROPOSES MANDATORY CARDIAC BUNDLES

1. New mandatory CMS bundles apply to acute

MI and CABG patients.

2. Bundles require hospital accountability for

cost and quality during inpatient stay and 90

days after discharge.

3. Hospitals chosen from 98 randomly selected

metropolitan statistical areas.

4. Bundles would begin July 1, 2017.

5. CMS will pay quality adjusted target payments

for each episode of care.

OPPORTUNITIES FOR COLLABORATION

Relentless pursuit of:

• High quality outcomes.

• Optimized publicly reported measures.

• Reduced cost.

• Increased revenue.

• Improved patient experience.

• Increased affordability.

• Growth.

• Improved health of the community.

QUALITY OF CARE FOCUS

“Quality improvement is the most powerful

driver of cost containment.”~ Michael Porter, PhD Harvard Business School

Need for CV Care InnovationNEED FOR CV CARE INNOVATION

The development of the MHI Center for Healthcare Delivery

Innovation places Allina Health as a national leader in driving

necessary change in our healthcare delivery system.

• Focused on reducing variation through:

• Standardized cardiovascular care protocols.

• Advanced risk-stratification tools.

• Real time decision support at the point of care.

• Innovative strategies for care delivery.

The Center leverages the existing infrastructure of Allina’s EDW

and cardiology participation in national registries to achieve the

Triple Aim goals of improving population health, reducing per

capita costs, and improving the patient experience.

Primary Care

• Healthy lifestyle.

• Weight management.

• Smoking cessation.

• Exercise.

• Lipid management.

• Routine treatment protocols.

• Referral protocols.

Outpatient Cardiology

• Timely access to specialists.

• Guideline driven testing and treatment.

• Comprehensive diagnostic testing.

Sub-Specialty Cardiology

• Complex patients requiring further evaluation and treatment.

• Cardiac surgery.

• Arrhythmias.

• Structural heart disease.

• Prevention.

Inpatient and Emergency

Services

• Level I program.

• ST-segment elevation myocardial infarction (STEMI).

• Critical limb ischemia.

• Aortic dissection.

• Abdominal aortic aneurysm.

• Specialized inpatient CV care.

Advanced Therapies

• Extracorporeal membrane oxygenation (ECMO.)

• Left ventricular assist device (LVAD).

• Heart transplant.

• Trans-catheter aortic valve replacement (TAVR).

• MitraClip

• Percutaneous mitral valve repair (MVR).

Developing The Healthcare Delivery Information Center

OPTIMIZE CARE ACROSS THE CV CONTINUUM

POPULATION

HEALTH

MANAGEMENT

• Quantify the population

needs and measure

adherence to clinical

guidelines.

• Develop strategies and

tools to improve care

access and efficiency.

REDUCE CLINICAL

VARIATION

• Reduce unnecessary

variation in clinical care.

• Standardize care pathways

and protocols.

• Increase value.

TEST NEW

PROCESSES OF

CARE & PAYMENT

MODELS

• Build on existing best

practice programs and

protocols to improve

quality and efficiency in

care delivery.

• Develop and test new

payment models.

LEVERAGE

CUTTING EDGE

TECHNOLOGY

• Cardiomems Monitoring.

• TAVR, MitraClip.

• Linq.

Improve health of the

population through

adherence to clinical

guidelines across the

continuum.

Transform care delivery

through the reduction of

clinical variation.

Transform care delivery by

piloting new and creative

processes and payment

models.

Explore new ways to

efficiently care for patients.

MHI-HDI FOUNDATIONAL PILLARS

CLINICAL INTELLIGENCE TOOLS

What happened? What happening? What may happen?

Retrospective Real time Predictive

Genera

lS

pecific

Potentially Preventable

Readmissions (PPR)

Dashboard

2012: Limited Tracking of Performance Enhancement $

•Acute myocardial infarction (AMI) optimal care.

•Heart failure (HF) optimal care.

•Coronary artery bypass (CAB) surgical care improvement project (SCIP) optimal care.

•Bivalirudin or radial access increased from 25% to 55% in high risk bleeding patients.

•Revised and standardized HF, AMI and percutaneous coronary intervention (PCI) patient education documents.

•United HF readmissions reduced from 19.25% to 14.9%.

•Society of thoracic surgeon (STS) dashboard developed.

•100% of cardiologist trained on the clinical documentation improvement project (clinical documentation).

•Length of stay (LOS) savings $73,000.

•$1.3M in supply cost savings.

2013 Performance Enhancement: $12,074,221

•Bivalirudin use in high risk PCI pts:

69.0% at Abbott Northwestern Hospital

(ANW), 68.8% at Mercy Hospital, and

75.0% at United Hospital.

•72% (124/173) patients seen in pre-op clinic.

•Blood utilization.

•Goal: $461,641.

•Actual: $396,000.

•RBC: 2.14 1.98 u/case

•FFP: 1.43 .94 u/case

•Platelets: .72 .59 u/case

•HF dashboard developed.

•Cardiovascular (CV) LOS:

•104% baseline.

•102.6% Actual.

•Savings: $640,221.

•Supply chain savings: $2,670,600.

•Clinical documentation: $8,367,400.

•Willingness to recommend: 94%.


•160 more PCI patients at high risk for bleeding had a closure device used.

•114 intensive care unit (ICU) days were avoided for low risk ST segment elevation myocardial infarction (STEMI) and transcatheter aortic valve replacement (TAVR) patients.

•481 more HF patients had care coordinated by a HF care coordinator.

•13 more HF patients appropriately evaluated by Advanced HF referrals for ventricular assist device (VAD)/transplant.

•400 days saved through HF LOS efforts.

•886 fewer units of blood given to CV surgery patients.

•22% more patients who developed Afib post CV surgery were treated using the Afib protocol.

•28,029 fewer unnecessary creatine, kinase, muscle, and brain (CKMB) lab test completed.

•$2.9M: over utilization and LOS improvements (8 improvements noted above).

•$7.2M: clinical documentation.

•$3.5M: decreased variation in supply chain contract.

TRACK RECORD OF SUCCESS


•STEMI LOS $120,600.

•Advanced HF referrals $1,432,000.

•TAVR ICU days $153,500.

•HF care coordination $819,600.

•Troponin testing $29,500.

•CKMB Lab Testing $426,900.

•Closure device $395,100.

•Clinical documentation $2,094,000.

•Vascular supply chain $509,500.

•Afib protocol $393,990 (Jan14-Aug 15 at ANW and United Hospital).

EXAMPLES: CV DASHBOARDS

PCI:

• Use of closure devices in high risk patients.

Structural Heart Disease:

• Population management of severe symptomatic aortic stenosis.

‒ Up to date on guideline recommended echo surveillance.

‒ Role of primary care physician (PCP), cardiologist, valve specialist.

‒ Survival curves with and without definitive procedure.

‒ Cost implications.

CV Surgery:

• Real-time physician scorecard.

• Bundled payments.

EXAMPLE: PCI BLEEDING RISK

Area of Opportunity:

• Peri-procedural bleeding complications are common following PCI (3-6%).

• Transfusion rates across Allina Health were higher than national average for patients undergoing PCI.

Accurate Data:

• NCDR national PCI registry provides standardized, nationally benchmarked, abstracted data.

• EDW enables linking of multiple data sources to evaluate the impact of novel care processes on clinical quality and costs.

IMPACT OF CLOSURE DEVICES

4%6%

23%

3%6%

10%

0%

5%

10%

15%

20%

25%

Low Intermediate High

Any Complication

No Vascular Closure Device Yes Vascular closure Device

1.0% 1.7%

12.6%

0.7%2.3%

5.9%

0%

5%

10%

15%


RBC Transfusion


1% 1%

8%

0%2%

3%

0%

2%

4%

6%

8%

10%


Bleeding with 72 Hours


0.3% 0.4%

6.8%

0.2% 0.1%

1.4%

0%

2%

4%

6%

8%


Mortality


EXAMPLE: PCI BLEEDING RISK KEY STEPS

• Accurately calculate a pre-PCI

Bleeding Risk Score for all PCIs

across the Allina Health System.

• Apply consensus guidelines in

clinically appropriate cases.

• Effectively communicate bleeding

risk to providers managing the

patient’s care.

• Track outcomes and provide

timely feedback.

EXAMPLES: CV DASHBOARDS

PCI:

• Use of closure devices in high risk patients.

Structural Heart Disease:

• Population management of severe symptomatic aortic stenosis.

‒ Up to date on guideline recommended echo surveillance.

‒ Role of primary care physician (PCP), cardiologist, valve specialist.

‒ Survival curves with and without definitive procedure.

‒ Cost implications.

CV Surgery:

• Real-time physician scorecard.

• Bundled payments.

KEY POINTS

• Healthcare market forces are driving an increased need for complex data analytics to improve value.

• Allina Health has developed an Enterprise Data Warehouse (EDW) that provides leading data analytic capabilities.

• A relentless focus on improving quality drives lower costs.

• Success requires 3 components:

Physician Leadership

Strong care team collaboration (MDs, RNs, Administrators)

An EDW with access to accurate data analytic resources

LESSONS LEARNED

• Strong, committed leadership is essential for success.

• A focus on innovation is required to navigate present

and future challenges.

• Collaborative teamwork is essential in order to realize

the Triple Aim

• Robust analytics is a powerful tool to achieve the best

quality and cost outcomes.

THANK YOU

session #20 leveraging data and strong partnerships to ...€¦ · thrive in the land between...

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