Transforming Service Lines and Institutes to Achieve Success In a Value Based Era

Brian Sweeney, RN, MBA, FACHE Vice President for Clinical and Support Services Thomas Jefferson University Hospitals Philadelphia, PA

Becker’s Hospital Review – May 4, 2015

Objectives

•  Describe how service lines and institutes must evolve to align with value based care

•  Identify methods to align key stakeholders and achieve results with service line initiatives

Agenda

I.  Old model II.  New model III.  Transformational tactics IV.  Evidence these tactics work

Nomenclature Varies in Healthcare Systems

Service Line Institute

Center of Excellence

Key Purpose: Organize Services and Care Delivery

Old Model

Led By Business People

Focused Mostly on Growth

Admissions

Surgeries

Office Visits

ED Visits

Hospital at Core of Model – Provider Centric

Virtual Integration

Develop New Programs to Drive More Procedures

More Marketing Please…

Old Model is Not Aligned with IHI Triple Aim

New Model

Physician Led; Administrator Managed

Focus on Outcomes…Which Positions You for Growth

HCAHPS

Cost/Case

Days to 1st Appointment

Readmissions

Mortality

Include the Whole Continuum of Care – Consumer Centric

Achieve True Integration and Alignment

Develop Programs to Keep Patients Out Of Hospital

Transformational Tactics

Executive Sponsors: Richard Webster, Mitchell Harris, Anne Docimo, MD

Champion: Brian Sweeney Mitchell Conn, MD

Financial Analyst: Vincent Sborlini

Physicians:

Cataldo Doria, MD, David Tichansky, MD, Jerry McCauley, MD, Gary Rosato, MD, David Kastenberg, MD, David Sass, MD, Scott Goldstein, MD, Serge Jabbour, MD, George Francos, MD, Thomas Kowalski, MD

Administration: Maria Neff, Barbara Clancy-Sweeney, Gloria Rosado, Chad Gorn, Dianne MacRae, Joyce Hartman, Mellissa Panagiotidis, Vicki Jones

Nursing: Eleanor Gates, RN, MSN

Performance Improvement: Jenny Bosley, RN, MSN

Marketing and PR: Allison Benton, Katie Krauss

Assure You Have the Right Team

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Embed Performance Improvement Leaders in Model  

Conduct  value  stream  mapping  Assess  current  PI  process  

Lean  educa7on  

Gemba  walks  

Iden7fy  projects  and  priori7ze  

Educate  and  engage  team  members  

Specify  performance  metrics  

Design  and  launch  new  PI  program  

Implement  changes  

Sustain  performance  

Roadmap  for  the  Future  

Recognize You May Need to Enhance Their Skills

Invest in Physician Leadership Development, Including Coaching

Engage Physicians

•  Strategic planning •  Budget and P&L statements •  Performance improvement projects

Assure Strategic Plans Extend Beyond Growth

Loss of P4P Dollars

Payor  1    $      30,000.00    Payor  2    $  190,000.00    Payor  3    $      76,250.00    Payor  4    $  176,000.00    Payor  5    $      80,000.00    Payor  6    $      37,000.00    TOTAL    $  589,250.00    

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MEASURES    

-­‐  Diabetes  Annual  HbA1c  Level  TesKng  -­‐  Diabetes  Annual  Lipid  Level  TesKng  -­‐  Diabetes  Annual  ReKnal  Exam  -­‐  Diabetes  Annual  HbA1c  Management  -­‐  PaKent  Centered  Medical  Home  -­‐        RecogniKon  

Need to invest in diabetes educators, nutritional counselors, and care coordinators to capture this P4P revenue and achieve system cost reductions

Minimize Clinical Variation

Adjust Marketing Campaigns to Include Outcomes

Clinically Integrate and Align

•  Incentive compensation •  Clinically integrated network •  Co-management agreements •  Network agreements

Change Dashboard Metrics from Fee For Service Measures to Value Measures

•  Outmigration •  Episode expense •  Evidence based care compliance •  Access

Assure Accountability and Results

Evidence These Tactics Work

Example # 1 – Improved GI Access in Physician Practice by Reducing Days to First Appointment

•  Action plan •  Lean training •  Process mapping/brainstormed solutions •  Incentive compensation plan •  Operator model •  Text appointment reminders •  Endoscopy SOP

26% 28% 28%

33% 32% 30%

43%

48%

52% 51%

56% 55%

50%

0%

10%

20%

30%

40%

50%

60%

Mar '14 April '14 May '14 June '14 July '14 Aug '14 Sept '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15

G.I. % of New Patients Scheduled within Threshold (<14 Days)

Example # 2: Improved Stroke Care through Telehealth

•  Action plan •  Telestroke network – 28 hospitals •  Stroke education •  Patients remain at lower cost site •  Stroke centers established

Results •  Consults:  6,000+  •  PaKents  Remaining  in  Community:  85.3%  •  tPA  Treatment  Rate:  16%  •  Mean  Response  Time:  12  minutes  •  Cost  avoidance  for  healthcare  system  

Example # 3: Align Physicians Through Orthopedic Co-Management Agreement

•  Action plan •  Co-management agreement •  Hip fracture performance improvement project •  Multidisciplinary team •  Pathway

Results

•  LOS: 8.86 daysà 6.64 days (statistically significant reduction of 1.72 days)

•  Time from admission à OR decreased by 31.68 hours •  50% reduction in number of cardiac testing units per patient

Post Becker’s Self Assessment for Your Organization

Do you have the right members on your team? Are they focused on quality/cost initiatives…in addition to growth? Is your integration and alignment strategy optimized? Have you modernized your measures? Have you prepped your team for healthcare transformation?

Contact Information: Brian Sweeney, RN, MBA, FACHE brian.sweeney@jefferson.edu (215) 955-7937