Marketplace Collaboratives Better, Faster and More Affordable Robert S. Mecklenburg , MD Center for Healthcare Solutions at Virginia Mason © 2010 Virginia Mason Medical Center

The Sensei and the Waiting Room © 2010 Virginia Mason Medical Center

Health care is unaffordable. The Problem Health care is unaffordable. © 2010 Virginia Mason Medical Center

Wasted Healthcare Dollars Unnecessary waits and delays Reduce efficiency Non-value-added variation in content of care Reduces effectiveness © 2010 Virginia Mason Medical Center

Affordable Healthcare Requires Providers producing quality Payers reimbursing for quality Purchasers buying quality All three are essential for healthcare reform. © 2010 Virginia Mason Medical Center

Doing the Right Thing A focus on conditions of high cost for employers Back pain Shoulder, knee and hip pain Headache Heart burn Respiratory disorders © 2010 Virginia Mason Medical Center

Doing Things Right A focus on employers’ definition of quality Evidence-based care 100% patient satisfaction Same-day access Rapid return to work Affordable price for employer and provider © 2010 Virginia Mason Medical Center

Previous Pathway for Back Pain PT visits 1-15 PCP PCP MRI PCP Neurosurg Physiatry TIME Waits and delays Waiting has indirect cost to employer of over $18/hr Non value-added Evidence-based value © 2010 Virginia Mason Medical Center

Current Pathway for Back Pain Spine Clinic Wait for appt PT: 2.8 visits Waits and delays Non value-added Evidence-based value TIME Waiting has indirect cost to employer of over $18/hr © 2010 Virginia Mason Medical Center

Better, Faster, More Affordable Better for patients All patients have value-added PT; none have unnecessary imaging 4.9/5.0 patient satisfaction Faster for patients, employers and providers Patients and employers: half the work loss Providers: twice the MD work units per day More affordable for employers, providers and health plans Purchasers: fewer office visits, less imaging and less work loss Providers: more patients with lower cost of production per patient © 2010 Virginia Mason Medical Center

What Lean Looks Like To VM Providers 1. Home for dinner with better economics... © 2010 Virginia Mason Medical Center

What Lean Looks Like To VM Providers 2. …by providing health care in a different way Delivering care from the patient’s perspective Gaining reliability through systems Providers create the system prospectively Quality is built in and delays built out “Mistake-proofed” processes replace inspection steps Zero defects are adopted as performance standards Creating a worksite that is efficient, effective and “visual” © 2010 Virginia Mason Medical Center

Scalable and Transportable Another market. Another Collaborative. © 2010 Virginia Mason Medical Center

The obstacle is the path. - Zen aphorism © 2010 Virginia Mason Medical Center