Driving Toward Quality What It Will Take for Value-Based Care to Be Successful?

Keegan Bailey Founder & Chief Value Architect Navaste Health LLC keegan@navastehealth.com Clinical Associate Professor Health Policy, Management & Behavior University at Albany, School of Public Health kbailey@albany.edu

Our Objectives What is value based health care? Population health and quality management as one of six domains in the value based health care framework. Challenges and perspectives. The ideal state of quality. Measure rationalization and the reality of quality management today.

Our Panel Dr. Kallanna Manjunath, Chief Medical Officer, Albany Medical Center PPS Dr. Tom White, VP, Clinical Quality and Behavioral Analytics, CDPHP Kathleen Mattice, BSN, RN, Chief Clinical Officer, CapitalCare Medical Group

Sustainability Problem Spending Increasing Now @ $10,000 per capita Premiums and deductibles increasing Waste Outcomes?

Sustainability Problem Spending Increasing Now @ $10,000 per capita Premiums and deductibles increasing Waste Outcomes?

Sustainability Problem Spending Increasing Now @ $10,000 per capita Premiums and deductibles increasing Waste Outcomes?

The Catalyst: Waste in Healthcare "Health Policy Brief: Reducing Waste in Health Care," Health Affairs, December 13, 2012. http://www.healthaffairs.org/healthpolicybriefs/

Sustainability Problem Spending Increasing Now @ $10,000 per capita Premiums and deductibles increasing Waste Outcomes?

(Outcomes That Matter) The Value Equation O (Outcomes That Matter) V (Value) = C (True Costs) The Strategy That Will Fix Health Care Michael E. Porter, Thomas H. Lee – HBR, Oct. 2013

The Value Framework

Population Health Organize care delivery around cohorts of patients rather than patients individually. Plan outcomes improvement initiatives and interventions, with a focus on outcomes that matter to patients. Prioritized patient lists must be created and applied in the right place at the right time with the right stakeholder to effect change. Situational awareness for business units seeking to identify improvement opportunities and empower clinicians and others to capitalize on them at the patient and community levels. Evidenced-based improvement science scaled to the point of care increasing the data relied upon for outcomes improvement and operations Comply with new and rapidly evolving outcomes programs.

The Cost of Quality

“Quality” – Heart Failure vs. Heart Failure

The Panel Are today’s quality measures meaningful? Would more meaningful metrics drive better health outcomes? How do we measure health outcomes that matter to patients? What are strategies organizations can use to rationalize the multitude of diverse quality program requirements? Are today’s approaches sufficient and good business? How do organizations free enough creative space to tackle outcomes that matter to patients, while simultaneously box-checking?