Pursuing the Triple Aim Chapter 1 - HealthPartners Dr. Joan Burtner, Certified Quality Engineer Associate Professor of Industrial Engineering and Industrial Management

Care Model Process Basics Reliability, Patient-centeredness, Standardization Design Principles Use existing staff Use no added resources Start small Make it condition neutral Ensure that the right person is doing the right work Increase provider efficiency Support the patient provider relationship Establish joint accountability ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 2 Spring 2013

Standardizing Then Customizing “HealthPartners has learned that standardization is really part of a two-step process.” “First, design reliable systems and processes, and then and only then we customize to individual patient preferences, values, or changes in clinical guidelines.” ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 3 Spring 2013

ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 Flow Stations Involves unbatching lab results, prescriptions, phone care and medical forms. Instead of batching the work for the end of the day, the physician deals with it real time between visits. The flow station process has significantly reduced the possibility of human error that existed with batching. It is estimated that using flow stations will allow primary care doctors to shave three minutes off a twenty-minute appointment. ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 4 Spring 2013

Aggressive Goals for Chronic Conditions Creation of the optimal diabetes measure Five targets (patient goals) Hemoglobin A1c ≤ 7.9 Low-density lipoprotein ≤ 99 Blood pressure ≤ 139/89 Non-tobacco user Regular aspirin user Patient must achieve all five goals to meet the standard. ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 5 Spring 2013

ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 Diabetes Wizard Built into the electronic medical record (EMR) Guides clinicians in their decision making about what treatments might be best Results in significantly better glucose and blood pressure control in those patients whose providers use it Clinical inertia is a bigger problem than patient non-compliance ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 6 Spring 2013

Successful Redesign of a Care Process Key Elements A clear vision A Triple Aim focus The right leadership structure Design principles Cultural change Involvement of patients and families Teamwork ISE 468 ETM 568 Pursuing the Triple Aim Chapter 1 7 Spring 2013