The High Value Healthcare Collaborative (HVHC) Model for Driving Innovation/Spread in Care & Payment Reform Lucy Savitz, Ph.D., MBA Director of Research and Education Institute for Health Care Delivery Research Intermountain Healthcare

The High Value Healthcare Collaborative (HVHC) is a collaborative of provider organizations who’s mission is to: improve healthcare value – defined as quality and outcomes over costs, across time – for its service population in the U.S. Serve as a model for national healthcare reform. Sustainable Health System, Provider-driven

HVHC delivers on its mission by: –identifying best-practice care models –testing value-based payment models –accelerating adoption of these models through: collaborative improvement efforts a common information infrastructure tools to support care delivery Resulting in: 1)Improved Population Health, 2)Value-Based Care, and 3)Reduced Costs. Sustainable Health System, Provider-driven

4 20 Members and Growing 31 states; patients in every state

5 70,000 PHYSICIANS 300,000 STAFF 20 MEMBERS 70,000,000 PATIENTS 30,000 BEDS 200 HOSPITALS 31 STATES Working together, we can really make a difference

Founding Partners Mayo Clinic Intermountain Healthcare Dartmouth Hitchcock Medical Center (The Dartmouth Institute (TDI) – data center, convener) Denver Health

Partners Baylor Health Care System Scott & White Healthcare University of Iowa Health Care Beaumont Health System North Shore-Long Island Jewish Health System MaineHealth Providence Health & Services (affiliate) UCLA Medical Center Virginia Mason Medical Center Beth Israel Deaconess Medical Center

More Partners Hawaii Pacific Health Sinai Health System NYU Boston Children’s Dept of Defense Tricare (MCA signed)

 All are integrated delivery systems (+/- insurance – ownership vs. partnership)  Other systems showing active interest  Core funding: Annual member payments supplemented by grants

Core Activities  MCA – Master Collaborative Agreement: establishes principles by which we work together and share data  Criteria for Membership  “All in” collaborative projects – Total knee (e.g., HA article) Diabetes mellitus Heart failure (just starting) Episodic bundled payment (focus: total knee) Medicare data base analysis

Core Activities (continued)  Voluntary collaborative projects – o CMMI Innovation Challenge - ~$120 million Shared Decision Making – hip, knee, spine, diabetes, HF Sepsis 3 QI projects in complex chronically ill patients o Other

Shared Learning 3 levels of deployment: Directly participate in a project Adopt a success from another subgroup (direct access to front-line, hands-on expertise) Transparently Publish

HVHC Organization Structure 13 HVHC Program

HVHC Data Trust & Collaborative Tools 14

HVHC TKR patients, every state

Addressing Unwarranted Variation in Health Care: Can Better Care Cost Less? 16 Cost = cost per episode x # of episodes Variation in cost per episode: Cost of TKRs across HVHC sites Variation in # of episodes: # of TKRs across HVHC sites

Sample: % TKR Patients Discharged to Self-care Site E higher due to lack of insurance Site G higher due to intentional process HVHC is now testing

Sample: TKR Length of Stay (LOS) Improvement 18 Average Length of Stay (in days) Site C has reduced its Length of Stay for TKRs by almost a day Early results of change

CMMI Innovation Challenge Award The goals of this initiative are to: 1.Improve quality, outcomes, and cost of care by advancing best practice care models for patients considering hip, knee, or spine surgery and patients with diabetes, congestive heart failure, or sepsis 2.Improve patient experience and reduce utilization and total cost by implementing: a.Shared decision making (SDM) interventions for preference- based decisions (hips, knees, spine surgery) b.Patient engagement interventions (e.g., decision tools, motivational interviewing, patient management) for complex patients with diabetes or CHF 19

20 35,000 Knee Patients 55,000 Knee Surgery Patient Data Cohorts 385,000 Diabetes Patients 40,000 Sepsis 39 Million CMS Beneficiaries Patient Data: identify best practices, assess impact of change, support research