VALUE BASED CARE: The Role of INTERMACS INTERMACS 8 TH Annual Meeting James B, Young, M.D. Study Chair – INTERMACS May 5 th, 2014

Bob Dylan 2006 “…you’d better start swimming or you’ll sink like a stone…for the times they are a- changin!” (1964) Bye Bye Borders (RIP; )

The Interagency Registry For Mechanically Assisted Circulatory Support (INTERMACS), a National Heart Lung and Blood Institute–sponsored collaborative database, analyzes United States (U.S.) Food and Drug Administration (FDA)–approved durable mechanical circulatory support (MCS) device implants in the United States MCSD centers. Incorporated into INTERMACS are a set of demographics, procedural, & outcomes measures (including adverse event definitions) which have been agreed upon by Industry, Clinicians and the FDA. Resource utilization can be both measured and modeled.

“A medical condition should be defined from the patient’s perspective. It should encompass the set of illnesses or injuries that are best addressed with a dedicated and integrated care delivery process.” - Michael Porter and Elizabeth Teisberg Redefining Health Care 2006 WE MUST TRANSFORM HOW CARE IS DELIVERED…

“Our system of uncoordinated, sequential visits to multiple providers, physicians, departments and specialties works against value. Instead we need to move to integrated practice units that encompass all the skills and services required over the full cycle of care for each medical condition…..” - Michael Porter NEJM 2009;361(2): A strategy for health care reform – Toward a value based system WE MUST TRANSFORM HOW CARE IS DELIVERED…

APPROACH TO HEALTHCARE 21 ST Century

THE NEW CHALLEGE OF ADVANCED HEART FAILURE CARE Patient outcomes –Appropriateness, quality & satisfaction Value –Value = Outcomes/Cost Bureaucratic regulation –Definitions –Allocation –Justification –Reimbursement

Multifaceted Outcome of Care Survival Costs/Burden Direct and Indirect Cost Caregiver Burden Lost Opportunities Adverse Events Quality of Life Physical Function Symptoms Mental, Emotional Social Outcome Relevant to Patient From Robert Kormos M.D.

Multifaceted Outcome of Care Survival In hospital mortality Long term mortality Costs/Burden Direct and Indirect Cost Caregiver Burden Lost Opportunities Adverse Events Quality of Life Physical Function Symptoms Mental, Emotional Social Outcome Relevant to Patient Current applications within INTERMACS

Inpatient Mortality Functional Level Achieved Pain Level Achieved Extent of return to physical activity Ability to return to normal activities Time to return to physical activity Pain Length of Stay Infection Bleeding Neurological Function Arrhythmias Other adverse events Maintained functional level Ability to live independently Need for readmission Need for other surgery Chronic adverse events Device reliability Infection Stroke Chronic right heart failure From Robert Kormos M.D.

Federal YearFFY VBP1.0%1.25%1.5%1.75%2.0% HCAHPSReporting 1.0% Readmissions1.0%2.0%3.0% TOTAL at Risk2.0%3.25%5.5%5.75%6.0% HCAHPS = Hospital Consumer Assessment of Healthcare Providers & Systems Progressive Financial Impact From Robert Kormos M.D. Oct Oct Oct Oct Oct Jan 2013 Jan 2014 Jan 2015 Apr.-Dec 2012 Measurement Period Financial Impact Timeline

A proposal –Expand INTERMACS “business world” activities –Provide more value to various constituencies (expand annual reports and increase contract work) Value = Cost & Outcomes for MCSD/Cost –Objective data –Modeled data “Consulting” analysis of MCSD programs Strengthening/Rejuvenating partnerships with FDA, CMS & Industry Establish relationships with private/public payers –Create “new” model for providing even more value

We have the expertise – Clinical trial expertise – Clinical registry expertise We have the data with >10,000 patients We have the relationships –NIH, CMS, FDA, Industry, Joint Commission, Private payers, MCSD centers, Transplant programs, UNOS/SRTS We have the need, desire & passion WHY? WE ARE YOU AND YOU ARE INTERMACS!