Surf’s Up! Pursuing Excellence in a Decade of Health Care Reform Why Now? Using Baldrige to Meet the Challenges of Healthcare Reform Era Steve Durbin Durbin Consulting – Healthcare Quality Strategies Member, WSQA Board of Directors 1

Durbin Consulting – Healthcare Quality Strategies Breakout Session Objectives Learn from two leading healthcare organizations on their use of Baldrige to pursue performance excellence Learn from two leading healthcare organizations on their use of Baldrige to pursue performance excellence Learn from ideas on how Baldrige can be used to help prepare care providers for an era of healthcare reform, and its potential application across “aligned” care provider organizations and communities Learn from ideas on how Baldrige can be used to help prepare care providers for an era of healthcare reform, and its potential application across “aligned” care provider organizations and communities 2

Durbin Consulting – Healthcare Quality Strategies Waves of Change - Hunker Down or Surf with the Waves A very challenging, changing economy impacting healthcare markets A very challenging, changing economy impacting healthcare markets Reductions in payment for health care services Reductions in payment for health care services Emergence of providing value in delivery of health care as a necessity of staying in business Emergence of providing value in delivery of health care as a necessity of staying in business Convergence of six plus years of national initiatives in quality measurement, care coordination and payment reform Convergence of six plus years of national initiatives in quality measurement, care coordination and payment reform And now, a Healthcare Reform law that brings many of these trends together And now, a Healthcare Reform law that brings many of these trends together And increased demand thru expanded insurance coverage And increased demand thru expanded insurance coverage 3

Durbin Consulting – Healthcare Quality Strategies Healthcare Reform Implications for Providers Pricewaterhouse Coopers Report: Pricewaterhouse Coopers Report: New reimbursement models favor hospital and physician alignment, including physician employment, over the traditional private practice model. New reimbursement models favor hospital and physician alignment, including physician employment, over the traditional private practice model.  Bundled payments, accountable care organizations, medical homes, reduced readmissions, and quality based reimbursement require hospitals and physicians to become partners in payment. Beginning in 2015, a 300-bed hospital with poor quality metrics could be penalized by more than $1.3 million per year. Beginning in 2015, a 300-bed hospital with poor quality metrics could be penalized by more than $1.3 million per year. 4

Durbin Consulting – Healthcare Quality Strategies What Does “Alignment” Mean? Key Premise – hospitals, physicians, and other components of a local care system will need to have true coordination and integration of clinical care. Partnerships can’t be just paper and legal arrangements to garner revenue, with providers continuing to operate in their silos Partnerships can’t be just paper and legal arrangements to garner revenue, with providers continuing to operate in their silos Implies a need for an operating structure and systems designed to deliver improved quality, efficiency and value Implies a need for an operating structure and systems designed to deliver improved quality, efficiency and value Its what patients and families expect care providers to do! 5

Durbin Consulting – Healthcare Quality Strategies Why Baldrige for Aligned Care Provider Organizations (ACOs?) and Communities? Baldrige is a framework for assessing and planning how things will work Baldrige is a framework for assessing and planning how things will work Mission, Strategies and Results – What are they trying to achieve, how will the joint mission be deployed across aligned organizations? Mission, Strategies and Results – What are they trying to achieve, how will the joint mission be deployed across aligned organizations? How will the aligned organization operate? How will the aligned organization operate? Assess Process, Customer, Workforce, Knowledge & information management Assess Process, Customer, Workforce, Knowledge & information management 6

Durbin Consulting – Healthcare Quality Strategies Assess Care Processes Across Currently Fragmented, Siloed Local Care Systems 7

Durbin Consulting – Healthcare Quality Strategies Resources and Contacts WSQA Preferred Consultants WSQA Preferred Consultants WSQA Learning Opportunities WSQA Learning Opportunities Lite Assessment Application Process for Quality Award Lite Assessment Application Process for Quality Award Online Assessment Survey Tool Online Assessment Survey Tool WSQA offers workshops WSQA offers workshops Introduction Introduction Self Assessment Self Assessment Case Study Case Study Preparation for Application Preparation for Application 8