1. Moving the Needle in Quality Tom Evans, MD SCHA Transforming Health Symposium April 7, 2016 100 E. Grand Ave., Ste. 360 Des Moines, IA 50309-1835 Office: 515.283.9330 Fax: 515.698.5130 www.ihconline.org

2. Consider the transformation of clinical care introduced through Affordable Care Act (ACA) Describe the Partnership for Patients campaign and efforts to improve quality and patient safety in Iowa Explore the impact on clinical performance improvement and the future Objectives

4. Health Cost Trend 4 The rate of growth in expenditures on hospital care and physician & clinical services is remarkable. And while that rate of growth has been on a steep upward curve for two decades, the curve becomes nearly vertical in the last five years. Health System Micro Economies 25 % 60 % Data shown is total, inflation adjusted dollars that are going into health care through commercial insurance, Medicare, and Medicaid Source: Neal C. Hogan, PhD. BDG Advisors, LLC. The End of the Third Bubble. Winter 2009. Carol Corp. / United Health Group October 2010

5. Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Analysis of World Health Organization mortality files and CDC mortality data for U.S. U.S. Lags Other Countries: Mortality Amenable to Health Care Source: Adapted from E. Nolte and M. McKee, “Variations in Amenable Mortality—Trends in 16 High-Income Nations,” Health Policy, published online Sept. 12, 2011.

6. National Health Care Reform

7. 1.Put the patient in the center 2.Transparency and openness 3.Elimination of waste and continuous improvement 4.Collaboration and partnership The Four Pillars for Health Care Transformation

8. A Whole New Sport

10. Move away from classic fee-for-service payment Pay health care providers in new ways to spur delivery system reform, enhance patient care, get rid of waste and slow the growth of health spending (ACOs, PCMHs, APMs, etc.) Various pilot and demonstration projects, some new, some building on experiments tried in previous administrations Simplified Structure of Health Care Reform

11. Partnership for Patients

12. Partnership for Patients Campaign Nationwide over three years, reduce… Preventable inpatient harm by 40% Readmissions by 20% How do we get ready?

13. If we have to bend the curve, where do we start to transform health care? 20-30% of hospitalized patients experience some kind of harm… Improve Patient Safety Around 20% of Medicare patients are readmitted within 30 days… Improve Care Coordination The hospital is the health care community hub for the sickest patients… Start at the hospital Why this focus?

14. Readmissions Adverse drug events Venous Thromboembolism (VTE) Falls Pressure Ulcers OB adverse events Catheter associated UTI Surgical Site Infection (SSI) Ventilator-associated Pneumonia (VAP) Central line infection PfP Scope of Work

15. PFP-Measured HACs Pie Chart (2010)

16. Hospital Engagement Network (HEN)* Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Falls Pressure Ulcers Obstetrics HAI Cardiovascular VTE Alignment of Federal Program Investments in Iowa March 3, 2015

17. IHC HEN Safety Across the Board HEN Baseline 2012

18. HACs for PfP Campaign HACs/1000 145142132 121

19. Impacts of Major Improvements in Patient Safety: Compared to 2010 Baseline 17% Reduction in HACs 2010-2014 –from 145 per 1,000 discharges to 121 per 1,000 discharges in 2013 and 2014 –39% reduction in preventable HACs – nearly at 40% goal $19.8B in Estimated Associated Cost Savings 2010-2014 –$4B for 2011 and 2012 combined –$15B for 2013 and 2014 combined 87,000 Lives Saved 2010-2014 –~15,000 lives saved for 2011 and 2012 combined –~72,000 lives saved for 2013 and 2015 combined * Final MPSMS-based 2013 HACs, Preliminary 2013 NHSN-based HACs, and extrapolation of 2012 Data for 2013 PSI-based HACs; Partnership for Patients 12/1/14 press release

20. Transforming Clinical Practice

21. “HEN for Docs” Enhance outpatient skill in population- based care to “thrive in value-based reimbursement” Multi-state application with rural focus Five Phases of Transformation Transforming Clinical Practice Initiative (TCPI)

22. Set Aims Use Data to Drive Care Achieve Progress on Aims Achieve Benchmark Status Thrive as a Business via Pay for Value Approaches Transforming Clinical Practice Initiative Phases of Transformation 22

23. Participating States and Lead Organizations

24. Transforming Clinical Practice (TCPI)* Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement PQRS Measures Cardiovascular VTE Prevention (Tobacco, Obesity) Diabetes Alignment of Federal Program Investments in Iowa MU Measures

25. State Innovation Model

26. Develop and test of state-led, multi-payer health care service delivery and payment models Medicaid Modernization in Iowa State Innovation Model (SIM)

27. Cardiovascular and Stroke Palliative Care (IPOST) Obstetrics Healthcare-associated Infection Diabetes (June ‘15) Medication Safety (July ‘15) Statewide Strategies

28. Diabetes Social Determinants of Health Clinical Focus (What) Operational Focus (How) Community Care Coordination Patient and Family Engagement Medication Safety and Effectiveness Obstetrics Tobacco Obesity HAI State Innovation Model (SIM) Clinical Improvement

29. Cardiovascular and Stroke Palliative Care (IPOST) Obstetrics Healthcare-associated Infection Diabetes (June ‘15) Medication Safety (July ‘15) Patient and Family Engagement (July ‘16) Social Determinants of Health (July ’16) Statewide Strategies

30. State Innovation Model (SIM) Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Obstetrics HAI Social Determinants of Health Prevention (Tobacco, Obesity) Diabetes Alignment of Federal Program Investments in Iowa

31. Hospital Engagement Network (HEN)* Transforming Clinical Practice (TCPI)* State Innovation Model (SIM) Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Falls Pressure Ulcers Obstetrics HAI Social Determinants of Health PQRS Measures Cardiovascular VTE Prevention (Tobacco, Obesity) Diabetes Alignment of Federal Program Investments in Iowa MU Measures

32. Hospital Engagement Network (HEN)* Transforming Clinical Practice (TCPI)* State Innovation Model (SIM) Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Falls Pressure Ulcers Obstetrics HAI Social Determinants of Health Asthma Cardiovascular VTE Prevention (Tobacco, Obesity) Diabetes Population based, Community Applied

33. Population-based, Community applied

34. 1. Change the balance of power…co- production 2. Standardization 3. Customization 4. Promote well being 5. Joy in the work The Ten Elements of Radical Redesign

35. 6.Make it easier…Lean 7.Modernization 8.Collaboration 9.Assume abundance 10.Return the money The Ten Elements of Radical Redesign