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Transforming Healthcare Presentation to the Academy on Violence and Abuse Joe Mott, MBA, FACHE Vice President – Healthcare Transformation April 2013
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“Everybody is trying to systemically improve value and quality, but at Intermountain they have worked out the operational system and culture to do it.” - John Mendelsohn, MD President MD Anderson Cancer Center
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“Opportunities for quality and value improvement are legion … Today, a growing number of providers - such as Intermountain Healthcare in Utah, MD Anderson Cancer Center in Houston, and the Cleveland Clinic in Ohio - have such processes. Imagine if the right kind of competition demanded such efforts by every provider … The potential in terms of value improvement for patients is staggering.”
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“Intermountain is the best model in the country of how you can actually change health care for the better.” - John Wennberg, MD Dartmouth College The Dartmouth Atlas White Paper concludes that the nation could reduce healthcare spending by 40% if Intermountain Healthcare was used as a benchmark for the country.
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U.S. Debt and Unfunded Federal Obligations in Trillions
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Utah Medicaid Source: Initial Analysis of Federal Health Reform Legislation. Utah Department of Health. March 30, 2010. Available online at http://www.ncsl.org/portals/1/documents/health/UDOH10-2010.pdf. Source: Fiscal Year 2011 Budget Summary. Governor’s Office of Planning and Budget. May 2010. Available online at http://www.governor.state.ut.us/budget/Budget/Budget%20Summaries/FY%202012_SumBk.pdf
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Commercial Health Insurance Premiums
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Financial Doom Cycle Increasing commercial insurance costs Higher numbers of Medicaid and uninsured Medicaid and uninsured payments fall further behind costs Commercial insurance becomes less affordable
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More is Less Jerome Hoffman, MD UCLA Medical Center Source: This American Life on WBEZ 391 – More is Less. 10-09-2009
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Is More Healthcare Better?
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What Are Payers Doing? Medicare Medicare Advantage (Part C) Accountable Care Organizations – PPACA Shared Savings – 220 Advanced Payment ACOs – 35 Pioneer ACOs – 32 Bundled Payment Medicaid Utah “ACO” Model January 2013 Commercial
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Components of Cost Healthcare Cost Per Person = XX Population Utilization Health Episodes Per American A hospitalization Intracase Utilization Processes Per Health Episode Days, MRIs, Lab Tests Efficiency Cost Per Process Cost per day, cost per MRI, etc. “How much it costs.” “How much we use.”
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Our Problem: Unwarranted Variation 1. We have a lack of evidence-based best practices 2. Hospitals and physicians are paid for volume 3. Physicians & patients are largely cost unconscious
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Clinical Programs establish system- wide, evidence-based standards Hospitals and physician clinics implement these standards Providing Evidence-based Care “We are in a state of avoidable ignorance” Shannon Brownlee
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Five Things Physicians and Patients Should Question Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is: Supported by evidence Not duplicative of other tests or procedures already received Free from harm Truly necessary
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Evidence-based Standards provide the best legal defense
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Aligning Financial Incentives Physician and Hospital Payment Models Sharing Risk with Payers
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Engaging Patients and Members 1.Shared Decision Making 2.Health Promo & Wellness 3.Case Management 4.Benefit Design 5.Transparency
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Abandon Hope All Ye Who Enter Here The Inferno Purgatorio Paradiso Do Not Abandon Hope
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Returning Value to the Community Reducing GDP spend by 2.5%
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What Should You Do? Be sure you are developing and using evidence-based guidelines Be willing to be flexible in considering new payment models Think about your strategic alliances Think Prevention – a service for which we will finally (might) pay!
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“There is no more time left for timidity.” Don Berwick, MD
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