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Adult Enterprise Leadership Update
February 10, 2015 Mitch Edgeworth and Robin Steaban
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Today’s Agenda The Triple Aim Goal Alignment Our Journey
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Our agenda is consistent with the national movements in healthcare…
The IHI Triple Aim
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The national agenda is moving rapidly…
Value-driven, Coordinated Care Future Delivery System Changes Care Coordination Provider Feedback & Accountability Measurement around Quality & Efficiency CMS Bundled Payment Hospital-Acquired Conditions Penalties HITECH/ Meaningful Use Penalties TennCare Bundles Commercial Bundles 2016… 2015 2014 2013 2012 …2011 CMS Bundled Payment Pilot DRG Readmissions Penalties Value-Based Purchasing Incentives The healthcare is changing. Current market pressures require that we move from a fee for service payment system to a pay for value system. We are moving from a system that has rewarded fragmented care with unmeasured and unvalued outcomes to a system that requires clinical integration across a continuum of care with demonstration of positive outcomes for patients. We have been on this trajectory for some time with payers moving from incentivizing quality performance to penalizing organizations not meeting quality thresholds. CMS and Tenncare are rapidly moving to a payment system that extends payment for an acute event beyond the hospitalization to 30, 60, 90 days post discharge and puts us at risk for the delivery of quality outcomes. This change will dramatically affect how we deliver care. HITECH/Meaningful Use Incentives CMS Community Care Transition Program Today Volume-driven, Fragmented Care Fragmented event driven care Payment System Changes Fee-for-Service Episode or Comprehensive Care Payment Clinical Integration
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Fee-for-service will soon be in our past
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What does “Care Across the Continuum” mean?
Admission Discharge 30 Days Pre-op Admissions/Discharge planning Surgery/ Diagnostic Post-op Treatment SNF/HH/Home/PCP Discharge Simple Stable Routine Personalizing Care Across the Continuum Matching Resources to Patient Care Needs Complex Catastrophic Fragile Unstable “Everything the Patient Needs ad Nothing They Don’t”
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How are we responding to these new challenges?
Creation of PCC structure Better measurement in cost and quality Redesigning the entire episode of care Development of VHAN Investment in information technology The Patient Care Center structure has create a situation allowing us to re-organize care around patient medical conditions – Population health We are Increasing our ability to measure outcomes and costs for every patient – Improving Patient Experience We are moving our focus from acute care to redesigning care for the entire episodes of care - Population Health We are organizing to begin to clinically integrate as a multi-site care delivery systems – Population Health Expand geographic reach in areas of excellence – Patient Experience Build an enabling information technology platform – Patient Expereince
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Group feedback There are many efforts underway to accomplish the triple aim. What are ideas in your area where we can: Prepare for population heath Improve the experience of care Reduce costs per capita
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Goal alignment is critical
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Pillar Goals Focus Our Efforts
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Goal Attainment Requires Action at Every Level of the Organization
Perceived quality of care HCAHPS Administration Connect goals with actions Create and share results Provide resources Managers Patient Leader Rounding Measure and manage Staff Aidet Patient engaged bedside report Key words at key times Shared goal setting This slide begins to explode what is required at every level of the organization to achieve our service pillar goals. This cascade of action can be applied to all pillar goals. People at every level of the organization must take action if we are to meet our pillar goals. We must: challenge ourselves to use the best evidence translate those best processes into standard work apply the best practices to every patient, every time. And, because we do not manage what we do not measure, we must measure our performance and make our results transparent. To that end, you will start to see performance boards in areas. We are staring with the inpatient areas and posting results in public places for staff, patients and families to see. The new performance central system allows us to cascade goals down to every employee. As leaders, think about actions and behaviors are required to meet each goal. Standard Work Measurement /Reporting Role Clarity / Accountability
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Goal Attainment - Action at Every Level
PCC Administration Managers Staff Reduce Hospital Acquired Injuries Accuracy and access to date Ensure access to best practices Reduce PCC Falls with injury rate Standardize approach to falls reduction at unit level Reduce falls with injury on a unit Educate staff on best practice standard Leader Rounding Measure performance at an individual level Coach for success Targeted toileting Hourly Rounding Bedside report Falls prevention bundle This slide begins to explode what is required at every level of the organization to achieve our service pillar goals. This cascade of action can be applied to all pillar goals. People at every level of the organization must take action if we are to meet our pillar goals. We must: challenge ourselves to use the best evidence translate those best processes into standard work apply the best practices to every patient, every time. And, because we do not manage what we do not measure, we must measure our performance and make our results transparent. To that end, you will start to see performance boards in areas. We are staring with the inpatient areas and posting results in public places for staff, patients and families to see. The new performance central system allows us to cascade goals down to every employee. As leaders, think about actions and behaviors are required to meet each goal. Increase time to last fall Standard Work Measurement /Reporting Role Clarity / Accountability
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Our Journey
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Tremendous work is underway thanks to many people in this room
Case management redesign Discharge phone calls Time to fill vacancies Nurse triage B/P acquisition accuracy The Vanderbilt Clinic Model (aka Standard Clinic Operating Model) iRound Nurse call replacement Documentation of start and stop times of medication infusions for outpatients Clinical documentation excellence Standard check-in / check-out Continuous monitoring EVS workflow improvement New food production and menus Estimated date of discharge Lab ready labels New units - 7 South and TVC Observation Standard Inpatient Operating Model Rapid cycle redesign
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Other Important Challenges Are Before Us
VU/VUMC Split Replacement of all clinical IT systems Replacement of Medication Cabinets Hiring and onboarding
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Preparing ourselves through constant training is vital as we pursue the Triple Aim…
Preparation for quality and TJC Lean training - HPP Communication training – Kimberly Pace Staff engagement tactics – Advisory Board
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Summary IHI Triple Aim - Connecting the Dots -
HCAHPS Access Discharge phone calls Nurse triage Episode of Care Care coordination Case- management redesign Discharge phone calls VHAN Falls prevention Pressure ulcer prevention CLABSI CAUTI Readmissions Mortality LOS Episode of Care/Bundle work
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Questions & Answers
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Thank You
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Future of Outcomes Monitoring
To be competative in the market we will have to move to a different kind of outcome measurement. Harvard Business School highlights three tiers of outcomes. The first tier focuses on hard outcomes of survival and the degree with which people recover health after a health related occurrence. The next tier focuses on the “disutility” of Health care. This tier focuses on time to return to work and complications that may prevent a timely recovery. The top tier focuses on how long patients are bale to maintain health after an acute event and long term consequences of treatment such as cancer therapy induced cardiac disease. When we begin to measure these outcomes we can expect a dramatic change in the way we provide care and extraordinary challenges in determinations of the right care applied to the each patient. All of these changes, although in response to market pressures shine a light on the opportunities we will have to increase value for patients.
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