1. © 2010 University of Southern California Session V, Panel I Integrated Health Care Delivery Systems in Action II Organizing for Sustainable Quality Health Care Delivery A Time for Change: Restructuring America’s Health Care Delivery System Cornell University, Wednesday, May 12, 2010

2. © 2010 University of Southern California Susan Mohrman, Center for Effective Organizations, University of Southern California Michael Kanter, Southern California Permanente Medical Group, Kaiser Permanente Patti Harvey, RN, MPH, CPHQ, Kaiser Permanente Southern California Region Walter Allen, Coalition of Kaiser Permanente Unions Guido Bergomi, Director, Quality & Patient Safety, Cleveland Clinic Linda McHugh, Executive Administrator, Cleveland Clinic

3. © 2010 University of Southern California SM102T Demographic trends Escalating costs National economic adjustments in healthcare resources Powerful, expensive, and disruptive medical care technologies for treatment, prevention, and cure Skill shortages Active government stakeholders Relentless degradation of the environment

4. © 2010 University of Southern California Definitions of Sustainability Development that "meets the needs of the present without compromising the ability of future generations to meet their own needs” (Brundtland Commission, 1983) Our working definition of the sustainable provision of health care outcomes: the complex healthcare system operates to continually deliver high quality health, societal, and ecological value and operates with a viable economic model. SM26U

5. © 2010 University of Southern California The Health Care Eco-System May Look Quite Different in the Future The Cleveland Clinic and Kaiser Permanente are among those leading the way They are making headway with multi-faceted approaches involving integrated health care delivery and system optimization SM20U

6. © 2010 University of Southern California Principles of Health Care Sustainability Increase Value: Quality and impact of the health care services that are delivered and the benefits derived from health care resources Decrease consumption of resources that does not contribute value Optimize the system Build effective work systems Empower patients to take responsibility for their health SM22U

7. © 2010 University of Southern California A Tale of Two Systems – Institutional Contexts Not-for-Profit Kaiser Permanente – Capitation and Member Model Cleveland Clinic—Fee for Service Values Based Integrated Care Focus KP—Prevention and Life-Cycle Care; Integration across primary and specialty care CC—Multi-specialty care brought to bear on patient SM23U

8. © 2010 University of Southern California Institutional Context, Continued Knowledge Leverage and Growth Strategies KP—increase market penetration; raise bar for health status and outcomes of entire membership; build on deep longitudinal knowledge from millions of members CC—leverage cutting edge health care knowledge into new markets and services Research and Evidence-Based Approaches SM23U

9. © 2010 University of Southern California Common Elements of Emerging Healthcare Delivery System Comprehensive electronic medical records provide ease of integration of care Organizational and process integration across multi-specialty medical system Resource leverage through the rationalization/system-wide integration of multi-facility system Work system and organizational redesign Developing shared, evidence-based standards, protocols, methodologies and technologies New care modalities enabled by I.T. and other technological advances System regulation Learning, innovating, and improving Beyond “Traditional Health Care” focuses: – Ecological impact – Health community SM24U

10. © 2010 University of Southern California Conclusion The major elements of the sustainability transformation of the two systems are the same The particular manifestations are impacted by the institution contexts and business model The journey to sustainable health care is: Systemic Multi-Organizational Multi-Level SM25U