1. The Sheba Journey Towards Value Measurement Eyal Zimlichman MD, MSc Ahuva Weiss-Meilik PhD Ari Shamiss MD, MPA Delegation of North America Hospital CEOs to Israel February 5, 2012

2. Sheba Medical Center has developed since 2002 a balanced-score-card management systems – CHESS ( “Clinical and Health Economy and Satisfaction Simulator” ) measuring:  Clinical process  Clinical outcome  Patient level activity based costing To allow for correlation between process and outcomes – both clinical and costs, SMC has been developing an approach that would allow through case-mix and correlation algorithms to optimize total value (Medilogica). Sheba Road Map

4. Measuring Cost… To create value we need to relate quality to cost Measuring cost using claims as proxies is insufficient The $ value of an outcome is essential for comparative effectiveness or more accurately “comparative efficiency” Therefore Patient-Level Costing is an important denominator

10. The Challenge It is difficult to correlate between outcomes and process variability Clinical leaders and clinicians are minimally involved in the efforts to maximize value 10 Sheba Medical Center

11. Medilogica: Measuring and Optimizing Value

12. What is Medilogica? A value (quality and cost) measurement and optimization system that allows redesigning care to maximize health care value Allows clinicians and managers to identify process steps that would increase value (reducing costs of care while improving clinical outcomes) on a procedure/diagnosis level Patient level costing data as well as clinical process and outcomes need to feed the Medilogica engine Engine algorithms have been developed and tested individually. Sheba Medical Center is about to launch the full solution for the first time. 12 Sheba Medical Center

13. CHESS: Sheba’s Organizational Value Compass Sheba Medical Center 13 ORGANIZATIONAL GOALS MEASURES Clinical Financial Patient oriented CRM/academic Senior Steering Committee 8 Work Groups Balanced Score Card ORGANIZATIONAL VALUE COMPASS “Clinical and Health Economy and Satisfaction Simulator”

14. CHESS: IT Architecture Sheba Medical Center 14 EMR Lab ADT PACS CPOE IRB HR Financial Academic Safety/RM Infec. Dis. Training DATA WAREHOUSE Data analytics Case-mix adjustment CHESS measures SQL data Dashboard presented on an organizational web portal (Microsoft office SharePoint) Overall – 86 quality indicators: 43 – clinical perspective 18 – financial perspective 11 – patient perspective 9 – Crew resource and academic perspective 5 – Case-mix measures General dashboard Nursing dashboard

15. Where does Medilogica fit? 15 CHESS VALUE COMPASS MEDILOGICA

16. Principles of Medilogica Measuring process and outcome alone is not sufficient to maximize health care value Medilogica provides a correlation engine that allows clinical leaders to drive care processes according to expected clinical and financial outcomes Medilogica’s case-mix clustering principle allows to group patients sharing similar clinical profiles – thus adjusting for case-mix 16 Sheba Medical Center

17. Case-mix Clustering 17

18. The Medilogica Platform Grouping of patients using the case-mix cluster algorithm  Correlate financial and clinical outcomes  Optimize total value of the clinical product  Segment similar cases leveraging case mix adjustment algorithm  Real time predictive modeling tools for clinicians  Assess the variation in outcomes and identify areas of potential improvement Data collection:  Clinical, financial and administrative information systems  Smart pop-up dialogue boxes  Enterprise data warehouse 18 Sheba Medical Center

19. Data Platform and Solutions 19 Sheba Medical Center

20. Patient Level Costing Financial outcome data feeding the Medilogica system has to on a patient level, be activity based and time derived in as a real-time fashion as possible 20 Sheba Medical Center is operating an information technology – real time - activity based patient level costing system (TMR by Gomla). Sheba Medical Center

21. DEMO Sheba Medical Center21

22. Dashboard: Clinical Orientation 22

23. Dashboard: Financial Orientation 23

24. Financial and Clinical Outcome Fracture of Hip 24

25. Correlating Outcome to Process: Defining Best Practice 25

26. 26 Value Optimization Engine Fracture of Hip

27. 27 Value Optimization Engine Fracture of Hip

28. 28 Value Optimization Engine Fracture of Hip

29. Current Status Case-mix and correlation algorithms have been developed during the last 10 years at Sheba Medical Center (Dr. Ahuva Meilik-Weiss and Dr. Eyal Zimlichman). SMC owns the intellectual property for the algorithms Sheba Medical Center is about to launch a full implementation of the system. Colon surgery was chosen as a pilot condition. Sheba will be looking for partners to jointly develop the operational system. 29 Sheba Medical Center

30. Planned Medilogica Pilot Develop and implement a fully operational value (quality and cost) measurement and optimization system for colon surgery patients, setting the stage for measurement and optimization of other conditions and procedures across the hospital. 30 Sheba Medical Center

31. Piloting at other hospitals 31 Defining: process maps, clinical outcomes Enhancing costing system Validate case-mix cluster algorithm Develop preliminary dashboard Data collection in real-time (manual plus IS) Report to managers Sheba Medical Center

32. Looking ahead… How many conditions do we need to cover? Pareto rule, top 10-20 in terms of variation in costs and clinical outcomes would account for the vast majority of potential improvement Looking across the continuum of care (did someone say ACO?...) Cross providers-patient level costing systems Patient centered longer-term outcomes (patient reported) Optimizing process across the continuum, following the patient 32 Sheba Medical Center

33. THANK YOU 33 MEDILOGICA Sheba Medical Center