1. Symposium on Delivery Science: Evolution & Application A focus on: The boundaries of Delivery Science Tools and expertise for success in patient care in the reformed health system The role of supply chain in new models of innovation Meeting the dual demands for clinical and economic integration A panel from academia, practice, and the supplier community including: Amol Navathe, M.D., Ph.D., Co-Editor, Health Care: The Journal of Delivery Science and Innovation Keith Lindor, M.D., Executive Vice Provost and Dean, College of Health Solutions, ASU Terry Loftus, M.D., MBA, Medical Director of Surgical Services and Clinical Resources, Banner Health Michael Nagel, MBA, President and CEO, Vomaris Innovations Natalia Wilson, M.D., MPH, Co-Director Health Sector Supply Chain Research Consortium, ASU

2. The Science of Healthcare Delivery: Moving Beyond Theory Terry Loftus, MD, MBA, FACS Medical Director Surgical Services & Clinical Resources Banner Health, Phoenix, Arizona

3. Agenda Challenges – Volume to Value – Transition from High Cost to Low Cost Centers – The Great Migration Approaches – Contracting – Utilization – Physician Support – Clinical Practice – Patient Safety

4. CHALLENGES

5. Volume to Value

6. Quality of Life Comfortable setting Chronic Disease Management Cost Effective Independent, Healthy Living $1$10$100 Home Care Assisted Living Skilled Nursing Facility Residential Care ICU Community Hospital Specialty Clinic Acute Care Cost of Care / Day Source: IBM ‘Connected Health’ Solution, 2011 $10,000$1000 High Cost to Low Cost Centers

7. The Great Migration

8. VALUE ANALYSIS PROGRAM Contracting

9. VAP: EVAR/ELGs Vendor AVendor B Vendor C Vendor D

10. Value Analysis Teams EVAR/ELGs* Synthetic Mesh* Biological Mesh* – Hernia & Breast Reconstruction Spinal Implants Ortho-biologics Heart Valves Urinary Incontinence

11. Value Analysis Savings $867K Total Savings

12. ORAL RINSE IN THE ICU Utilization

13. CHG Oral Care Case Study Critical Care Discipline Team identified a variance in supply usage (Q2 vs Q4) Worked with Supply Chain to reviewed literature to identify best practice (Q4) Team standardized practice across system and reduced costs System savings $129K (cut in half)

14. REPROCESSING Utilization

15. Reprocessing

16. ALL HANDS ON DECK Utilization

17. Aligning Strategies Preventing new non-value added spend just as critical as reducing current non-value added spend

18. Daily CHG Patient Hygiene Case Study Care Management and Supply Chain teamed with Infection Prevention – Care Mgt narrowed scope of patient population – Supply Chain lower cost alternative identified and contracted Potential $1M+ spend down to $300K

19. ENERGY DEVICE ADHESION BARRIER Physician Support

20. Ortho CCG Recommendation $255,570 Savings

21. OB/Gyn CCG: Adhesion Barriers --OB Clinical Practice* changed to eliminate adhesion barriers --Supply cost was reduced by nearly $1 million annually *Edwards RK, et al. Obstet Gynecol. 2014; 123: 919,923-928.

22. BOWEL SURGERY TOTAL KNEE ARTHROPLASTY Clinical Practice

23. Bowel Surgery – Key Process Steps: Early & frequent activity: ambulating 3 or more times on POD #1 Early alimentation: a minimum of 200cc of liquids on POD #1 Total Knee Arthroplasty – Key Process Steps: Early activity: mobilizing patient out of the bed, either to a chair, standing at the bedside or ambulating any distance on POD #0 Avoidance of continuous urinary catheter: no use of a continuous urinary catheter during their hospital stay Clinical Practice Metrics

24. Accelerating Adoption & Sustaining the Gains

25. Outcomes Bowel Surgery Outcomes* Reduction Complications -27.8% Gastrointestinal -30.2% Ileus -29.8% Pulmonary -34.4% 30-day Readmission -17.5% TKA Outcomes** Reduction Complications -10.5% Cost ($1000) mean -9.7% 30-day Readmission -18.8% LOS -7.6% * Loftus T, Stelton S, Efaw BW, Bloomstone J. A system wide care pathway for enhanced recovery after bowel surgery focusing on alimentation and ambulation reduces complications and readmissions. J. Healthcare Quality. 2014 Feb 20 (Epub ahead of print). ** Loftus T, Agee C, Jaffe R, Tao J, Jacofsky D. A simplified pathway for total knee arthroplasty improves outcomes J. Knee Surg. 2013 Nov 14 (Epub ahead of print). $3M Savings

26. SAFE SURGERY PROGRAM Patient Safety

27. Patient Safety & SRE Safe Surgery Program – Implemented in 22 acute and 8 ASC OR’s – Results Increase in days between SRE:121% Reduction in SRE:52% Est. 10 year cost avoidance:$5,565,523

28. Questions