1. November 5, 2015 Key Concepts in the Drive to Value Dr. Georgean G. deBlois, CMO

2. 2 Value Equation

3. 2 How Did We Get Here?

4. 2 Our Healthcare Costs More

5. 2 Ranking

6. 2 Healthcare Costs Outpace Inflation

7. 2 Costs Challenge Value

8. 2300% Increase 1970-2009 2 Healthcare Spend Increase

9. Aging Population – One in eight Americans are 65+ – 2009: 65+ comprised 12.9% of the population – 2030: 65+ will comprise 19% of the population – That is 72.1 million people 2 Drivers of Healthcare Costs

10. Chronic Disease – 1.875 Trillion annually – 85% of every health care dollar 2 Drivers of Healthcare Costs

11. 2 Medical Advances – Technology – Pharmacology $1,000 per pill ($84,000 course of therapy)

12. Hospital Readmissions – In 2011, nearly one in five patients was readmitted to the hospital within 30 days – Estimated preventable cost burden = $25 billion annually 2 Drivers of Healthcare Costs

13. 2 Where the Money Goes

14. 2 Crowding Out Other Spending

15. 2 What Can Be Done?

16. 2 Change Has Already Begun If Incentives are changing 180⁰… Strategy and Behavior must change as well

17. Identify the problem 2 What it Takes

18. Define the Goal 2 What it Takes It’s All About Value

19. 2 Value Not Volume

20. 2 Quality Matters

21. 2 Quality is Essential

22. Numerous Organizations – Develop – Track – Promote 2 Quality Determinants

23. Criteria: – Relevance – Importance Scientifically Sound, Evidence Based – Compelling evidence that the measures improve outcomes? – Do clinical guidelines demonstrate clear benefit? Valid, Reliable – Do the data produce consistent results? 2 Quality Measures

24. Care Gaps, Care Variation – Does closing gaps result in better outcomes? – What variation can be measured across providers? Feasibility – Are the data needed to support the measures widely available? – Are the data accurate? 2 Quality Measures

25. Outcomes – Pain Relief, no complications, survival Processes – Reliability of processes strongly associated c desired effect: Core measures, ED wait times Structures – In-place resources that infer higher quality of care Private room 24 hour intensivist coverage 2 Performance Measures Quality

26. Patient Satisfaction Surveys 2 Quality and Patient Experience

27. Data Transparency 2 It’s a New Day

28. “ That which is measured tends to improve. That which is measured publicly tends to improve faster. ” Steven M. Berkowitz, SMB Health Consulting “ What we concluded was that even when hospitals know their performance is not good, that’s not sufficient motivation for them to do something. Making it public made a big difference in motivating them to improve. ” Judith Hibbard, Health Affairs, 2003 2 Data Transparency

31. Learning from the Aviation Industry 2 Evidence Based Medicine

32. How Do We Establish Best Practices? Look to the Specialty Societies and their literature ? 2 Evidence Based Medicine

33. Eliminate Ambiguity “The elimination of ambiguity is consistently cited as a key factor in protocol success and safety” Degani & Weiner, 1993 Medical Guidelines tend toward ambiguity –May be easier to get buy-in of multiple physicians See Medicine as an Art as well as a Science Loath “cookbook” medicine 2 Lessons from the Airline Industry

34. Oxytocin Treatment Guidelines ACOG 2006 Compendium “Any of the low dose or high dose regimens outlined in table 2 are appropriate” – (0.5-6mU/min every 15-40 min) “Each Hospital’s OB/GYNdepartment should develop guidelines for the preparation and administration of oxytocin” “The uterine contractions and fetal heart rate should be monitored closely” 2 Example

35. Postdates Guidelines ACOG 2006 Compendium “Women with post-term gestations who have unfavorable cervices can either undergo labor induction or be managed expectantly” “Delivery should be effected if there is evidence of fetal compromise” 2 Example

36. How to Land a 747 In a Strong Cross Wind* *Had it been written by ACOG Use any settings of the plane’s instruments you feel like Every airline and pilot can do it differently Be really careful as you get close to the ground! Steve Clark, MD, SMB Health Consulting 2 Example

37. 2 Cost Matters

38. 2 The Way Forward

39. 2 Data Transparency

40. 2 Value Remains a Challenge

41. A Path to Value Patient Centered Promotes the Triple Aim 2 Population Health

42. 980 independent and 108 HCA-employed physicians 323 Primary Care Physicians 138 practices with 277 locations throughout Richmond metro Physician-Led Board of Managers and Committees more than 50 physicians serve on BoM and Quality, Performance and Payer Committees Global Quality Program Performance improvement through the collection and analysis of quality data across all payers, all patients Clinically Integrated Network 5 What is VCP?

43. Why? Formation of collaborative physician-led network sanctioned by FTC that can collectively negotiate value-based contracts and earn shared savings by: Quality and Care Cost 2

44. 2 VCP Clinical Services Improve the outcomes of patients through a coordinated, high quality network that controls costs

45. 2 It’s Not Easy

46. We’ve Done Some Things Right 2 However…..