AAMC LHSHigh-Value Health Care Delivery in an

Academic Health Enterprise:Implementation of Value Driven Outcomes (VDO) to

Enhance Health Services Research and Personalized Medicine

Yoshimi Anzai, M.D., M.P.H.Associate Chief Medical Quality OfficerUniversity of Utah Health Care

STEP NO 01: IDENTIFY OPPORTUNITY HIGH VALUE HEALTHCARE INTRODUCTION | SLIDE 2 of 23

Value Driven Healthcare

If you improve outcomes without escalating cost you have succeeded. If you have deliver equally good outcomes more efficiently, you have succeeded. If you didn’t do one of these two, you have failed.”

Michael Porter

01

“

STEP NO 02: SET GOALS HIGH VALUE HEALTHCARE INTRODUCTION | SLIDE 3 of 23

Utah Value Equation02

WHAT WE’LL COVERTODAY

1 2 3Factory of

ONEEmpowered

TEAMSCultural

ALIGNMENTTOP 50

Medical Conditions

organizing teams for meaningful change

Value Driven Outcomes (VDO)

engaging individual physicians to + value

acceleratingorganization change

University of Utah: HIGH-VALUE HEALTHCARE AAMC LHS: February 22, 2016 | SLIDE 4 of 23

Factory of OneValue Driven Outcomes (VDO)

STEP NO 01: IDENTIFY OPPORTUNITY VALUE DRIVEN OUTCOMES FACTORY OF ONE | SLIDE 6 of 23

Identify Opportunity

When providers understand the cost of treating patients, they can contemplate innovative approaches.”

Robert Kaplan & Michael Porter

01

“

STEP NO 02: SET GOALS VALUE DRIVEN OUTCOMES FACTORY OF ONE | SLIDE 7 of 23

Set Goals (organize)

Value Driven Outcomes (VDO)

• Implement confidentiality training and compliance process

• Provide training and access for clinical providers

• Develop actionable provider scorecards

• Record and monitor self-directed improvements

02

VALUE DRIVEN OUTCOMES: SCORE CARDS FACTORY OF ONE | SLIDE 8 of 23

Value Driven Outcomes (VDO)

VALUE DRIVEN OUTCOMES: AVERAGE COST PER CASE FACTORY OF ONE | SLIDE 9 of 23

Analyze Variation among providers

Select any combination of MS-DRG, Diagnosis, and

Procedure codes

Click on the legend to drill into the Cost

Categories

VALUE DRIVEN OUTCOMES: AVERAGE COST PER CASE FACTORY OF ONE | SLIDE 10 of 23

Drill into Direct Costs to view cost variation by

cost categories

Empower TeamsTOP 50 Medical Conditions

STEP NO 01: IDENTIFY OPPORTUNITY TOP 50 MEDICAL CONDITIONS EMPOWER TEAMS | SLIDE 12 of 23

Identify Opportunity

The first principle…requires a shift from today’s siloed organization by specialty department and service to organizing around the patient’s medical condition.”

Michael Porter & Thomas Lee

01

“

STEP NO 02: SET GOALS TOP 50 MEDICAL CONDITIONS TOP 50: EMPOWER TEAMS | SLIDE 13 of 23

Set Goals (organize)

Top 50 Medical Conditions• Define clinical conditions• Define populations• Explicitly develop value measures• Build scorecards• Bring together interdisciplinary teams

02

Balanced Value Improvement

TOP 50 MEDICAL CONDITIONS: PERFECT CARE INDEX EMPOWER TEAMS | SLIDE 14 of 23

12

34

PERFECTCAREINDEX

ExceptionalPatientExperience

PatientReportedOutcomesMeasurementInformationSystem

Quality& Safety

Disease Specific Outcomes &

AppropriatenessMeasures

TOP 50 MEDICAL CONDITIONS: SCORE CARDS EMPOWER TEAMS | SLIDE 15 of 23

Requires new ways to organize TEAMS…

TOP 50 MEDICAL CONDITIONS: “TEAM OF TEAMS” Top 50: EMPOWER TEAMS | SLIDE 16 of 23

Team of Teams: new rules of engagement for a complex world. Stanley A. McChrystal, Tantum Collins, David Silverman, Chris Fussell. New York, New York: Portfolio/Penguin 2015

Cultural Alignment

STEP NO 01: IDENTIFY OPPORTUNITY CULTURAL ALIGNMENT | SLIDE 18 of 23

Identify Opportunity

Creating a shared mental model of the system’s goals, tools and techniques are necessary to achieve improvement.

Experiential learning is essential to developing the ability to identify and institute system-based improvements in patient care.”

CLER Pathways to Excellence

01

“

STEP NO 02: ORGANIZE CULTURAL ALIGNMENT | SLIDE 19 of 23

Organize02

CULTURALALIGNMENT

1 2 3Recruit

LEADERSAlign

INCENTIVESBuild

SKILLS(What’s in it for me?

Find ways to simplify and improve

practice)

(Find peer leaders, create a guiding

coalition, engage the organization)

(Systematically support skill

improvement)

`

PHYSICIANS

VALUELEADING

STEP NO 03: SET GOALS CULTURAL ALIGNMENT | SLIDE 21 of 23

Set Goals03

System Clinical Goals System Tools Techniques & Experiential Learning

Value Summary Improvement Portal

ALIGN INCENTIVES: PHYSICIAN IMPROVEMENT CREDIT CULTURAL ALIGNMENT | SLIDE 22 of 23

Align Incentives: MOC-P4 Maintenance of Certification (MOC Part IV) Portfolio Sponsor Program

# active MOC Part IV Improvement Projects

(Value Summary Portal)

71# Faculty engaged

MOC Part IV projects

334Date University of Utah became

an ABMS approved sponsor

2/2014

ALIGN INCENTIVES: CME/CE ACCREDITED VALUE TRAINING CULTURAL ALIGNMENT | SLIDE 23 of 23

Align Training: VALUE UNIVERSITYHealthcare Value-driven Improvement Training

UTAH VALUEREVOLUTION

(internal + external)

Online LearningModules

(internal + external)

24/7 12 1-daySessions/year 2 Physician

Cohorts/year 2 Expert

Cohorts/year

Value ImprovementLeaders

(internal only)

Lean Six SigmaGreenbelt

(internal only)

JOIN THE REVOLUTIONSalt Lake City, Utah

Team-based value improvement culture training [Learn]Maximum of 3 organizations per session [Network]

Offered monthly, CME certified [Get credit]Register online today:

healthsciences.utah.edu/value-university/

Thank you.

Questions? y o s h i m i . a n z a i @ h s c . u t a h . e d u