Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
The presentation will begin shortly.
Strategically Pursuing the Triple Aim at St. Charles Health System Trissa Torres, Senior Vice President, IHI
AHA Webinar
September 11, 2014
Definition
System designs that simultaneously improve three dimensions: – Improving the health of the populations; – Improving the patient experience of care (including quality and
satisfaction); and – Reducing the per capita cost of health care.
Global Triple Aim Participants
Triple Aim Populations
• Defined Populations: A defined population that makes business sense (e.g. who pays, who provides) around the Triple Aim
• Community-Wide Populations: Working in a geographic area to accomplish the Triple Aim for the community
Triple Aim
Results
Defined Populations
Community-Wide
Populations
Determinants of Health and Their Contribution to Premature Death
Social circumstances
15%
Environmental exposure
5%
Health care10%
Behavioral patterns
40%
Genetic predisposition
30%
Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93.
Proportional Contribution to Premature Death
Potential Triple Aim Population Outcome Measures (6/2011)
Dimension Measure Population
Health 1. Health Outcomes:
Mortality: Years of potential life lost; Life expectancy; Standardized mortality rates
Health/Functional Status: single question (e.g. from CDC HRQOL-4) or multi-domain (e.g. SF-12)
Healthy Life Expectancy (HLE): combines life expectancy and health status into a single measure, reflecting remaining years of life in good health
2. Disease Burden: Incidence (yearly rate of onset, avg. age of onset) and/or prevalence of major chronic conditions
3. Risk Status: composite health risk appraisal (HRA) score
Experience of Care
1. Standard questions from patient surveys, for example: Global questions from US CAHPS or How’s Your Health surveys Experience questions from NHS World Class Commissioning or
CareQuality Commission Likelihood to recommend
2. Set of measures based on key dimensions (e.g., US IOM Quality Chasm aims: Safe, Effective, Timely, Efficient, Equitable and Patient-centered)
Per Capita Cost 1. Total cost per member of the population per month
2. Hospital and ED utilization rate
Setup for Population Management
1. Choose a relevant Population for improved health, care and lowered cost
2. Identify and develop the Leadership and Governance for a Triple Aim effort
3. Articulate a Purpose that will hold your stakeholders together
4. Develop a Portfolio (group) of projects that will yield Triple Aim results
Population Change Packages • Assess and segment the
population
• Activate the population
• Care for the population
• Address macrosystem factors that will support the population
Delivery of Services at
Scale
Community, Family and Individual Resources
Managing Services for a Population
Feedback Loops
Needs Assessment for
Segment Service Design
Coordination Goals
Integrator
Population Segmentation
Population Outcomes
Feedback Loops
Learning System for Population Management
1. System level measures 2. Explicit theory or rationale for system changes 3. Segmentation of the population 4. Learn by testing: PDSA cycles, sequential testing of
changes 5. Use informative cases: “Act for the individual learn for
the population” 6. Learning during scale-up and spread with a production
plan to go to scale 7. People to manage and oversee the learning system
with periodic review
Activities of a Population Management Learning System
Creating Readiness
Establish Triple Aim as a core part of your business strategy Articulate how the Triple Aim makes business sense Secure the commitment of top leadership Secure other key stakeholders Develop and deploy improvement capability to manage the portfolio of projects and learning system
What does it mean to be Strategic Partners?
Our missions and strategies align We are learning side by side Guide evolution of strategy and plan Access to learning and expertise from around the world Support for building improvement capability across the organization Work together to drive for results and expand impact
Jim Diegel, FACHE, CEO & President Robin Henderson, PsyD, Chief Behavioral Health Officer & VP Strategic Integration
The IHI Journey: Drivers, Aims and a Plan for Population Management
• 2008 - Embracing the Triple Aim • 2010 – Reorganization around IDS/TA • 2012 – Participation in TAIC • 2013 – TAIC + The Conversation Project • 2013 – New Vision/Mission/Values
St Charles IHI Journey
• 2013 – Open School Certificate for all leadership
• 2013 – Strategic Partnership with IHI, Aims, Primary Drivers, Improvement Advisors
• 2014 - Creation of Strategic Improvement Department
• 2014 – Joining IHI Leadership Alliance and founding partner of the 100 Million Lives project
• The Board developed four Strategic Aims: • Each Aim has several identified Primary Drivers • Each Aim has a set of global metrics to measure
progress • With the exception of the first Aim, there are
physician/administration dyads responsible for each Aim
Strategic Aims
STRATEGIC AIM: Independent Market Leader (Jim Diegel)
Secure Independent Market Leader Status Financial Strength / Capital Capacity
Manage Populations
Financial/Clinical Integration
Cost Management / Cost Structure • Financial performance meets Moody’s A2 targets
by year end 2014
• Cost per adjusted patient day decreased by 2% by year end 2014
• Achieve a 2% reduction in per capita medical expenditure trend from July 2013-July 2015
• 100 providers participating in at-risk contracts by year end 2014
• 2 new patient advisory groups activated by year end 2014
Partnership with Patients
PRIMARY DRIVERS
METRICS
STRATEGIC AIM
STRATEGIC AIM: Better Health/Better Value (Jeff Absalon, MD/Karen Shepard)
Manage Populations around the Triple Aim Integrated Data Support
Patient Centered Medical Home
Financial/Clinical Integration
Partnership with Community
Manage Populations
• Achieve a 2% reduction in per capita medical expenditure trend from July 2013-July 2015
• Improve Top box patient satisfaction scores by 2% by year end 2014
• Decrease inpatient utilization of populations by 1% by year end 2014
• Decrease ED visits of populations from 49.4/1000 member months to 44.6/1000 year end 2014
• Increase clinical depression screenings from XX% to XX% by year end 2014*
* 2014 target will be set by Oregon Health Authority in August 2014
PRIMARY DRIVERS
METRICS
STRATEGIC AIM
STRATEGIC AIM: Better Care/Better Value (Michel Boileau, MD/Pam Steinke, RN, MSN)
Improve Quality, Experience, and Value throughout system
Removal of Waste and Cost
Clinical Informatics
Workforce Management
• Improve risk adjusted mortality index measures by 10% by year end 2014
• Improve patient safety index measures by 20% by year end 2014
• Improve risk adjusted complication index measures by 10% by year end 2014
• Improve Top box patient satisfaction scores by 2% by year end 2015
• Cost per adjusted patient day decreased by 2% by year end 2014
Patient Experience
Process Improvement
PRIMARY DRIVERS
METRICS
STRATEGIC AIM
STRATEGIC AIM: Learning and Culture (John Nunes, MD/Nancy Pennell, PhD)
Build a Culture of Self-Awareness and
Continuous Improvement Caring: Reconnect soul and
role in the workplace
Science of improvement: Build capacity and capability
in the workplace
• 100% of managers and above hired after June 2013 complete IHI Open School within 9 months of hire
• 50 improvement projects started between January and December 31, 2014
• 90% of 228 caregivers who began the Soul & Science of Caring (SSoC) program in 2014-Q2 complete it by November 30, 2015.
• SSoC participant retention will be 20% better than overall SCHS caregiver trends.
PRIMARY DRIVERS
METRICS
STRATEGIC AIM
• Primary Drivers align with the Vision and Mission of the hospital
• The Vision is supported by the Mission • Better Health • Better Care • Better Value
• Each primary driver aligns with part of the Mission • The strategic program and projects are detailed for
each primary driver • The projects also have metrics identified in detail on
their dashboards (not included in this presentation)
Vision/Mission Alignment
VISION
BETTER HEALTH, BETTER CARE, BETTER VALUE
PRIMARY DRIVERS:
CARING: SCIENCE OF IMPROVEMENT
REMOVAL OF WASTE AND COST PROCESS IMPROVEMENT CLINICAL INFORMATICS
PARTNERSHIP WITH PATIENTS PATIENT EXPERIENCE PATIENT-CENTERED
MEDICAL HOME
PRIMARY DRIVERS:
INTEGRATED DATA SUPPORT
PARTNERSHIP WITH COMMUNITY
PATIENT-CENTERED MEDICAL HOME
PRIMARY DRIVERS:
FINANCIAL STRENGTH AND CAPITAL CAPACITY
MANAGE POPULATIONS
FINANCIAL/CLINICAL INTEGRATION
PRIMARY DRIVERS: INTEGRATED DATA SUPPORT • Population data management
PARTNERSHIP WITH COMMUNITY • Community health needs • Transform philanthropy
PATIENT-CENTERED MEDICAL HOME • Medicaid management program
BETTER HEALTH
INTEGRATED DATA SUPPORT • Population data management
PARTNERSHIP WITH COMMUNITY • Community health needs • Transform philanthropy
PATIENT-CENTERED MEDICAL HOME • Medicaid Management Program
BETTER HEALTH – Medicaid management program
Better Health Lower Cost Collaborative • Patient access • Patient engagement • Physician
Engagement Behavioral Health Integration in Primary Care
PRIMARY DRIVERS: CARING: SCIENCE OF IMPROVEMENT • Learning and culture
CLINICAL INFORMATICS • Viable clinical data management strategies
FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS • Hospital Strategic Growth PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council
REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service
BETTER CARE
CARING; SCIENCE OF IMPROVEMENT • Learning and culture CLINICAL INFORMATICS • Viable clinical data management strategies
FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS • Hospital strategic growth PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council
REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service
BETTER CARE – Learning and culture
Science of Improvement in Action • Open School • Improvement
Advisors • On-site SIA to
train leaders
CARING: SCIENCE OF IMPROVEMENT • Learning and culture CLINICAL INFORMATICS • Viable clinical data management strategies
FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS • Hospital strategic growth PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council
REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service
BETTER CARE – Hospital strategic growth
Patient Flow project (target start date October 2014)
CARING: SCIENCE OF IMPROVEMENT • Learning and culture CLINICAL INFORMATICS • Viable clinical data management strategies FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS
• Hospital strategic growth
PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service
BETTER CARE – Patient Advisory Councils
Patient/Family Advisory Councils
PRIMARY DRIVERS: FINANCIAL STRENGTH AND CAPITAL CAPACITY • Outpatient and strategic growth, SCMG • Harney District EMR • Health Plan Build Out
MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO and
evaluation of management populations FINANCIAL/CLINICAL INTEGRATION • Redesign payment methodologies and incentives for
ambulatory care
BETTER VALUE
FINANCIAL STRENGTH AND CAPITAL CAPACITY
• Outpatient and strategic growth, SCMG • Harney District EMR • Health plan build out
MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO and
evaluation of management populations FINANCIAL/CLINICAL INTEGRATION
• Redesign payment methodologies and incentives for ambulatory care
BETTER VALUE – High risk high cost strategies
Better Health Lower Cost TAIC: • Identification of High
Risk/High Cost (HR/HC) population
• Management of adult Medicaid HR/HC population
Management of Pediatric HR/HC New projects based on data
FINANCIAL STRENGTH AND CAPITAL CAPACITY
• Outpatient and strategic growth, SCMG • Harney District EMR • Health plan build out
MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO
and evaluation of management populations
FINANCIAL/CLINICAL INTEGRATION • Redesign payment methodologies and incentives for
ambulatory care
BETTER VALUE – Viable payment and risk models
Better Health Lower Cost TAIC • CCO Global Budget /
Risk Contract Discrete Population TAIC (2013-14) • Caregiver population
FINANCIAL STRENGTH AND CAPITAL CAPACITY
• Outpatient and strategic growth, SCMG • Harney District EMR • Health plan build out
MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO and
evaluation of management populations
FINANCIAL/CLINICAL INTEGRATION • Redesign payment methodologies and
incentives for ambulatory care
BETTER VALUE – Redesign payment methodologies
Physician Engagement aligned to Triple Aim goals
With Hospitals in Pursuit of Excellence’s Digital and Mobile editions you can: Navigate easily throughout the issue via
embedded search tools located within the top navigation bar
Download the guides, read offline and print
Share information with others through email and social networking sites
Keyword search of current and past guides quickly and easily
Bookmark pages for future reference
Important topics covered in the digital and mobile editions include: Behavioral health Strategies for health care transformation Reducing health care disparities Reducing avoidable readmissions Managing variation in care Implementing electronic health records Improving quality and efficiency Bundled payment and ACOs Others
@HRETtweets
#hpoe #equityofcare