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Adaptive Health Solutions

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Getting Healthcare Right

Getting Healthcare Right


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  • 1. 2nd Curve Healthcare –Who Owns the Space?Getting it right by design for the US Adaptive Health Solutions & Action Learning Systems 1 April 8, 2012
  • 2. What’s “Getting it Right?”• Cut healthcare cost 50%• Better quality• Greater access• More globally competitive economics• Growth in jobs & take-home pay• Minimum: cut care pct as grow GDP Adaptive Health Solutions & Action Learning Systems 2 April 8, 2012
  • 3. Four Key Actions… Think Systemically Create & Build Transfer Maintain & Sustain __________________________________(They spell “Act smart now for Reform 2015!”) Adaptive Health Solutions & Action Learning Systems 3 April 8, 2012
  • 4. Regional Ownership Challenge…• Regional outcome variance violates oath• Why is payment an insufficient incentive?• ANS: Payment per se doesn’t organize systems• And, why is regional healthcare an orphan?• ANS: No one owns the three-legged stool… – Wide-area population space – Wide-area provider space – Regional health-based economic space Adaptive Health Solutions & Action Learning Systems 4 April 8, 2012
  • 5. Here’s Why No One Owns…• Hospitals are largest competitive providers, but not wide-area focused and harmonized.• MCOs are largest wide-area players, but are having trouble using financial disincentives & rationing to improve provider & patient team outcomes (no incentive for non-FFS policy).• Regional agencies and funding for economic and workforce development are outside the healthcare conversation. Adaptive Health Solutions & Action Learning Systems 5 April 8, 2012
  • 6. A Way Forward to Reform 2015…• Patient-focused systemic actions will determine winners (accelerate ACOs).• (Even before asserting that better wide-area population health enables stronger regional economies.)• Needed – A Seven-layer Cake… Plus Public Metrics Adaptive Health Solutions & Action Learning Systems 6 April 8, 2012
  • 7. The First 4 Layers (Big Stuff)…• Milstein—medical home (practice level)• Keene—medical village (population level)• Asheville—region-wide care system coordination, coaching, and patient navigation (successful 10-yr Rx prototype)• Hannaford—employee risk assessments and healthy behavior credits (hint: scale up to “nudge” whole regional population) Adaptive Health Solutions & Action Learning Systems 7 April 8, 2012
  • 8. The Final 3 Layers (Nitti-Gritty)…• VA VistA—global patient data (patient & practitioner design, not billing & admin), interpretive tools, enable & mobilize global practitioner team to [support-track- assess] care across [knowledge-decisions-actions]• Virtual Expertise Centers—patient-focused and distance-delivered regional practitioner skills, data assembly, and interpretation: responsive, mobilized, integrated access linking [patient-team-knowledge]• Virtual Public Health Sensing+Visits—proactively look for population-wide patterns (distance-enabled risk assessment) & remotely deliver first-level follow-up (distance care) – seamless hand-off to hands-on care Adaptive Health Solutions & Action Learning Systems 8 April 8, 2012
  • 9. Metrics—We Get What We Measure • Patient Flow... Wait times to first and next service • Patient Safety… Entry/continuity, discharge, infection, errors • Patient Ratings... Care, courtesy, process, perceived results • Service Quality... Measured results & re-admission rates Adaptive Health Solutions & Action Learning Systems 9 April 8, 2012
  • 10. Metrics Part 2 – Context…• Patient Cost… Jeff Goldsmith recommends – Primary care: risk-adjusted capitation payments – Emergency care & diagnostic physician visits: fee- for-service (FFS) payments [editorial—but stop allocating hospital overhead to Emergency Depts.] – Specialty care episodes: bundled payments adjusted for severity [and for regional cost of living]• Also… – Dial down tort law & tort-distorted care – Update legal frame (Mark McCue, Relational Law) – Dont Compete on Safety (hold in common) Adaptive Health Solutions & Action Learning Systems 10 April 8, 2012
  • 11. ACO Value – Regional Ownership…• ACOs: not only hospitals, practitioners, payors.• Add patients, employers, populations, wide-area harmonization, economic & workforce agencies.• Idea: Interpret ACO value map as follows… – Accountable to patient and region – Care to whole regional population – Organization around patients not providers or payors; across silos, region, prevention, wellness, chronic and critical care to link disciplines, distance, data, and time Adaptive Health Solutions & Action Learning Systems 11 April 8, 2012
  • 12. What is Possible?• Medical Home (25% primary + specialist care & variance cost cuts from evidence based care)• Asheville Model (15% chronic care cost cut)• Hannaford Model (10% health-based cost cut)• Medical Village (region-wide population care) __________________________________ 50% Reduction in total cost of care Better quality & greater access Adaptive Health Solutions & Action Learning Systems 12 April 8, 2012
  • 13. Real Challenges & Stories…Challenges (Camille) Stories (Michael) Quotes (Michael)“People have reorganized, Baylor “40% reduction ofare operating well, and avoidable harm. Savedhave removed the kinks” $80 million.”“Providers are willing to Intermountain Health “Get smart cliniciansmake changes on their talking to each otherown and are working well and continue thosetogether” kinds of dialogues”“Insurance companies Mayo “11 of 14 surgeons are(and payors) are working profitable underwith you” Medicare Reimbursement” Adaptive Health Solutions & Action Learning Systems 13 April 8, 2012
  • 14. US Excellence 2015… System Integration & Care Coordination for Patients, Families, RegionsPUSH Accountable Care Organizations (refined) PULL Accountable to patient and region Care to whole region & populationEmployers— Organization around patients, across silos & Government—•Private Sector region—prevention, wellness, chronic, critical •Medicaid•Public Sector Medical Home: Milstein—practice level •Medicare Medical Village : Keene—region level •State & Regional Care Coord & Coaching: Asheville—10+ years Economic & -------------------------- Workforce Risk Assessments, Healthy Behavior Credits, Agencies Effective/Efficient Provider Preference: Hannaford—employer & region levels 3rd Dimension: IT info exchange—context-based information for knowledge & action Adaptive Health Solutions & Action Learning Systems 14 April 8, 2012
  • 15. Transition: 1st Curve to 2nd… “Theoretical Ideal” (IHI) 6+ sigma    4 sigma (Culture of Safety&  (Craft-age Excellence)  Culture) (Now)  (1910) Performance Time     - adapted from Ian Morrison, The Second Curve. Managing the Velocity of Change , 1996 Adaptive Health Solutions & Action Learning Systems 15 April 8, 2012

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