Inspired Caring: A Culture of Innovating for Health and Value

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This presentation demonstrates Holy Family Memorial's journey to live out its care system core beliefs, transform its delivery system, radically impact the cost of care and demonstrate value for population health.

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  • HPOE is the AHA strategy for accelerating performance improvement.HPOE started by initially focusing on 4 topics: (preventing infections, harm, medication safety and patient flow).In the last few months HPOE added 2 more topics: care coordination and implementing HIT.The next topic for HPOE is improving efficiency.
  • Purpose: Show some of the more tangible ways HFM has changed as a response
  • Data on this graph represents both Inpatient and Outpatient in the: HFM Total Service Area (includes all hospitals/clinics in our Service AreaOutagamie County (All Clinics and Hospitals in that county)Brown County (all Clinics and Hospitals in that county)
  • Add percentages
  • Visual connecting slides
  • May be able to add Mammography info
  • May be able to add Mammography info
  • Inspired Caring: A Culture of Innovating for Health and Value

    1. 1. INSPIRED CARING:A Culture of Innovating For Health and Value A COMMUNITY HEALTH SYSTEM’S 10 YEAR JOURNEY Mark Herzog, FACHE President & CEO Laura Fielding, Administrative Director Organizational Development
    2. 2. HFM…TodayHFM’s Silos…2001
    3. 3. EVOLUTION OF OUR ORGANIZATION • Systems & Processes • Culture & • Reform Readiness• Strategy & Achievement Structure • Quality/ • Organizational Outcomes/ Safety • Open Repositioning• Business Innovation, Fl Plans & • Innovation exibility • Proactive Facilities Incubation Transformation • Adaptation • Performance Improvement/VIP 2001 2004 2008 TODAY
    4. 4. First-Curve to Second-Curve Markets HOW WILL HOSPITALS SUCCESSFULLY NAVIGATE THE SHIFT FROM FIRST-CURVE TO SECOND-CURVE ECONOMICS? VALUE Based • Payment Rewards Population THE GAP Value: Quality & Efficiency VOLUME Based • Quality Impacts Reimbursement• Fee-for-Service Reimbursement • Partnerships with Shared Risk• High Quality Not Rewarded • Increased Patient Severity• No Shared Financial Risk • IT Utilization Essential for• Acute Inpatient hospital focus Population Health Management• IT Investment Incentives Not • Scale Increases in Importance Seen by Hospital • Realigned Incentives,• Stand-Alone Care Systems Can Encouraged Coordination Thrive• Regulatory Actions Impede AHA “Hospitals & Care Systems Hospital-Physician Collaboration of the Future” Fall 2011 4
    5. 5. Core Beliefs DRIVING HFM’S CARE SYSTEM DESIGNRIGHT CARE - The most effective evidence based approach possible.RIGHT SETTING - The most cost effective, safest, highest qualityand greatest value.RIGHT OUTCOME - Achieve the greatest long term benefit to thepatient and society while minimizing physical and financial risk .“Moving care to the right” is what makes HFM’sprocess, outcomes and value unique. 5
    6. 6. THE PRICE IS RIGHT QUIZ! How much might you pay, on average, for each of the following (match the service with the estimated price): A hospital stay? $200 A doctors office visit? $2,000 An outpatient procedure? $20,000Which of these is a cornerstone Doctor’sof Population Health? Office Visit 6
    7. 7. HFM Inpatient & Outpatient Volume Trends RELATED TO CHARGES 25% Reduction in Inpatient & Outpatient Market Volume 5K INPATIENT VOLUME $65M Total Charges 18% Decrease $55M 4K (less price increases) Since 2001 8% Increase Since 2001 $45M 3K OUTPATIENT VOLUME 43% Decrease $35M Since 2001 2001 2003 2005 2007 2009 2011 710/11/12
    8. 8. Inpatient Market Share FOR THE TOTAL SERVICE AREA (HFM Transformation had minimal market impact) 22% REDUCTION IN INPATIENT MARKET VOLUME SINCE 2002 60% HFM 4.8% Market Share Decrease Since 2002 40%Aurora TR 0.1% Market Share 20% Decrease Since 2002 2.9% Market Share Increase Since 2002Aurora 0%BayCare 2001 2003 2005 2007 2009 2011 8
    9. 9. HFM Care System DesignHOSPITAL PHYSICIANS SENIOR MISSION RECOGNITION & NP/PA LEADERS FOCUS90 bed 90 10 Senior Focus on Nationallyhospital Employed Leaders Wellness recognized Providers & for Safety, Prevention Innovation & Thought Leadership 5 Senior Focus on35 bed 35 Leaders the Sickhospital Employed Population Locally Physicians Recognized 9
    10. 10. Leading in new ways▪ Conscious effort to flatten the organization 57 49 44 10 6 5 2001 2006 2012 LEADERSHIP SENIOR LEADERS •Overall Reduced: -Network leadership by 27% -Senior leadership by 50% •Annual savings of $3.1 million from reduction •Role of outside eyes
    11. 11. HFM’s Margin While Transforming to a Second Curve Delivery Model 6.0% 5K INPATIENT VOLUME 4.0% Gain From Operations (%) 2.0% 4K 8% Increase Since 2001 0.0% 3K OUTPATIENT VOLUME 43% Decrease -2.0% Since 2001 2001 2003 2005 2007 2009 2011 11Source: WHA
    12. 12. Days Cash on Hand$220 HFM$200$180$160$140$120$100 Aurora $80 $60 2001 2003 2005 2007 2009 2011 12
    13. 13. While Competitors Talk This Game, only HFM Walks the Talk Locally!“Cost-Per-Episode vs. Unit PriceToo many health care purchasers focus on unit price, seeking tosave money with the lowest cost provider for X-rays, office visitsor surgical procedures. These initial “savings” are deceivingbecause they don’t take into account the most significant pieceof the health care cost equation – how health care services areutilized. Low unit-price providers can actually increase employercosts if they order unnecessary tests or provide inefficient carethat delays healing or causes a relapse.” As stated on a competitor’s website. 13
    14. 14. Inpatient vs. Outpatient Volume Trends AURORA –TR & BAYCARE FOR TOTAL SERVICE AREA 70% Increase Since 2001 $70M 6K $60M 87% Increase 5K Since 2001 $50M $40M 4K Total Charges (less price increases) 1% Decrease $30M 3K OUTPATIENT Since 2001 Volume INPATIENT 2K Volume 2001 2003 2005 2007 2009 2011 1410/11/12
    15. 15. Regional Hospital Market Comparison HFM’s leadership has kept the lid on the cost of high utilization 39% Market Volume 80K Increase Since 2001 60K Brown County 30% Market Volume 40K Increase Since 2001Outagamie County 8% Market Volume Increase Since 2001 20KLocal Service Area 2001 2003 2005 2007 2009 2011 15
    16. 16. Total Hospital Gross Charges 2001-2011 For the Total Service Area, Brown, and Outagamie Counties $900M 217% Increase Since 2001 $700M 148% Increase Since 2001 $500M $300M Brown Outagamie 110% Increase Since 2001 Total Service Area $100M 2001 2003 2005 2007 2009 201112/19/12 Source - WHA
    17. 17. Total Hospital Gross Charges 2001-2011 For HFM and Aurora TR + BayCare in the Total Service Area $110M 89% Increase Since 2001 $90M Excludes Open Heart $70M 173% Increase Holy Family Memorial Since 2001 $50M Aurora TR & BayCare $30M 2001 2003 2005 2007 2009 201112/19/12 Source - WHA
    18. 18. If HFM Were the Only Choice UNCOVERING COST SAVINGS FOR MANITOWOC COMMUNITYAmount our Community Spent on Hospital Care $283 Million If Manitowoc used HFM ONLY - $255 Million Reduced Cost for our Community $28 MILLION! That’s the power of “moving care to the right”!! Assuming all hospital services were provided toTotal Service Area residents by HFM from 2001 - 2011
    19. 19. HFM’s CMS Value Based Purchasing ▪ Total Performance Score: 57 ▪ Estimated Net Revenue Change: 0.1% ▪ Percentile Rank: 61 50% 25% 75% 0% 100%Source: The Advisory Board Company
    20. 20. HFM’s CMS Readmission Performance ▪ Estimated Penalty Percentage: 0% ▪ Estimated Net Revenue Change: $0 50% Hospitals subject to 1% Penalty Cap 25% 75% Hospitals subject to Penalty between 0% and 1% Hospitals Not Subject 0% 100% to Any PenaltySource: The Advisory Board Company
    21. 21. UW Population Health Model RANKINGS BASED ON THE FOLLOWING: Policies & Health Health Programs Factors Outcomes FOUR TYPES OF HEALTH FACTORS MEASURED: Health Behaviors (30%) 1. Access to Care Clinical Care (20%) 2. Quality of Care Social & Economic Factors (40%) Physical Environment (10%)Source: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute County Health Rankings model 2012 21
    22. 22. Manitowoc County Clinical Care Rank POPULATION HEALTH Health Behaviors (30%) Manitowoc’s Clinical Care Rank out of 72 WI Counties: Clinical Care (20%) ▪ 2010: 31 Social & Economic Factors ▪ 2011: 23 Improvement (40%) ▪ 2012: 18 Since 2009! Physical Environment (10%)Source: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute 22
    23. 23. At 21st & Franklin Street, Sept. 2012 23
    24. 24. Where bars trump grocery stores More Bars Source: flowingdata.com More Grocery Stores 24
    25. 25. Measuring “Quality” in Healthcare One thing is clear: Today there is no universal defining methodology or vendor that purchasers, providers and patients agree on! Data quality & reporting vary greatly. Oversimplifying is risky.1. Purchasers, providers or patients who make a major decision on solely one data source are not making a fully informed decision.2. Two types of quality measurement firms: I. Independent & objective, or II. Aligned with purchasers as a negotiating tool 25
    26. 26. HIGH DEDUCTIBLE = CONSUMER DRIVEN• Employers offer High Deductible Health Plans: • Nationally 17% of employers offer HDHP; Deductibles range $3000 - $4000 (Futurescan 2012) • Locally 60+% of large local employers & nearly all small employers offer HDHP, Deductibles range $5,000 - $10,000• Insured population beset by the triple whammy of high deductibles, stagnant wages, and fear of job loss • Result is, they prefer “not to know”• How will insurance exchanges fill the role of care coach for policy- shopping consumers? Will they value provider continuity?• Wellness/Prevention benefits dependent on employer HR leaders
    27. 27. High Deductible= Consumer Driven Employers offer High Deductible Health Plans: • Nationally 17% of employers offer HDHP; Deductible range $3000 - $4000 (Futurescan 2012) • Locally 60+% of large local employers & nearly all small employers offer HDHP; Many deductibles now range $5,000 - $10,000 Insured population beset by the triple whammy of high deductibles, stagnant wages and fear of job loss. • Result; they prefer “not to know”. How will insurance exchanges fill the role of care coach for policy- shopping consumers? Will they value provider continuity? Wellness/Prevention benefits dependent on employer HR leaders.
    28. 28. An HDHP Word of Caution▪ HDHP are generally effective if properly designed and reflect an employee’s ability to fund the deductible, and they are educated about and compliant with wellness & preventive benefits.▪ Considerable evidence exists that HDHP, combined with a soft economy, frequently mean important care & prevention forgone (mammo)▪ Sign of the future: HFM’s Community Care program wrote off nearly $450,000 to insured patients, almost all with HDHP. (applied to bills to be written off because of economic hardship) 28
    29. 29. HFM Employee Right Care Results 74.6 74.5 73.6 72.6 72.2Avg Age 46 Avg Age 47 Avg Age 47 Avg Age 48 Avg Age 4885% Female 84% Female 84% Female 85% Female 85% Female 2008 2009 2010 2011 2012 29
    30. 30. HFM Employee Right Care Results7% Average of 1,500 participants6%5%4%3%2% No No No No1% premium premium premium premium increase increase increase increase0% 2008 2009 2010 2011 2012 30
    31. 31. HFM Employee Right Care Results Inpatient stays by individuals covered under HFM’s health plan Inpatient stays in 2002 124 Inpatients stays in 2012 - 91 33 Fewer Inpatient StaysAverage Hospital Stay=$20k
    32. 32. Recent Recognition ▪ REGIONAL RECOGNITION ▪ 2010 New North Excellence in the Workplace ▪ 2009 Manitowoc Chamber Business of the Year ▪ TOP 2% NATIONALLY ▪ Solucient 100 Top Performance Improvement Leaders ▪ Top 25 Most Wired – Small & Rural Hospitals ▪ Healthcare Information & Management Systems – Society Stage 6 ▪ 4x Recipient of HealthGrades Excellence in Patient Safety 32
    33. 33. THANK YOU!QUESTIONS

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