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Pulse - Revolutionary Mindset

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  • 1. The Revolutionary Mindset and Redesign of Health Care Pulse Event November 12, 2013 Mike Slubowski, FACHE, FAC MPE President/CEO © SCL Health System © SCL Health System 1
  • 2. Incumbents vs. Revolutionaries • Incumbents – The old model has worked for an extended time period – In “Maintenance Mode” – don’t want to mess with “the formula” – Leverage brand and historical reputation – Adopting any new approach puts the model at risk • Can cannibalize one’s own business – Very few have adopted a revolutionary mindset and have been successful at changing the model • Revolutionaries – Victory comes by changing the model – Being scrappy, open to invention, leverage out-of-the-box thinking 2 © SCL Health System
  • 3. 3 © SCL Health System
  • 4. Outline • • • • • Brief background on SCL Health System The environment we face Why is “revolutionary behavior” an imperative? How are we transforming? Closing thoughts 4 © SCL Health System
  • 5. Brief Background: SCL Health System 5 © SCL Health System
  • 6. Where We Serve Size and scope….1 9 Hospitals 4 Safety net clinics 1 Mental health treatment center for children 190+ Ambulatory practices 500+ Employed physicians $2.2 Billion 2012 net patient service revenue 1Continuing operations 6 © SCL Health System
  • 7. Mission, Vision and Values MISSION We reveal and foster God’s healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable. VISION Inspired by our faith, • We will be distinguished as the premier person-centered health system and trusted partner. • We will share accountability with clinicians and other stakeholders to coordinate care across all settings and improve access, quality, health outcomes and affordability. • We will grow as community-based health networks to serve more people in partnership with others who share our vision and values. VALUES Caring Spirit We honor the sacred dignity of each person. Excellence We set and surpass high standards. Good Humor We create joyful and welcoming environments. Integrity We do the right thing with openness and pride. Safety We deliver care that seeks to eliminate all harm for patients and associates. Stewardship We are accountable for the resources entrusted to us. 7 © SCL Health System
  • 8. Strategic Priorities & Key Initiatives Ministry Excellence • Community health improvement • Quality, safety, patient experience • Financial and operational Leverage Skill & Scale • Knowledge sharing, best practices • Unified processes for efficiency • Benefits from scale Physician Alignment & Accountable Health Associate Empowerment Growth • Continued physician integration • Continuum of care services • Population health management • Culture and talent • Person-centered care • Continuous improvement • Ministry realignment • System and market expansion • New strategic plan 8 © SCL Health System
  • 9. Community Benefit and Charity Care 2012 • Charity Care - $98.4 million at cost • • • • $269,510 per day! Increased by $18.7 million (23.5%) over 2011 Has increased every year in the past 7 years Unified, system-wide financial aid policy • Total Community Benefit (includes charity care) - $252.8 million • 15.8% growth over 2011 • Charity care, unreimbursed Medicaid, community health programs, subsidized health services, contributions to communities • Over 197,500 lives touched by our community health improvement services • Health education programs, clinical services and support services • Of these, 107,160 lives touched by chronic disease programs 9 © SCL Health System
  • 10. Ministry Excellence Our health ministry is earning national recognition for Quality, including: − Denver hospitals among “Top 15” health systems nationwide − SCL Health System (all hospitals combined) in the “Top 20%” of health systems nationwide − Six care sites received Healthgrades Awards for Clinical Quality: Top 5% in the nation 10 © SCL Health System
  • 11. The Environment We Face 11 © SCL Health System
  • 12. 12 © SCL Health System 12
  • 13. Health Care Costs are Unsustainable 97% 13 © SCL Health System
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  • 17. 17 © SCL Health System
  • 18. Consumers want low premiums; will accept narrow provider networks to get them other specialty drugs 18 © SCL Health System
  • 19. Health Marketplaces/Exchange Lessons learned from Massachusetts 19 © SCL Health System
  • 20. Significant Market Share Upheaval in Massachusetts ) 20 © SCL Health System
  • 21. Utilization Rates Continue to Decline 21 © SCL Health System
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  • 23. 23 © SCL Health System
  • 24. Why is “Revolutionary Behavior” an Imperative? 24 © SCL Health System
  • 25. Rapid Change • • • • • • • • • • Extreme pressure to reduce cost and lower prices Private health exchanges Public health exchanges/marketplaces For-profit, niche providers Mergers and acquisitions Care shifts from inpatient to outpatient or “no-patient!” Medicare reform “Big Data” and eHealth New, previously unthinkable partnerships Shift to retail, person-centered, consumer focus 25 © SCL Health System
  • 26. Paradigm Shift – an overused term from the 1990s? • Paradigm Shift defined: – Coined in 1962 by Thomas Kuhn, a scientist – “A radical change in thinking from an accepted point of view to a new belief.” – “A paradigm is what members of a community, and they alone, share.” • Key question to be examined by us: – Are we so “locked in” to our current paradigm of health delivery that it will inhibit us from envisioning and building a new future for our ministry? – Or, can we open our minds to develop new beliefs? • Radical change never happens quite as quickly as we may initially think it will, but it does happen! – When it sneaks up on us gradually, we may miss opportunities if we are still viewing the world through the old paradigm. 26 © SCL Health System
  • 27. Quote from a wise planning executive • “I tell people we’re not going to get any more clarity. This is as good as it gets.” 27 © SCL Health System
  • 28. 28 © SCL Health System
  • 29. Familiar language • • • • • • • • • • • • • • • • AMI (Acute Myocardial Infarction) HF (Heart Failure) PN (Pneumonia) SCIP (Surgical Care Improvement Project) HAC (Hospital Acquired Conditions) VTE (Venous Thromboembolism) CLABSI (Central Line-Associated Blood Stream Infection) CABG SSI (Coronary Artery Bypass Graft Surgical Site Infection) CAUTI (Catheter-Associated Urinary Tract Infection) WOCN (Wound, ostomy and continence nursing) POA (Present on Admission) Admissions Patient days Outpatient procedures Fee-for-service Patient 29 © SCL Health System
  • 30. Familiar Roles • • • • • • • Nurses Technicians Clerks Housekeepers Food service workers Doctors Administrators 30 © SCL Health System
  • 31. New World 31 © SCL Health System
  • 32. New Language • • • • • • • • • • • • • • • • • • • MSSP (Medicare Shared Savings Program) ACO (Accountable Care Organization) BPCI (Bundled Payments for Care Improvement) PCMH (Patient-Centered Medical Home) ADSP (Adult Day Services Program) AHN (Accountable Health Network) PHOs/PPOs/MSOs PMPM/PMPY (Per member per month/per member per year Covered lives “Big data” analytics Risk pools Population health Virtual wellness platforms Health Marketplace Essential benefits Gold, bronze, silver HRO Person-centered Member 32 © SCL Health System
  • 33. New Roles • • • • • • • • • • • • • • • • • • • • Care continuum coordinator Medical home coordinator Home health coordinator ED life coach Medication management specialist Community resource specialist Program/project manager Payer analytics director ACO operations Lean sensei Report writer specialist Patient access managers Customer service coordinators Physician practice operation specialists Knowledge management leaders Business intelligence analysts Digital content specialist eHealth manager Insurance/actuarial/underwriting specialist Certified application counselor 33 © SCL Health System
  • 34. 34 © SCL Health System
  • 35. How are We Transforming? 35 © SCL Health System
  • 36. It Starts With a New Vision 36 © SCL Health System
  • 37. It Requires Commitment to Coverage and Access to Care for All 37 © SCL Health System
  • 38. It Requires a New Strategy Person-Centered, Consumer Centric Care Ministry Excellence Accountable Health Physician Partnership Growth Leverage Skill and Scale Associate Empowerment 38 © SCL Health System
  • 39. It Requires a Shift From “Patients” to “Consumers” • From “patients” (passive) to “consumers, members, guests” (active) – “person-centered” as our new mantra! • More customer-centric “retail” strategies • “Hardwire” approach to capturing customers/patients – Scheduling, follow-up, digital connections • Patients/customers as “members” of our system, not episodic “transactions” – How do we help them maintain/improve their health? • “Digital channel” expectations • Different leadership needed • Competing for price sensitive customers with access to lower cost niche providers • Quality, safety and the care experience are Job One! – “The price of admission” 39 © SCL Health System
  • 40. It Requires a New Definition of “Values-Based Care” Value Our Values • • • • • • Caring Spirit Excellence Good Humor Integrity Safety Stewardship • Person-centered • Safe • Health outcomes per dollar spent • Encompasses all services that determine success for patient’s needs • Holistic (body, mind, spirit) • Shared accountability among providers • Longer term 40 © SCL Health System
  • 41. It Requires a Shift to Accountable Health Networks We are moving community care beyond just our medical center campuses To a distributed, connected network of the care continuum we are developing in each market 41 © SCL Health System
  • 42. Denver Accountable Health Network We are developing networks in each market* Alliances and Partnerships: • Lutheran Health Partners • PHP/PPP • New West Physicians • Home Care Agencies • Long Term Care Facilities • Pre Hospital Agencies • Kaiser Permanente • CIGNA - Associate Health Plan • Anthem - QHIP in 2011 • Other Payors Inpatient • OB 19% • Dir Adm 29% Outpatient Denver Health Network • Hospital-based • Freestanding Information-driven • Epic Inpatient and Outpatient Bundled Payment • ESJH ACE Project • Medicare Bundled Payment Clinical integration • CPMG • Lutheran Health Partners (LHP) Pay for Performance/Quality Mgmt Readmissions Management • ELMC Transitions Program • ESJH CMS Transitions Eligible Chronic Care Management • Chronic Care Model • Cardiopulmonary Evidence-Based Medicine PreHospital Aligned Health Systems West Pines IP & OP Behavioral Services Colorado Permanente Medical Group ED Services Aligned Physicians • 52% of IP Adms • 42% of OP Visits Kaiser EPN & GME Hospice • Inpatient • Outpatient Home Care Colorado Lutheran Home • SNF w/Alzheimers • Assisted Living • Independent Living Long Term Care Contracted • ED • Hospitalists • Imaging • Etc. Denotes aligned service © SCL Health System *Illustrative example Employed Private Practice Physicians 42
  • 43. It Requires Reorganization of Leadership Community-Based Health System Medical Center Division (Hospital) Joint Operating Council Medical Group Division (Physicians) “Co-Dependent Equals” Integrated: Composed of separate parts united together to form a more complete or coordinated entity. © SCL Health System 43
  • 44. It Requires New Partnerships to Build the Care Continuum Home Care Partnership with Univita Health: Coordination Through a Single Point of Contact Traditional Home Health Industry Framework Univita’s Model & Approach Health Plan / Care Manager Health Plan / Care Manager Network Development Discharge Planner Physician Coordinator Home Health Agency DME / Respiratory IV Provider Patient Physician Discharge Planner Physician Coordinator Univita Patient Focus on Unit Cost © SCL Health System Network Development Physician Focus on Outcomes Property of Univita Health, 2012 44
  • 45. It Requires Partnerships for Population Health Management Population management infrastructure development • Contracted services of Lumeris, Inc. – Cloud-based data warehousing and electronic medical record – Market assessment, strategy and tactical planning support – Full risk population management decision support and reporting tools – Accountable Care Training Institute – Actuarial and TPA capability – Associate health plan data management support – Patient registries, clinical quality and preventive services reporting 45 © SCL Health System 45
  • 46. It Requires Management of Three Distinct Patient Populations HighRisk Patients Rising-Risk Patients Low-Risk Patients 5% of patients; Usually with complex diseases, comorbidities 15-35% of patients; May have conditions not under control 60-80% of patients; Any minor conditions are easily managed Source: Advisory Board © SCL Health System Dedicated team-based care Trade high-cost services for low-cost management Avoid unnecessary higher-acuity, high cost spending Keep patient healthy, loyal to the system (“sticky”) 46
  • 47. It Requires Demonstrated Leadership in Managing the Health of our Own Associates (Employees) • • • • • • • Our total annual spend for health coverage for our associates, spouses and dependents amounts to $78.6 million per year, and the associate cost contribution to premiums is about $22 million per year (this does not include deductibles, coinsurance and copayments, which are an additional cost to our associates and families) 19% of our spend is in prescription drugs There were 129 “catastrophic” claims (serious conditions like cancer and major orthopedic care that exceed $100,000 per claim) in 2012, and the median spend per claim was 23% higher than the Cigna norm for their entire covered groups Our “outlier” (very long) lengths-of-stay for inpatient care were in four areas: major gastrointestinal disorders, cardiothoracic surgery, joint replacements and elective back surgery and mental health/substance abuse care Young adults (ages 18-26 yrs.) accounted for 11% of adult inpatient admissions, and 33% of those admissions were for mental health/substance abuse care (an unfortunate sign of the times?) Expenditures on emergency care were our second highest outpatient costs. Our emergency department usage is higher than external benchmarks. And young adults had disproportionately higher rates of ED utilization than the rest of our population Chronic pain care drives significant outpatient costs for our population, with interventional pain procedures, advanced imaging and prescription drugs 47 © SCL Health System
  • 48. Opportunities to Improve Health of Our Associates • Care management opportunities for those experiencing chronic pain • Better coordination of care for those with requiring joint replacements • Use of more non-surgical treatment options for those with low back pain who would otherwise end up having elective back surgery where the medical evidence on outcomes may not lead to better health status • Improving access to primary care and urgent care for common ambulatory conditions to avoid use of expensive emergency services • More options to encourage routine preventive care and screening, and use of outpatient mental health and substance abuse support for young adults 48 © SCL Health System 48
  • 49. It Requires a Commitment to PERFECT CARE • We are not striving for incremental improvement • We are striving for PERFECTION in the care experience: – Quality, safety, satisfaction – Empowered and engaged patients and families – Outcomes • To be a “trusted partner” means we must be a HIGH RELIABILITY ORGANIZATION • Our Model for Perfect Care: Quality, Safety and Care Experience Collaboratives – Focused teams learning, identifying and implementing best practice solutions • This is meaningful work that requires teamwork to move us to the next level! 49 © SCL Health System
  • 50. It Requires a Commitment to Lower Cost Transformation” Project Accountable Health Transformation (AHT) is our operations improvement framework. Achieve Medicare profitability within 3 years. So far: $100 million. To go: $150 million. Year 1 Develop Plan Year 2 Implement Plan Communicate & Engage Operational Levers Year 3 Levers (Examples) Operational - Labor Productivity, Revenue Cycle, Supply Chain, Administrative (System Services) Utilization - Utilization Management and Reduction in Unnecessary Variation in Care Portfolio - Outpatient Growth, Surgical Services Growth, Program and Service Line Contribution Margin Analysis/Rationalization Utilization Levers Portfolio Levers Clinical / Quality Levers Clinical / Quality - Readmission Rates, Core Measures, and Care Experience Performance 50 © SCL Health System
  • 51. It Requires Leveraging Skill and Scale of Being a System Leveraging our Skill, Knowledge and Relationships • • • • Results from size (sites, revenue) More tangible Quantifiable in financial terms Requires more commitment to realize benefits • Results from size and scope (people, situations) • Generally quantifiable in terms of increased learning and savings from “recreating the wheel” • Design and implement work products together • Rapid replication and adoption of best practices 51 © SCL Health System
  • 52. It Requires “Connecting the Silos” 52 © SCL Health System
  • 53. Servant Leader - Partnership Behaviors Accountability for results Engagement and enthusiasm for change Adaptability and continuous learning Trust, respect and collaboration Transparency and candor Efficient, data-driven decision making Urgency and follow-through 53 © SCL Health System
  • 54. It Requires Carving a New Growth Path Grow Market Share of Volume Grow Market Share of Lives • Best-in-Class Acute Care Destination • Full-Service Population Health Manager • ConsumerOriented Ambulatory Network • FinanciallyIntegrated Delivery System (Insurer) © SCL Health System Source: Advisory Board 54
  • 55. It Requires Growth That is Essential to Invest in Our Future • Not growth for growth’s sake • $4-5 billion size is a goal to leverage skill and scale • IT investments, care management and clinical integration investments, best-in-class system services such as revenue cycle and supply chain • Can occur through shared services, partnerships, management agreements, JOAs, mergers – Alliances and partnerships, not control • Growth opportunities pursued: • • • • • Local, stand-alone providers/hospitals Physician groups Home care Joint ventures Other Catholic, secular and faith-based systems 55 © SCL Health System
  • 56. It Requires Focus and Execution “Great execution, less initiatives” 56 © SCL Health System
  • 57. Closing Thoughts 57 © SCL Health System
  • 58. What We Covered • • • • • Brief background on SCL Health System The environment we face Why is “revolutionary behavior” an imperative? How are we transforming? Closing thoughts 58 © SCL Health System
  • 59. Incumbents vs. Revolutionaries • Incumbents – The old model has worked for an extended time period – In “Maintenance Mode” – don’t want to mess with “the formula” – Leverage brand and historical reputation – Adopting any new approach puts the model at risk • Can cannibalize one’s own business – Very few have adopted a revolutionary mindset and have been successful at changing the model • Revolutionaries – Victory comes by changing the model – Being scrappy, open to invention, leverage out-of-the-box thinking 59 © SCL Health System
  • 60. Revolutionary Requirements • • • • • • • • • • • • • • • • New vision Commitment to coverage and access New strategy Shift from “patients” to “consumers” New definition of “value” Shift to accountable health Reorganization of leadership New partnerships Managing three distinct patient populations Demonstrated leadership in managing the health of our own associates A commitment to perfect care Lower cost Leverage skill and scale Connecting silos Carving a new growth path Focus and execution 60 © SCL Health System
  • 61. Revolution, or Evolution? Axiom: “Really fast evolution requires a revolution!” - Mike Slubowski 61 © SCL Health System
  • 62. Ministry and Business Perspectives (Our Success Model) • • • • • • • Accountable Care Community Benefit Ministry Community Health Person-Centered Care Experience Quality and Safety Access to Care Drives Population Health Ministry The Ministry is why we exist! Business Model To Support • Commitment to Excellence (Top Decile/Zero Defects) • Access to Capital and Credit Strength • Geographic Diversity • Credit Strength 62 © SCL Health System
  • 63. 63 © SCL Health System
  • 64. 64 © SCL Health System