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Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians
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Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians

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Achieving Affordability with Visual Analytics; Variation Reduction as a Tool to Engage Clinicians

Ingenix User Conference
May 2011

Michael van Duren, M.D., MBA
Sutter Health

A Project of the Sutter Medical Network
and Sutter Physician Services

Published in: Health & Medicine, Business
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  • Key Point: Value of understanding problems within context and involving key users in the problem solving processIssue is not what initially presentsIssue lies hidden in actual situation, not pre-definedTurn to context to uncover and then define issueObserve to understand the context we work in and the context our patients receive care in. By understanding the context we can more successfully uncover opportunities to improve practiceStory:
  • Transcript

    • 1. Achieving Affordability with Visual AnalyticsVariation Reduction as a Tool to Engage Clinicians
      Ingenix User Conference
      May 2011
      Michael van Duren, M.D., MBA
      Sutter Health
      A Project of the Sutter Medical Network
      and Sutter Physician Services
    • 2. About us
    • 3. California’s Highest Quality Health Care System*
      Serving more than 3 million patients
      • Approximately 48,000 employees
      • 4. 5,000 physicians
      • 5. Aligned under the Sutter Medical Network
      • 6. Physician medical foundation and IPAs
      Part of more than 100 communities
      • 25 DHS-licensed acute care hospitals
      • 7. Home health & hospice and long-term care services throughout Northern California
      Partnering with providers, patients
      and communities
      • Medical research and medical education/training
      • 8. 24 fundraising organizations
      *Source: The Lewin Group, 2009
    • 9. The Sutter Medical Network
      • The Sutter Medical Network provides a leadership role in the development of a physician and provider network, coordinating patient care and creating a culture of quality, service and affordability throughout the Sutter Health system.
      • 10. SMN Standards of Participationcreate collective accountability thatencompasses the entire spectrum of clinical and service quality:
      • 11. Clinical Pay for Performance
      • 12. Primary care appointment wait times
      • 13. Patient satisfaction with the care experience
      • 14. Adoption of online services
      • 15. Variation reduction efforts
    • Physician Organizations in the Sutter Medical Network
      • Alta Bates Medical Group
      • 16. Brown & Toland Physicians
      • 17. Central Valley Medical Group
      • 18. Marin IPA
      • 19. Mills-Peninsula Medical Group
      • 20. Palo Alto Medical Foundation
      • 21. Sutter East Bay Medical Foundation
      • 22. Sutter Gould Medical Foundation
      • 23. Sutter Independent Physicians
      • 24. Sutter Medical Foundation
      • 25. Sutter Pacific Medical Foundation
    • Why Variation Reduction?
      What engages physicians?
      Healthcare affordability
      High deductible plans
      High co-pays
      Losing marketshare to competitors
      Curiosity
      Competitiveness
      Do the right thing
      Quality improvement, professionalism
      6
    • 26. How To Engage Physicians
      Respect their intelligence & time
      Trust their motives
      Adult learning: peer setting
      Solution: variation reduction program
      7
    • 27. Variation Reduction Program Components
      Leadership
      Which is the most important component?
      Remove any one and it won’t work…
    • 28. DATA
      9
    • 29. Purpose for Data Sharing  Practical Implications
      Show clinicians how they differ from each other
      Must be:
      Apples to apples
      Simple and explainable
      Clinically relevant
      Compelling: “Aha, I see what I need to change”
      ETGs with drill down accomplishes all this
      Hi-Lo Variation is typically 100 - 300%
      Therefore data needs only to be directionally correct
      Attribution: anything less than 50% loses credibility
      10
    • 30. Data Issues for Provider Groups vis-à-vis Plans
      Less complete data
      HMO: claims, but only for the risk that groups took
      Excludes facility costs (not a problem , but beware low cost outliers)
      Excludes out of network, behavioral health, negotiated carve outs, etc
      PPO: billing data, but only for care that was provided
      Pharmacy: only what is provided by HMOs
      More complete data
      Clinical sources
      Outcome data: Blood Pressure, A1c, LDL
      Rx written, not just filled
      More recent data: yesterday
      11
    • 31. Clinicians Are Very Discerning re Value of ETGs
      Problematic areas discovered:
      Hernias
      All types (inguinal, abdominal, hiatal) together
      Gyn tumors
      Uterus and ovaries grouped together
      Gyn irregular bleeding
      Postmenopausal bleeding not distinct
      Knee procedures
      Total knee and arthroscopy cases grouped together
      12
    • 32. Provider Network Clinical Integration Issues
      Competitors can not share pricing
      Work with data stripped of all pricing
      Uniform charge master applied to all data
      Multiple data sources
      Lab vendors
      Pathology contractors
      Surgery at multiple sites
      Integrate all payers
      Changing systems
    • 33. DISPLAY
    • 34. Why Is Visual Data Display So Important?
      Can not afford distractions:
      Accuracy
      Methodology
      Detailed questions
      15
    • 35. Why Is Visual Data Display So Important?
      16
      Must be all right brain, gut level, intuitive
      “Aha, I see I am an outlier. I know what I should do differently!”
      Need to achieve this in seconds, without words
    • 36. 17
    • 37. 18
    • 38. 19
    • 39. 20
    • 40. How to Speak to the Right Brain?
      Visual data; not words or numbers
      Message must jump out on its own
      Remove all extraneous text
      Personal impact
      Change desired must be obvious
      21
    • 41. Example of Other Dashboards
    • 42. Visual Display of Variation
      23
    • 43. HMO Statin Prescription VolumePPO volume not included
      24
    • 44. 25
    • 45. 2nd Line Diabetes Drug
      26
    • 46. 27
    • 47. 28
    • 48. 29
    • 49. 30
    • 50. 12 Month Run Chart (volume of 30 day supply)
      31
    • 51. 32
    • 52. 33
    • 53. New Features: Frequency of Surgery
    • 54. New Features: View Individual Episodes
    • 55. Each Bar is an Individual Episode
      36
    • 56. Curiosity About a Single High Episode
      37
    • 57. Select and Episode to View Claims
      38
    • 58. Claims View
      39
    • 59. Claims View - Continued
      40
    • 60. people
      41
    • 61. Philosophy of Physician Behavior
      42
    • 62. Philosophy of Physician Behavior
      43
    • 63. Contextualist Approach
      Deductive Approach
      COMPLIANCE
      Contextualist Approach
      EMPOWER
      Copyright 2009 VHA Inc. All rights reserved. Authorized use of this content is limited to reading and analyzing the content for its internal use, printing a copy of any page for its internal use and disclosing the content to other VHA alliance members . For internal VHA member use only.
    • 64. Two Approaches
      Bottom up
      Multiple small projects
      Maximizes physician buy-in
      • Top down
      • 65. Standardized implementation
      • 66. Maximizes savings
    • Guiding Principles for VR Facilitation
      Follow Curiosity
      Pull, not push
      Bottom up, not top down
      Safety, fun
      Non-punitive
      Respect – sincere
      (no agenda other than being helpful)
      Talk about emotions
      (before talking about the data)
    • 67. Guiding principles for VR facilitation
      Transparency – names not blinded
      Use natural competitiveness in a playful way
      Talking about affordability is ok and necessary (“I am not going to apologize”)
      Must lead to a “project” –
      must result in an improved outcome
      this requires some nudging
      Improvise, Adapt, Think Fast
    • 68. Resources for Data & Emotions:Nudge, Switch
      48
    • 69. Reactions from Physicians
      “I haven't had this much fun since residency”
      “I have been waiting for this for ten years”
      “That was a lot more fun than I expected from the title of the meeting”
      “When are you guys coming back?”
      49
    • 70. process
      50
    • 71. Variation Reduction Program Components
      Phases
      Introduce and orient dept chair
      Meet with whole dept (5-15)
      Explore various ideas, dig & clarify
      Narrow selection to one project
      Write charter, define goals, commit to interventions
      Track progress, modify interventions
    • 72. Improvement Project Sequence
      Use SCPA to identify variation reduction opportunities
      Clinicians agree on a standard and define performance metrics
      Clinicians agree to launch an improvement project
    • 73. VR Project Charter
      Sample process from one group
    • 74. Problem Statement
      What is the problem we are solving for?
      Duration, where, what, why
      In [time period], there were [count] patients with [diagnosis] who experienced [what undesirable care was done] and this is a problem, because [impact].
    • 75. Problem Statement
      In 2010, 55% of 1182 patients with new onset Sinusitis were treated with antibiotics, other than Amoxicillin. This resulted in unnecessary pharmaceutical costs.
    • 76. Goal Statement - AIM
      [increased/decreased] [metric] from [baseline]to [goal level] as measured by [XX] by [when].
      Specific
      Measurable
      Achievable
      Reasonable
      Time bound
    • 77. Goal Statement - AIM
      Increase the percent of patients with new onset sinusitis that receive treatment with Amoxicillin from 45% to 62% by the end of 2011.
      Reduce the average cost of initial antibiotic treatment for Sinusitis from $57 to $45 by the end of 2011.
    • 78. % of Patients treated with Amoxicillin
      58
    • 79.
    • 80. Primary Metric
      How will you know you’ve made an improvement
      Rate is percent of numerator/denominator
      Denominator: [all patients with x]
      Numerator: [patients who received treatment x]
      Inclusions/exclusions
      Balance metric (how do we check that we are not causing harm?)
      Associated quality or outcome metric?
    • 81. Project Metric
      Name of metric: Percent of all patients prescribed Amoxicillin as 1st line antibiotic for treatment of sinusitis
      Numerator: number of sinusitis patients prescribed Amoxicillin
      Denominator: all Sinusitis patients with antibiotic prescription
      61
    • 82. Defining Patients
      • Exclusion criteria:
      • 83. Anybody with any of the diagnoses in the prior 30 days (so that we are looking only at NEW onset sinusitis)
      • 84. PCN allergy
      • 85. Exclude pts with pneumonia or bronchitis in any of the other diagnoses
      • 86. OR use Epic linkage to pull onlyabx linked to sinusitis
      • 87. No recent abx use for anything else for 30 days
      • 88. No sinusitis in prior 12 months
      Inclusion criteria for diagnosis:
      461 P ACUTE SINUSITIS 
      461.0 ACUTE MAXILLARY SINUSITIS 
      461.1 ACUTE FRONTAL SINUSITIS 
      461.2 ACUTE ETHMOIDAL SINUSITIS 
      461.3 ACUTE SPHENOIDAL SINUSITIS 
      461.8 OTHER ACUTE SINUSITIS 
      473 P CHRONIC SINUSITIS 
      473.0 CHRONIC MAXILLARY SINUSITIS 
      473.1 CHRONIC FRONTAL SINUSITIS 
      473.2 CHRONIC ETHMOIDAL SINUSITIS 
      473.3 CHRONIC SPHENOIDAL SINUSITIS 
      473.8 OTHER CHRONIC SINUSITIS 
      473.9 UNSPECIFIED SINUSITIS 
      62
    • 89. Expected Benefit
      Improved affordability
      Improved consistency
      Enhanced adherence with clinical guidelines / best practices
    • 90. Implementation Plan
      1st test of change (what are the changes you plan to make? How will they be implemented?)
      Who, what, when, where
    • 91. Implementation Plan
      First “Test of Change”
      Communicate to all ----- providers in meeting 4/1/2011
      Distribute monthly run charts to individuals
      Work on smart set for Epic / consistent documentation
      Create guideline for consistent diagnosis of sinusitis: e.g. purulent discharge (Dr W----- & Dr L----)
      Other ideas (on hold for the future):
      Patient education “why you are seeing your ENT and still getting Amoxicillin”
      Also education for ER
      Address outliers
      Epic BPA
      Other…
    • 92. Balance measure
      Cure rate?
      Are we seeing more failures on Amox?
      Return within 30 days for same diagnosis?
      Track baseline, see if it changes…
    • 93. Local Standard
      Sinusitis guidelines? Am Acad of Otolaryngology 2007 (?). AAO.
    • 94. Formal Project Charter
      68
    • 95. 69
    • 96. Variation Reduction: Projects in Process
    • 97. Staging of Savings
    • 98. Additional Analytics Tools Needed
      Add in EMR data
      More recent
      All payers
      Has outcome data
      Progress over time (SPC)
      Simple drug comparisons of cost (3 bar)
      Bubble chart
    • 99. Success Factors
      73
    • 100. Roles Required for VR Projects
      74
    • 101. Questions?
      Reactions?
      vandurenm@sutterhealth.org
      916-402-7492
      75

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