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NVTC Capital Health Tech Summit: Dr. Shannon Keynote

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The 2017 Capital Health Tech Summit took place on June 15, 2017 at the Inova Center for Personalized Health. Dr. Richard Shannon, Executive Vice President, Health Affairs, University of Virginia provided the Summit's second keynote.

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NVTC Capital Health Tech Summit: Dr. Shannon Keynote

  1. 1. The Role of Technology in Healthcare Reform Richard P Shannon, MD Louise Nerancy Professor of Health Policy Science Executive Vice President, Health Affairs
  2. 2. Disclosures • Board Member: Kaiser Foundation Health Plan and Hospitals • Board Member: National Institutes of Health Clinical Center • Senior Teaching Fellow of IHI
  3. 3. Framing Health Care Reform for the Organization • It’s not political; its biological and demographic • Population health is a euphemism for moving risk from payers to providers and patients • Don’t focus on payment reform; focus on practice reform • Drive value through process excellence • Technology and innovation can drive process excellence • Provide what the patient needs when they need it, on time, the first time, no defects error or waste
  4. 4. The Birth of Medicare: July 30,1965
  5. 5. PPACA: March 10, 2010
  6. 6. The Tyranny of Measurement • UVA reports 484 measures to 11 agencies • $17M in annual operating expenses • Reporting on all; focused improvement on only some • We report mortality to 8 reporting agencies which have 4 different values as to our mortality
  7. 7. Unintelligible Public Reporting: Teaching to the Test vs True Improvement
  8. 8. Penalties Are Not a Measure of Quality But Simply a Blunt Cost Cutting Instrument • Hospital Characteristics Associated With Penalties in the Centers for Medicare & Medicaid Services Hospital- Acquired Condition Reduction Program • Ravi Rajaram, MD, MS; JeanetteW. Chung, PhD; Christine V. Kinnier,MD, MS; Cynthia Barnard, MBA; Sanjay Mohanty, MD, MS; Emily S. Pavey, MA; Megan C. McHugh, PhD; Karl Y. Bilimoria, MD,MS • JAMA. 2015;314(4):375-383. doi:10.1001/jama.2015.8609 • CONCLUSIONS AND RELEVANCE Among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditations, offered advanced services, were major teaching institutions, and had better performance on other process and outcome measures. These paradoxical findings suggest that the approach for assessing hospital penalties in the HAC Reduction Program merits reconsideration to ensure it is achieving the intended goals.
  9. 9. Bending the Cost Curve: Two very different approaches Cutting (Payer) • Decrease payment for services • Decrease services • Decrease staffing (costs) • Decrease access for patients Estimated savings: $8-900B over 10 years Improving (Provider) • Focuses on patient needs • Decreases that which adds no value • Right care/right patient/right place • Annual $300B savings to CMS • $6-900B reduction in US expenditures • Estimated savings: $6-9 trillion over 10 years
  10. 10. Forms of Waste • Harm • Overtreatment • Failures in care delivery • Failures in care transitions • Excessive administrative costs • Fraud and abuse 14 Drive Value Through Process Excellence!!
  11. 11. Work Redesign Supported By Technology • New Structures Service lines • New systems Be Safe/ Be Well/ Be Wise/ • New work processes Real time to root cause problem solving • Infrastructure alternatives • Virtual visits/eConsults • Labor and Supplies Enhancements • Intelligent Augmentation (IA) • Clinical variation reductions • Predictive analytics
  12. 12. PHC4 2013 77% reductions in CA-BSI/UTI 46% reduction in SSI 52% reduction in C. difficle 27% reduction in neonatal mortality from sepsis
  13. 13. What Matters to You? • Clinical Outcomes • Complication Rates • Time to return to work
  14. 14. Survival: PCI Risk Adjusted Mortality Rate for STEMI Patients Heart & Vascular Center UVA is above the 90th percentile 11.1% reduction year over year
  15. 15. Adverse Events: PCI with STEMI Heart & Vascular Center 22.7% reduction year over year
  16. 16. Adverse Events: PCI with STEMI 0.0% 2.1% 0.0% 0.0% 5.3% 4.0% 0.8% 0.7% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% Bleeding 72 hrs after procedure Heart Failure New Dialysis Requirement CVA/Stroke UVA Health System NCDR 50th %tile Eliminating Complications Reduces Cost
  17. 17. • ERAS Work Redesign: Colorectal Surgery • 43% reduction in mortality • 2 day reduction in LOS • 84% reduction in opiod use • 41% reduction in readmissions • $7982 reduction in cost per case • Lowest to highest quartile in patient satisfaction • Lowest decile in post op complications
  18. 18. Technology Platforms at UVA • Predictive Analytics (IA) • Neonatal Sepsis • Imaging • Hovering at Home (C3) • TeleHealth (11,000-60,000 visits) • Mid-Atlantic Regional Center • Locus Health • Redefining Prevention wearables to insideables to trainables to shockables
  19. 19. Redefining the University-Industry Relationship • UVA-Astra Zeneca Partnership (Cardiovascular/Metabolic) • VA-Mitre Partnership (Precision Analytics/Hovering) • Hemoshear
  20. 20. Inova-UVA Academic Partnership • UVA School of Medicine • Global Genomics and Bioinformatics Institute • Darden Business School iLab • SEAS : material sciences/mechanical/engineering/computer science • Data Science Institute
  21. 21. UVA School of Medicine – Inova Campus 3rd & 4th Year Clinical Clerkships Joint Research Institute NCI Comprehensive Cancer Center NIH CTSA Program Venture Fund LP Pediatric Network UVA Collaborations: iLab, SEAS EDUCATION INNOVATIONRESEARCH Expanding UVA’s Presence in Northern Virginia: Faculty Investigators, Educators, Infrastructure & Investment
  22. 22. Inverting the Discovery Paradigm • Reductionist Approaches: The Needle in a Haystack • Big Data Approaches: Drug Repurposing
  23. 23. Doubling Down: UVA and the Strategic Investment Fund •Cell Based Immunotherapy $11M •Pri-Med Type 1 Diabetes $17M •The Brian Initiative $15M •Focused Ultrasound $12M
  24. 24. AMCs as Customers and Investors •Seed and Venture Fund •Locus Health •Type Zero •Tear Solutions
  25. 25. The American Dream Universal access to affordable, high quality healthcare Technologies

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