Improving Healthcare Outcomes: Keep the Triple Aim in Mind

1. Improving Healthcare Outcomes: Keep the Triple Aim in Mind ―Michael Barton

2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. “Improve Outcomes” Improving outcomes means at a high level means improving the health of patients and the patient experience, while reducing costs. Once organizations get into the work of measuring outcomes— the question of what constitutes an improvement becomes much more complex. The truth is that not all outcomes are created equal.

3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Triple Aim: Improving Healthcare Outcomes Everyone in healthcare is probably familiar with the Institute for Healthcare Improvement’s Triple Aim: Triple Aim • Improving the individual experience of care • Improving the health of populations • Reducing the per capita cost of care for populations Better Value SOURCE: IHI TRIPLE AIM

4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Triple Aim: Improving Healthcare Outcomes The Triple Aim at its most basic represents a framework for improving healthcare delivery outcomes. When healthcare organizations go about improving outcomes they will want to consider all three dimensions of the Triple Aim. It’s an ambitious framework that requires a high degree of system change to attain.

5. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Triple Aim: Improving Healthcare Outcomes Consider this example: An organization might initially cut costs by decreasing length of stay (LOS), but this “improvement” isn’t as meaningful without considering how decreasing LOS affects clinical outcomes and patient experience. • Did the quick discharge increase the incidence of readmission, risking patient safety and increasing costs? • Did it increase or decrease patient satisfaction?

6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Triple Aim: Improving Healthcare Outcomes Achieving the appropriate balance among the three dimensions is the central idea driving the Triple Aim and critical to achieving real, long- term change in healthcare delivery outcomes.

7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Triple Aim: Litmus Test The Triple Aim provides a valuable litmus test for assessing whether an organization’s efforts to improve outcomes have the right focus by answering these questions: • Does this outcome pass muster as something relevant to the patient populations we serve? • Is it the most impactful initiative in terms of improved healthcare delivery and health outcomes? • Does it encompass multiple dimensions of the Triple Aim?

8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Triple Aim: Litmus Test It’s also a good way to test the maturity of the organization. • Is the organization ready to take on rapid improvement cycles to deliver meaningful outcomes? • Are the outcomes helping to improve healthcare delivery? • Can they automate measurement of all three dimensions of the Triple Aim?

9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Visibility Using the Triple Aim framework helps put outcomes in a more meaningful context, demonstrating improvement that is visible, meaningful, and relevant. Senior leaders share this detail with their board of directors. It is critical this information be widely disseminated to ensure organizational alignment regarding priorities and incentives.

10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Visibility Communicating successful outcomes improvements to the entire organization is crucial. Visibility to the results of an improvement initiative gives leaders a level of understanding as to the engagement and support of the strategy by all team members. It also allows leaders to identify the capabilities of the organization.

11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Visibility Not every outcome will fulfill all dimensions of the Triple Aim, however developing the capability to relate to Triple Aim is important and worthy. As you investigate your readiness to improve outcomes, ask this: • Is your organization capable, on a regular basis, of approaching outcome improvement from a Triple Aim perspective?

12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Start SMART: Approaching Improvement Measures Effectively Tackling the Triple Aim successfully requires defining improvement measurements before implementing improvement initiatives. Improvement measures can be described in three main categories: • Outcomes • Process • Balance

13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Start SMART: Approaching Improvement Measures Effectively Regardless of the type of measure, using the SMART acronym is helpful to ensure that goals and aims state how you will measure success. Caution: While regulatory measures like those from the CMS or The Joint Commission are necessary, and often based on best practices, focusing solely on these measures won’t drive necessary care improvement across the organization.

14. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Outcome measures are the ultimate arbiter of whether an organization is achieving high-level goals supporting the Triple Aim. For example, an outcome goal might state that the organization will decrease the mortality rate of sepsis patients by 20% by a certain date. While iterative improvements will occur, the outcome measure – reduced mortality – is the ultimate goal of those improvements.

15. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Outcome measures hold the improvement team accountable, setting the standard for whether the team is meeting its goals. They deliver important visibility to the organization about the value of the improvement team work. The resulting transparency from sharing the team’s progress against these measures builds momentum and support.

16. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures An outcome measure maintains the focus of the improvement team and prevents scope-creep. It’s the guiding star of the project. When creative people gather to solve problems, it’s common to hear things like: The outcome measure lets the group determine whether the idea furthers goal achievement. Wouldn’t it be cool if we tried this?”

17. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Aim and Measures Although outcome measures show improvement toward the high-level goals of the organization, they don’t define how to achieve those goals. That’s where process aims and measures come in. Aim statements specify targets for measureable process improvements that ultimately contribute to achievement of outcome goals.

18. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Aim and Measures For example, an aim statement to decrease the time it takes to recognize sepsis in the emergency department and to initiate evidence-based interventions like the 3-hour bundle. Associated measures may be: Time from ED arrival to sepsis recognition. Time from sepsis recognition to initiation of the 3-hour bundle.

19. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Aim and Measures Other aim statements may specify a target for improving overall compliance to the sepsis 3-hour bundle, or to improvement in individual elements of the bundle, like timely antibiotic administration. Associated measures may be: “X” percent compliance to all the sepsis 3- hour bundle. Time from sepsis recognition to antibiotic administration. See more: Learn to create effective aim statements here.

20. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Aim and Measures Process aims and measures empower clinicians to take action on the data and improve care. An outcome goal to improve sepsis mortality by 20% fails to provide detail for how clinicians contribute to achieving the goal. Engaging frontline employees in process aims and measures allows them to understand how care processes contribute to outcome evaluation and improvement.

21. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Aim and Measures Clinicians see how improving the timeliness of antibiotic administration contributes to achieving the outcome of improved mortality. The measure provides direction and instruction for the clinician. It is an early indicator of whether they are meeting the objectives of the improvement initiative. Over time, the outcome will reflect these improvements in the process.

22. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Balance Measures The Triple Aim serves as the ultimate framework for thinking of balance measures. An improvement in one of the dimensions of the Triple Aim should not result in a negative outcome for the other two. Achieving balance is key as organizations pursue these ambitious and very important improvement objectives.

23. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Sepsis Example from Thibodaux Regional Medical Center As Thibodaux Regional entered the shared-risk market, it was critical that senior leaders and physicians identify and prioritize improvement opportunities—together. Employing an enterprise data warehouse and analyzing key process analytics, the cross- functional team identified sepsis as an area for improvement. Keeping the Triple Aim at the forefront, Thibodaux Regional set goals to reduce overall sepsis mortality by 25%, reduce costs by 20%, and maintain a 99% patient satisfaction rate.

24. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Sepsis Example from Thibodaux Regional Medical Center To improve patient outcomes, the team established early recognition protocols in the ED They developed an algorithm for early identification of at-risk patients, and initiated three- and six-hour sepsis bundle protocols. They created aim statements and process measures around these changes, and physicians were held accountable for complying with the new protocols.

25. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Sepsis Example from Thibodaux Regional Medical Center At the start of the improvement initiative, Thibodaux Regional’s sepsis mortality rate was already outperforming the national sepsis mortality rate of 14 to 18%. The Thibodaux Regional team has decreased their sepsis mortality rate to half of the U.S. national average while reducing variable cost per sepsis case by 7.3% and increasing patient satisfaction for sepsis patients to the 93rd percentile.

26. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. A Sepsis Example from Thibodaux Regional Medical Center Thibodaux Regional represents the positive returns hospitals can achieve as they strive to improve outcomes for quality, patient satisfaction, and cost. Keeping the Triple Aim in mind when creating a strategy for optimizing outcomes empowered the organization to confidently and successfully pursue care improvement objectives.

27. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Prospective Analytics: The Next Thing in Healthcare Analytics Anne Marie Bickmore, Engagement Executive, VP Patient Engagement And Outcomes Improvement from the Patient’s Perspective Steve Catmull Outcomes Improvement: What You Get When You Mix Good Data with Physician Engagement Paul Horstmeier, Chief Operating Officer Improving Outcomes for Sepsis Patients: 3 Key Solutions Proven to Help Paul Horstmeier, Chief Operating Officer Delivering Excellence: How Stanford Health Care Uses Analytics to Improve Outcomes Paul Horstmeier, Chief Operating Officer Link to original article for a more in-depth discussion. Improving Healthcare Outcomes: Keep the Triple Aim in Mind

29. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Michael Barton joined Health Catalyst as an Engagement Executive Vice President in January 2013. He completed his training at the University of Utah Health Sciences Center. Upon graduation in 1994, he was employed with the Pharmacoepidemiology Team, a multidisciplinary team of epidemiologists, infection control practitioners, quality control specialists, pharmacists, and healthcare IT specialists at the University of Utah. After four years, Michael moved his clinical practice to the Shock-Trauma ICU at LDS Hospital. Here, he had the opportunity to apply his infectious disease and critical care knowledge. After eight years of clinical practice in conjunction with five years of IT industry consulting experience, Michael joined HIT startup TheraDoc, Inc. as a consultant in 2000 and full-time in 2001. Michael spent 12 years with TheraDoc, where he served in various roles. The last 5 years Michael served on the senior leadership team as SVP, Knowledge and Product Development where Michael oversaw the Knowledge Management, Product Management, Engineering, and Quality teams. For Michael, joining Health Catalyst means continuing to pursue his passion of improving the quality and safety of patient care through applied healthcare IT solutions. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com