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The Top Success Factors for Making the
Switch to Outcomes-Based Healthcare
̶ Dr. Bryan Oshiro
© 2016 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
There is someth...
© 2016 Health Catalyst
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Why Outcomes-Ba...
© 2016 Health Catalyst
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Why Outcomes-Ba...
© 2016 Health Catalyst
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Why Outcomes-Ba...
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Why Outcomes-Ba...
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Top Three Chall...
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Challenge #1: L...
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Challenge #2: L...
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Challenge #3: I...
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The Top Outcome...
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The Top Outcome...
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The Top Outcome...
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The Top Outcome...
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The Top Outcome...
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An Outcomes-Bas...
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An Outcomes-Bas...
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An Outcomes-Bas...
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An Outcomes-Bas...
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An Outcomes-Bas...
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Leading Health ...
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The Top Success Factors for Making the Switch to Outcomes-Based Healthcare

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Transitioning to outcomes-based healthcare is an industry wide goal. While some health systems, such as Texas Children’s Hospital, are in the process of making the switch (and doing it successfully), many systems don’t even know where to begin. Despite the challenges of achieving outcomes-based healthcare, it is essential for surviving the transition from fee-for-service (FFS) to value-based care. Systems can overcome the top three challenges associated with making the switch (lack of analytics, lack of access to information, and inappropriate organizational structure) by focusing on the most important success factors:

Analytics
Multidisciplinary Teams

Armed with an enterprise data warehouse (EDW) to make data-driven decisions about the best outcomes improvement goals to pursue, and permanent multidisciplinary teams responsible for continuously improving care, systems can start making the switch to outcomes-based healthcare.

Published in: Healthcare

The Top Success Factors for Making the Switch to Outcomes-Based Healthcare

  1. 1. The Top Success Factors for Making the Switch to Outcomes-Based Healthcare ̶ Dr. Bryan Oshiro
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. There is something healthcare leaders can agree on: health systems need to embrace outcomes-based healthcare in order to survive the transition to value-based care. This presentation takes a closer look at outcomes-based healthcare and what it really entails. Outcomes-based healthcare Despite the popularity of the outcomes- based healthcare discussion, a standard definition has not been found. One possible explanation is outcomes- based healthcare’s scope; it encom- passes a vast spectrum of strategies used to transition from fee-for-service (FFS) to value-based care.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Why Outcomes-Based Healthcare Is The Ultimate Goal Historically, U.S. healthcare has been more reactive than proactive; its primary focus has been helping sick patients restore their health. Most outcomes-based healthcare definitions center on a reactive approach to healthcare—curing diseases, for example. Operating in reactive mode, health systems continuously ask, “Did we cure that sepsis patient?” or “Did we properly treat that heart failure patient?”
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Why Outcomes-Based Healthcare Is The Ultimate Goal In outcomes-based healthcare, the focus is on reducing variation in how a variety of diseases and conditions are treated. The process requires all clinicians to provide accurate diagnoses and treatment algorithms to improve patient outcomes. Health systems are constantly striving to overcome inefficiencies and provide high quality care to patients.
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Why Outcomes-Based Healthcare Is The Ultimate Goal Although improving the way health systems care for sick patients is vital, it is not the only goal of outcomes-based healthcare—solely focusing on improving health system inefficiencies is myopic. Outcomes-based healthcare also targets a more proactive approach to healthcare: creating a healthcare system that strives to maintain healthy populations and prevent illness.
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Why Outcomes-Based Healthcare Is The Ultimate Goal Embracing the proactive aspect of outcomes- based healthcare leads health systems to consistently ask several questions: How do we maintain the health of our patient populations? How do we prevent illness and keep individuals out of the hospital? How do we operate outside our system walls to optimize community healthcare? How do we incorporate population health into our business model? > > > >
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Top Three Challenges in Making the Switch to Outcomes-Based Healthcare If transitioning to outcomes-based healthcare was easy, every health system would have done it by now. Although many systems are well on their way, no health system has successfully completed the switch to outcomes-based care. Health systems struggling to make the transition face three similar challenges: 1. Limited Analytics Capabilities 2. Limited Access to Information 3. Inappropriate Organizational Structure
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenge #1: Limited Analytics Capabilities Many health systems are healthcare data rich and analytics poor. To succeed in outcomes- based healthcare, health systems need the analytics capabilities to make data actionable. At the very least, systems need the ability to measure performance against outcomes goals, and the effectiveness of their outcomes improvement strategies. The lack of analytics and the resulting inability to evaluate performance and processes are barriers to health systems trying to move away from FFS models.
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenge #2: Limited Access to Information Health systems need to get data into the hands of frontline staff. Health systems can’t change how they care for patients unless they equip frontline staff with information; the data-driven insights needed to improve outcomes. From pharmacy to claims data, clinicians need access to the right information to effectively manage patient populations. Aggregating and distributing information requires the technology infrastructure and support most health systems don’t have.
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Challenge #3: Inappropriate Organizational Structure Without an effective organizational structure in place, organizations struggle to combat the inertia inherent in systems that have been delivering care in the same FFS way for decades. Healthcare leaders won’t transition their systems to outcomes-based healthcare unless they provide their organizations with realistic strategies and step-by-step guides for making incremental changes.
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Top Outcomes-Based Healthcare Success Factors: Health systems successfully navigating the transition to outcomes-based healthcare have two common denominators: Analytics Multidisciplinary teams Although the transition requires more than just the right teams armed with the right information, these are critical first steps when making the switch. > >
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Top Outcomes-Based Healthcare Success Factors: Analytics The Texas Children’s success story (described later) is an example of how aggregating data into an enterprise data warehouse (EDW) and putting that data into the hands of the multidisciplinary team responsible for spearheading improvements are the essential ingredients for the outcomes-based healthcare transition.
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Top Outcomes-Based Healthcare Success Factors: Multidisciplinary Teams Successful systems establish and empower multidisciplinary teams to be agents of change, responsible for continuously improving targeted care processes. A team-based approach to outcomes- based healthcare leverages the expertise and influence of key stakeholders throughout the organization.
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Top Outcomes-Based Healthcare Success Factors: Multidisciplinary Teams Outcomes-driven teams typically consist of key members: Clinician lead (most commonly a physician or someone with domain expertise) Nurse or administrative champion (someone who can make administrative changes) Data analyst (someone who can use data to ask and answer questions) Representatives from other key stakeholders in the targeted care process
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Top Outcomes-Based Healthcare Success Factors: Multidisciplinary Teams These teams lead the implementation and measurement of improvement efforts. The critical characteristic of an outcomes- driven team is that it’s permanent and dedicated to continuous improvement. Once health systems achieve their desired improvements (for example, a reduction in 30-day heart failure readmissions), outcomes-driven teams work to sustain the improvements.
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. An Outcomes-Based Healthcare Success Story: Texas Children’s Hospital Making the switch to outcomes-based healthcare comes with inevitable yet surmountable challenges. Texas Children’s, a not-for-profit health system consistently ranked among the top children’s hospitals in the nation, has had measurable, sustained success in its transition to outcomes-based healthcare.
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. An Outcomes-Based Healthcare Success Story: Texas Children’s Hospital By aggregating data into an EDW, running targeted analytics on that data, and putting multidisciplinary teams in place to spearhead change, Texas Children’s has made significant quality and cost improvements. Texas Children’s has improved physician productivity and decreased length of stay (LOS) while generating $74 million in operational improvements.
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. An Outcomes-Based Healthcare Success Story: Analytics in Action Texas Children’s first significant success came as a result of analyzing data; it discovered significant cost variation in asthma care. Drilling down into the X-ray data, they discovered that physicians were ordering chest X-rays for 65 percent of their asthma patients—evidence-based practice calls for an X-ray in only 5 percent of cases. The team achieved a dramatic 46 percent reduction in unnecessary chest X-rays.
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. An Outcomes-Based Healthcare Success Story: Multidisciplinary Teams in Action Texas Children’s leaders established a multidisciplinary team consisting of physicians, nurses, and experts in patient safety, quality improvement, finance, and IT. Leaders tasked this team with assessing and managing acute asthma from the time of arrival in the ED to discharge. The team was responsible for improving asthma care across all hospital facilities.
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. An Outcomes-Based Healthcare Success Story: Multidisciplinary Teams in Action Texas Children’s clinical improvement team’s work didn’t end with its asthma care outcomes improvement. As a result of owning outcomes improve- ment for asthma care, the team has long- term responsibility for sustaining excellence in other care processes. The team also took on reducing the delay between the time a child walks into the ED and the time he or she receives the appropriate asthma medications.
  21. 21. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Leading Health Systems Prioritize Outcomes-Based Healthcare and Upstream Health Truly mature health systems will transition to outcomes-based healthcare and, eventually, upstream health, in which genomic and epigenetic factors are incorporated into the patient care model. A successful transition to upstream health requires access to and analysis of new sources of data, and the implementation of meaningful predictive analytics to care for patients and prevent disease from occurring in the first place.
  22. 22. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Leading Health Systems Prioritize Outcomes-Based Healthcare and Upstream Health When health systems integrate the two common denominators of success: analytics infrastructure and empowered multidisciplinary teams, they can overcome the challenges of converting to outcome- based healthcare. By starting small—focusing on one improvement area and identifying a capable and enthusiastic team, health systems can transition to outcomes-based healthcare with the same measurable success as Texas Children’s.
  23. 23. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  24. 24. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. The Top Success Factors for Making the Switch to Outcomes-Based Healthcare Why a Patient-centric Approach Is Best: Stories from a Physician Dr. Bill Knowles, Senior Director of Client Engagement 7 Features of Highly Effective Outcomes Improvement Projects Brant Avondet, Vice President of Client Operations Improving Healthcare Outcomes: Keep the Triple Aim in Mind Michael Barton, Engagement Executive, VP; Tracy Vayo, Director, Knowledge Development Kathleen Merkley, Clinical Improvement – Vice President Michael Porter and Others Show How to Deliver Better Care in Value-based Healthcare Documentary Paul Horstmeier, Senior Vice President The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement Bobbi Brown, Vice President of Financial Engagement; Jared Crapo, Sales, VP
  25. 25. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Bryan Oshiro, MD, joined Health Catalyst in January 2014 as the Medical Director. He received his medical degree and completed his residency in Obstetrics and Gynecology at Loma Linda University School of Medicine and completed his fellowship in Maternal-Fetal Medicine at the University of Texas in Houston before moving to Salt Lake City to join Intermountain Health Care and served as the Medical Director of the Women and Newborn Service line. He also was a member of the department of Obstetrics and Gynecology at the University of Utah. He then joined Loma Linda University where he became the division director of Maternal-Fetal Medicine and the vice-chairman for the department of Obstetrics and Gynecology. He co-chairs the American College of Obstetricians and Gynecologists Patient Safety Committee for District IX and received the Elaine Whitelaw Service Award from the March of Dimes for his work on a 5 state initiative to eliminate elective deliveries less than 39 weeks gestation. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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