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Dr. Roger Ray Presentation
- 1. The “Transition”: Challenges and Opportunities Roger Ray, MD Chief Physician Executive Carolinas HealthCare System May 2015
- 2. 2
- 3. 3 The Agenda • Who are we? • The Transition • Whole System Context – Maturity Model – Harm Agenda • Your Work – Challenges – Opportunities
- 4. 4 Carolinas HealthCare System We’re big… • 39 hospitals • 900+ care locations • 30,000 employees • 3,000 physicians • 15,000 nurses • 11M+ annual patient encounters • $8B+ annual revenue 4
- 5. 5 We deliver integrated, quality care on a large scale • Innovative care organizations and services • 18 million transactions/day in our EMR • More than 65,000 diabetic patients in managed care • Large virtual critical care (e-ICU) programs • 500+ behavioral health ED consults conducted virtually per month • Saved nearly $60 million in health care-related costs over two years 5
- 6. 6 Fundamental: The Transition from Volume to Value 6 Current Strain uncoordinated facility based variable Silo work volume-based fee for service Issue-focused individual patient focus VOLUME VALUE team accountability standardization engaged physicians cost containment improved quality safe patient-centric transparency care coordination innovation team-based care information technology reactive
- 7. 7 Reflection on Transformation Why are we pursuing quality? Are we willing to change? Do we have a model that increases access to care and leverages integration? Have we made a commitment to embrace technology and be excellent in its application? Are we actively moving to a value-based system ahead of external drivers? Are we willing to be accountable and transparent? 1 2 3 4 5 6
- 8. 8 Role of Quality Pursuit • Performance • Unification • Engagement • Accountability • Culture • Differentiation • “Value”
- 10. 10 Integration Maturity Model Criteria 1. Clinical Integration Priority Tool used 2. One and three-year Cross continuum/geographies plans 3. Specialty “Principle Coordinator of Care” criteria developed 4. Integration with palliative care, home health, etc. 5. Service line work influencing primary care, continuing care and/or acute care 6. Method to stratify patients is developed and deployed 7. Chronic Disease Management Model for key conditions and chronic populations 8. Navigator/Coordinator connected to the medical home 9. Action plan for readmission reduction is in place 10. Goals articulated in all three dimensions of value 11. Cross continuum value dashboards are developed 12. Care coordination models, clinical pathways, transitions developed and executed 13. Physician leaders engaged in strategy and tactics through physician colleagues 14. Physicians ensure compliance with cross continuum care pathways/protocols 15. Team-based care models are developed 16. Access leverage 17. Action plan positively impacting our employee population is developed/executed 18. Action plans: high drug costs utilization; unnecessary lab testing; high cost test settings; avoidable ED visits
- 11. 11 Driving Change Integrated System of Care: Work differently and do different work • Integration across service lines and points of care • Navigator connected to medical home • Readmission reduction action plan • Team-based care models • New training approaches 11 CHS Maturity Model 0% 20% 40% 60% 80% 100% Orthopaedics SNF Children's Behavioral Health Emergent Care Hospice & Palliative Care Hospitalist Care Neurosciences Home Health Rehabilitative Care Cardiovascular Trauma Cancer Critical Care Primary Care Respiratory Health 2013 2014 2015
- 12. 12 Broad Array of Results 12 175HOME HEALTH TRANSFERS to acute care have been avoided 954READMISSIONS have been avoided 9,844PATIENT SAFETY EVENTS AVOIDED THROUGH OUR Hospital Engagement Network 25,614 PATIENTS Received documented APPROPRIATE CARE 28,094MORE PATIENTS WERE discharged from emergency departments in fewer than 180 MINUTES THAN IN 2012 $60 million savings in related health care costs from quality programs
- 13. 13 Harm Agenda
- 14. 14 HEN & LEAPT
- 16. 1616 Challenges • ‘Proceduralist’ vs. Episode Manager • Upstream capability • Immaturity of global measurement • Ecosystem strain Your Work
- 17. 1717 Opportunities • Physician Leadership • Aggressive use of technology • Embrace move to reliability • Value measurement • Creation of evidence Your Work
- 18. 18
Editor's Notes
- Everything – even an introduction – is influenced by the new health care landscape. 10 years ago, what I would tell you is this 39 hospitals, more than 180 primary care offices and 900+ care locations including urgent care and free-standing Eds 30,000 employees including nearly 3,000 physicians/ACPs and 15,000 nurses Full continuum of care including several nationally recognized specialty services Geographic footprint that spans South Carolina and North Carolina and reaches into Georgia More than 11 million patient encounters every year More than $8 billion in annual revenue But it’s not 2005. And while we do describe ourselves in these terms still today, we no longer define ourselves by these terms. Why? Big only matters if big = access to care. full continuum of care matters if care is integrated and produces value Today, I’ll introduce CHS this way…
- Innovative care organizations and services One of the most comprehensive electronic medical records systems in the country More than 60,000 diabetic patients in managed care One of the largest virtual critical care (e-ICU) programs in the nation More than 500 behavioral health ED consults conducted virtually per month Patient safety initiatives prevented more than 9,800 patient safety incidents and saved nearly $60 million related health care costs over two years Why is this our we describe ourselves today? Up until now providers could have had and/or position when it comes to volume or value. But in today’s world the conversation about value is a conversation about strategy. Quality is the driver of evolving integrated delivery networks and moves beyond what is just transactional. Surgeons, like all providers, have a decision to make. The question is what do you want your role to be? Is it a narrow role? In the case of surgeons, just a procedural role? Or is it broader, with more responsibility? There are positives and negatives to both. The burden is educating yourselves to make strategic choices and asking the right questions.
- FROM VOLUME TO VALUE Volume: Facility based, Individual patient focus, variable, Issue-focused, Silo work, Fee for Service, Uncoordinated Value: Team-based care, Safe, Improved Quality, Engaged Physicians, Transparency, Care Coordination, Team Accountability, Standardization, Innovation, Cost Containment, Patient-centric, Reactive, Information Technology
- Our system faces many of the same issues and questions that you do. And as we look at these areas and see the overlap and understand how the landscape is changing for both us as providers we have asked ourselves hard questions about our direction and our focus. How we are able to answer those questions drives how we redefine ourselves and how we create a high-quality, high-value, high-performing system that is positioned to thrive in a new economic reality. These are six questions that our organization had to ask of ourselves as we began to decide what our role would be in the transformation. How would be move from a service model to a performance model? As went about answering these questions we uncovered the challenges and the opportunities facing us.
- Pursuit of quality is a long journey Not directly about revenue – though they are related. These five words represent many of the challenges we face as we go through our particular journey. Performance Unification Accountability Culture Differentiation
- From a system standpoint, we can no longer look at treatment as episodic. What happens before the OR and what happens after the OR impact outcomes and therefore impact performance
- Never easy, never quick but necessary Work different & do different work ISOC Maturity Model A whole new way of thinking: deconstruct to reconstruct Provides roadmap Aligned with our cause for change Training: One example Carolinas Simulation Center Only one in region ACS accredited Level I and Society for Simulation in Health ARTE accredited Three year study developing a mental skills curriculum to help surgeons remain focused in the OR (being led by Dr. Stefanidis, using a grant from AHRQ) Strategy to enhance safety and performance – training not typically offered but a necessary change in part to adapt to new payment pressures
- Among our results 25,614 patients received appropriate care 9,844 patient safety events avoided $60 million in related health costs avoided Nearly 1,000 readmission avoided More than 28,000 patients discharged from the ED in under 180 minutes
- Overall strategy of collaboratives, coaching and cultural improvement achieved transformative results: One of the first systems to form a Patient Safety Organization Federal PSO designation provides to improved information sharing across the System One of 27 healthcare organizations selected for CMS’ Partnership for Patients Hospital Engagement Network (HEN) One of just two healthcare systems to receive HEN contract modification: Leading Edge Advanced Practice Topics Aggressively reduce harm in five areas: Sepsis, Antibiotic Stewardship, Procedural Harm, HACs, Readmission and Community Care Culture is impacted by two key themes: patient and family engagement and safety across the board: Identified as a leader and recognized by the Caregiver Action Network (CAN) as one of the national top 25 patient and family engagement best practices for the “Carolinas approach” of obtaining a deep understanding of each hospital’s genuine performance and establishing and sharing linkages between patient and family engagement and HEN outcomes Achieved significant milestones in the transformation of our culture towards engaging patients and families as partners, including: Family member voice keynoting annual HEN leadership meeting to discuss patient harm event Significant increase in the number of hospitals in our HEN who have established Patient and Family Advisory Councils Patient and family engagement as the central topic for our quarterly Leadership Development Institute, a gathering of approximately 1,400 leaders representing the entire care continuum Patient keynote during our Quality and Service Sharing Day, a gathering of nearly 1,000 to celebrate the best projects in safety, quality and service
- Overall strategy of collaboratives, coaching and cultural improvement achieved transformative results: One of the first systems to form a Patient Safety Organization Federal PSO designation provides to improved information sharing across the System One of 27 healthcare organizations selected for CMS’ Partnership for Patients Hospital Engagement Network (HEN) One of just two healthcare systems to receive HEN contract modification: Leading Edge Advanced Practice Topics Aggressively reduce harm in five areas: Sepsis, Antibiotic Stewardship, Procedural Harm, HACs, Readmission and Community Care Culture is impacted by two key themes: patient and family engagement and safety across the board: Identified as a leader and recognized by the Caregiver Action Network (CAN) as one of the national top 25 patient and family engagement best practices for the “Carolinas approach” of obtaining a deep understanding of each hospital’s genuine performance and establishing and sharing linkages between patient and family engagement and HEN outcomes Achieved significant milestones in the transformation of our culture towards engaging patients and families as partners, including: Family member voice keynoting annual HEN leadership meeting to discuss patient harm event Significant increase in the number of hospitals in our HEN who have established Patient and Family Advisory Councils Patient and family engagement as the central topic for our quarterly Leadership Development Institute, a gathering of approximately 1,400 leaders representing the entire care continuum Patient keynote during our Quality and Service Sharing Day, a gathering of nearly 1,000 to celebrate the best projects in safety, quality and service
- Transparency is being demanded by consumers and forced by third-party rating systems – there will only be more Last year Consumer Reports released it’s first ranking of CV care US News & World Report is about to release data on five common hospital diagnoses: heart bypass, heart failure, knee replacement, hip replacement and COPD Metrics include safety and performance – people will have more data and ask more questions Even if payments aren’t directly linked to performance, public perception of performance can impact volumes Efforts to be transparent Value Report Past two years published extensive report on quality Online Building out quality sections of website Engaging with the media to discuss our programs talk about quality
- TAKEAWAYS The landscape is changing … changing to what, we don’t exactly know. We know directionally but the journey isn’t fully mapped out. We are all going to have to be more integrated, more connected and more collaborative. New care models depend on an management structure that allow integration to occur Providers need to have a vision to change and a strategy to get them there.
- TAKEAWAYS The landscape is changing … changing to what, we don’t exactly know. We know directionally but the journey isn’t fully mapped out. We are all going to have to be more integrated, more connected and more collaborative. New care models depend on an management structure that allow integration to occur Providers need to have a vision to change and a strategy to get them there.