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Intermountain’s	
  Journey	
  
Kim	
  Henrichsen,	
  RN,	
  MSN	
  
Vice	
  President,	
  Clinical	
  Opera2ons	
  and	
  CNO	
  
	
  	
  	
  
GETTING	
  TO	
  KNOW	
  
INTERMOUNTAIN	
  
Who	
  are	
  we?	
  	
  
	
  
Since	
  1975	
  
•  22	
  hospitals	
  
•  2,784	
  licensed	
  beds	
  
Since	
  1983	
  
•  Health	
  plans	
  
•  700,000+	
  members	
  
Since	
  1994	
  
•  1,200	
  employed	
  physicians	
  
•  558	
  advanced	
  pracOce	
  clinicians	
  
•  30	
  Instacare	
  Clinics	
  
Since	
  1997	
  
•  10	
  key	
  service	
  lines	
  
Highly	
  Integrated	
  Health	
  System	
  
Hospitals	
  
SelectHealth	
  
Medical	
  
Group	
  
Clinical	
  
Programs	
  
Our	
  Charge:	
  	
  To	
  become	
  a	
  	
  
“Model	
  Healthcare	
  System”	
  
OUR	
  MISSION	
  
Helping	
  people	
  live	
  the	
  healthiest	
  lives	
  possible	
  
OUR	
  VISION	
  
Be	
  a	
  model	
  health	
  system	
  by	
  providing	
  extraordinary	
  
care	
  and	
  superior	
  service	
  at	
  an	
  affordable	
  cost	
  
GETTING	
  TO	
  KNOW	
  
INTERMOUNTAIN	
  
How	
  are	
  we	
  doing?	
  
	
  
The	
  Intermountain	
  Way	
  
Engage	
  	
  
paGents	
  	
  
&	
  align	
  	
  
incenGves	
  
Evidence-­‐
based	
  best	
  
pracGces	
  
SystemaGc	
  
approach-­‐	
  	
  	
  	
  
measure	
  &	
  	
  	
  	
  
improve	
  
OpOmal	
  Outcomes	
  
High	
  Quality	
  Clinical	
  Care	
  
Utah	
  	
  	
  	
  
Rank	
  
Utah	
  
Amount	
  
U.S.	
  	
  
Median	
  
Utah	
  
Differ.	
  
Healthcare	
  expenditures	
  per	
  capita*	
   1	
   $5,031	
   $6,815	
   -­‐26%	
  
Medicare	
  admits	
  75	
  yrs+	
  /	
  1,000	
  beneficiaries	
   2	
  	
   42.0	
   68.0	
   -­‐38%	
  
Medicare	
  30-­‐day	
  hospital	
  readmission	
  rate	
   3	
   28.0	
   45.0	
   -­‐38%	
  
Mortality	
  amenable	
  to	
  healthcare	
  /	
  100,000	
   4	
   62.0	
   82.0	
   -­‐24%	
  
Home	
  health	
  paOents	
  with	
  hosp.	
  admission	
   1	
   14.0	
   17.0	
   -­‐18%	
  
Source:	
  Commonwealth	
  Fund	
  State	
  Scorecard,	
  April	
  2014;	
  *Wall	
  Street	
  Journal,	
  April	
  8,	
  2013	
  	
  
 
•  There	
  is	
  usually	
  wide	
  variaOon	
  in	
  
clinical	
  pracGce	
  	
  
•  ObjecOve	
  data	
  measurement	
  will	
  
demonstrate	
  opportunity	
  for	
  
improvement	
  
•  Performance	
  improves	
  with	
  
systemaGc	
  adopGon	
  of	
  best	
  pracOces	
  
•  Intermountain’s	
  main	
  physician	
  
engagement	
  strategy:	
  	
  OpGmal	
  
paGent	
  outcomes	
  
Clinical	
  Program	
  Principles	
  
Our	
  Experience	
  
Value	
  Based	
  	
  
Purchasing	
  	
  
	
  
Intermountain	
  	
  Discharge	
  MedicaOons	
  in	
  2000	
  
99%
95%
91%
94%
90%
30%
40%
50%
60%
70%
80%
90%
100%
ASA HmG BB p MI ACE for CHF Coumadin
% Eligible Patients Treated at Discharge
with Appropriate Medications
2000 National Statistics
Impact	
  of	
  	
  Intermountain	
  Discharge	
  Med	
  Program	
  
on	
  Heart	
  Failure	
  Readmissions/Mortality	
  
ACE	
  inhibitor	
  prescripGon	
  at	
  hospital	
  discharge	
  increased	
  from	
  65%	
  
in	
  1997	
  to	
  95%	
  in	
  1999-­‐2001	
  and	
  for	
  these	
  IHC	
  heart	
  failure	
  
paGents:	
  	
  
•  One-­‐year	
  readmissions	
  were	
  reduced	
  from	
  46.5	
  %	
  to	
  38.5%	
  
•  551	
  readmissions	
  are	
  prevented	
  per	
  year	
  	
  
•  $2,480,000	
  are	
  saved	
  based	
  on	
  avoided	
  readmissions	
  	
  
•  One-­‐year	
  mortality	
  rate	
  reduced	
  from	
  22.7%	
  to	
  17.8%	
  
•  331	
  lives	
  are	
  saved	
  per	
  year	
  
 
CMS	
  Pay	
  for	
  Performance	
  Programs	
  
VBP,	
  Readmission	
  ReducGon,	
  HAC	
  
Intermountain	
  Healthcare	
  
Hospital	
  
Acquired	
  
CondiOons	
  
Value	
  Based	
  
Purchasing	
  
Readmission	
  
ReducOon	
  
Program	
  
FY	
  2015	
   9	
  of	
  22	
  (penalty)	
   1	
  of	
  22	
  (penalty)	
   3	
  of	
  22	
  (penalty)	
  
FY	
  2016	
   9	
  of	
  22	
  (penalty)	
   2	
  of	
  22	
  (penalty)	
   5	
  of	
  22	
  (penalty)	
  
Awards	
  &	
  RecogniOon	
   Benefits	
  
Credibility	
  
Strategic	
  Fit	
  Low	
  
Low	
  
High	
  
High	
  
Public	
  Quality	
  ReporGng	
  	
  
•  Intermountain	
  Healthcare	
  
hospitals	
  score	
  very	
  well	
  on	
  some	
  
surveys	
  and	
  poorly	
  on	
  others	
  
with	
  similar	
  metrics.	
  	
  	
  
•  There	
  is	
  variability	
  exisGng	
  even	
  
between	
  our	
  faciliGes	
  
•  Intermountain	
  was	
  an	
  early	
  
leader	
  in	
  core	
  measures,	
  we	
  fell	
  
in	
  ranking,	
  not	
  in	
  performance	
  as	
  
public	
  reporGng	
  increased	
  
Summary	
  
Closing	
  Thoughts	
  
•  CMS	
  Pay	
  for	
  Performance	
  metrics	
  are	
  
aimed	
  at	
  improving	
  care	
  for	
  paGents	
  
•  CMS	
  should	
  conGnue	
  to	
  replace	
  process	
  
measures	
  with	
  outcome	
  measures	
  
•  OrganizaGons	
  should	
  conGnue	
  to	
  focus	
  
on	
  areas	
  where	
  literature	
  supports	
  
improved	
  paGent	
  outcomes	
  
•  ConsideraGon	
  should	
  be	
  given	
  to	
  
reducing	
  complexity	
  for	
  those	
  delivering	
  
the	
  care	
  (and	
  burden	
  of	
  measurement)	
  
Right	
  
Thing	
  	
  
Right	
  
Time	
  	
  
Every	
  
Time	
  	
  

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  • 1. Intermountain’s  Journey   Kim  Henrichsen,  RN,  MSN   Vice  President,  Clinical  Opera2ons  and  CNO        
  • 2. GETTING  TO  KNOW   INTERMOUNTAIN   Who  are  we?      
  • 3. Since  1975   •  22  hospitals   •  2,784  licensed  beds   Since  1983   •  Health  plans   •  700,000+  members   Since  1994   •  1,200  employed  physicians   •  558  advanced  pracOce  clinicians   •  30  Instacare  Clinics   Since  1997   •  10  key  service  lines   Highly  Integrated  Health  System   Hospitals   SelectHealth   Medical   Group   Clinical   Programs   Our  Charge:    To  become  a     “Model  Healthcare  System”  
  • 4. OUR  MISSION   Helping  people  live  the  healthiest  lives  possible  
  • 5. OUR  VISION   Be  a  model  health  system  by  providing  extraordinary   care  and  superior  service  at  an  affordable  cost  
  • 6. GETTING  TO  KNOW   INTERMOUNTAIN   How  are  we  doing?    
  • 7. The  Intermountain  Way   Engage     paGents     &  align     incenGves   Evidence-­‐ based  best   pracGces   SystemaGc   approach-­‐         measure  &         improve   OpOmal  Outcomes  
  • 8. High  Quality  Clinical  Care   Utah         Rank   Utah   Amount   U.S.     Median   Utah   Differ.   Healthcare  expenditures  per  capita*   1   $5,031   $6,815   -­‐26%   Medicare  admits  75  yrs+  /  1,000  beneficiaries   2     42.0   68.0   -­‐38%   Medicare  30-­‐day  hospital  readmission  rate   3   28.0   45.0   -­‐38%   Mortality  amenable  to  healthcare  /  100,000   4   62.0   82.0   -­‐24%   Home  health  paOents  with  hosp.  admission   1   14.0   17.0   -­‐18%   Source:  Commonwealth  Fund  State  Scorecard,  April  2014;  *Wall  Street  Journal,  April  8,  2013    
  • 9.   •  There  is  usually  wide  variaOon  in   clinical  pracGce     •  ObjecOve  data  measurement  will   demonstrate  opportunity  for   improvement   •  Performance  improves  with   systemaGc  adopGon  of  best  pracOces   •  Intermountain’s  main  physician   engagement  strategy:    OpGmal   paGent  outcomes   Clinical  Program  Principles  
  • 10. Our  Experience   Value  Based     Purchasing      
  • 11. Intermountain    Discharge  MedicaOons  in  2000   99% 95% 91% 94% 90% 30% 40% 50% 60% 70% 80% 90% 100% ASA HmG BB p MI ACE for CHF Coumadin % Eligible Patients Treated at Discharge with Appropriate Medications 2000 National Statistics
  • 12. Impact  of    Intermountain  Discharge  Med  Program   on  Heart  Failure  Readmissions/Mortality   ACE  inhibitor  prescripGon  at  hospital  discharge  increased  from  65%   in  1997  to  95%  in  1999-­‐2001  and  for  these  IHC  heart  failure   paGents:     •  One-­‐year  readmissions  were  reduced  from  46.5  %  to  38.5%   •  551  readmissions  are  prevented  per  year     •  $2,480,000  are  saved  based  on  avoided  readmissions     •  One-­‐year  mortality  rate  reduced  from  22.7%  to  17.8%   •  331  lives  are  saved  per  year  
  • 13.   CMS  Pay  for  Performance  Programs   VBP,  Readmission  ReducGon,  HAC   Intermountain  Healthcare   Hospital   Acquired   CondiOons   Value  Based   Purchasing   Readmission   ReducOon   Program   FY  2015   9  of  22  (penalty)   1  of  22  (penalty)   3  of  22  (penalty)   FY  2016   9  of  22  (penalty)   2  of  22  (penalty)   5  of  22  (penalty)  
  • 14. Awards  &  RecogniOon   Benefits   Credibility   Strategic  Fit  Low   Low   High   High  
  • 16. •  Intermountain  Healthcare   hospitals  score  very  well  on  some   surveys  and  poorly  on  others   with  similar  metrics.       •  There  is  variability  exisGng  even   between  our  faciliGes   •  Intermountain  was  an  early   leader  in  core  measures,  we  fell   in  ranking,  not  in  performance  as   public  reporGng  increased   Summary  
  • 17. Closing  Thoughts   •  CMS  Pay  for  Performance  metrics  are   aimed  at  improving  care  for  paGents   •  CMS  should  conGnue  to  replace  process   measures  with  outcome  measures   •  OrganizaGons  should  conGnue  to  focus   on  areas  where  literature  supports   improved  paGent  outcomes   •  ConsideraGon  should  be  given  to   reducing  complexity  for  those  delivering   the  care  (and  burden  of  measurement)  
  • 18. Right   Thing     Right   Time     Every   Time