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.

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. Disclosures
• Board Member: Kaiser Foundation Health Plan and
Hospitals
• Board Member: National Institutes of Health Clinical
Center
• Senior Teaching Fellow of IHI

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. The Birth of Medicare: July 30,1965

7. PPACA: March 10, 2010

10. 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

11. Unintelligible Public Reporting:
Teaching to the Test vs True Improvement

12. 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.

13. 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

14. 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!!

15. 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

16. PHC4 2013
77% reductions
in CA-BSI/UTI
46% reduction in
SSI
52% reduction in
C. difficle
27% reduction in
neonatal
mortality from
sepsis

17. What Matters to You?
• Clinical Outcomes
• Complication Rates
• Time to return to work

18. Survival: PCI Risk Adjusted Mortality Rate for STEMI Patients
Heart & Vascular Center
UVA is above
the 90th
percentile
11.1% reduction
year over year

19. Adverse Events: PCI with STEMI
Heart & Vascular Center
22.7% reduction
year over year

20. 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

21. • 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

22. 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

23. Redefining the University-Industry Relationship
• UVA-Astra Zeneca Partnership
(Cardiovascular/Metabolic)
• VA-Mitre Partnership (Precision Analytics/Hovering)
• Hemoshear

24. 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

25. 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

27. Inverting the Discovery Paradigm
• Reductionist Approaches: The Needle in a Haystack
• Big Data Approaches: Drug Repurposing

28. 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

29. AMCs as Customers and Investors
•Seed and Venture Fund
•Locus Health
•Type Zero
•Tear Solutions

30. The American Dream
Universal access to affordable, high quality healthcare
Technologies