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A re You Destined for Reform?

A re You Destined for Reform?. Today’s discussion. Introduction to destination centers. Why now? Case Study – The Cleveland Clinic. What is a destination center?. Destination Center. Patient label. Center of excellence. Provider/payor labels. Center of distinction.

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A re You Destined for Reform?

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  1. Are You Destined for Reform?

  2. Today’s discussion • Introduction to destination centers. • Why now? • Case Study – The Cleveland Clinic.

  3. What is a destination center? Destination Center Patient label Center of excellence Provider/payor labels Center of distinction Disease specific care center

  4. What is a destination center? • Regional, national, and international draw. • Advanced specialty care. • Exceptional quality, outcomes, service at competitive prices. • Coordinated care.

  5. NOTmedical tourism They’re not passengers arriving from a crash. They're part of our medical tourism travel package.

  6. A step above and a step ahead

  7. Why now? • Despite reform specifics, competition for the healthcare dollar will come down to value • To the patient, • To the provider(s), • To the payor.

  8. What is value? • Good value - Meeting expectations. • Great value - Exceeding expectations: • Quality • Service • Coordination • Price.

  9. VALUE in care provided… • Aligned providers • Quality and outcomes • Continuum of care • Population health

  10. …And in service • Schedule all services in the same day or few days. • Coordinate provider schedules, referrals, billing, accommodations and insurance approvals. • Anticipate and address concerns with reimbursement, copays, bills. • Provide concierge services as needed – • Lodging • Transportation • Other.

  11. Destination – Neurosciences

  12. The Cleveland Clinic – a step above and a step ahead • MyHealth assessment • Collect and report outcomes in all clinical departments • Population management - telemedicine • Evidence based care paths • CI imbedded staff – LEAN philosophy • Value purchasing - direct to employer • National & international cardiac and neuro affiliation programs • Business reviews

  13. MyHealth assessment • Started as Spine Clinical Outcomes Information System. • 2008 redesigned as The Knowledge Project. • Currently used in 14 departments. • Assessments are tailored to disease. • Direct integration with EMR. • Used for reporting outcomes. • Tablet based.

  14. Tablet based • Patient or patient’s delegate enters information based on visit type.

  15. Outcomes • Clinical department start up 2003. • In print and on line • Thousands mailed annually. • Annual schedule. • Steering committee. • Collected by department. • Transparency is key – all outcomes reported.

  16. Telemedicine • Get the right patient…shortageof neurologists and stroke experts to treat patients. • To the right therapy…EDcaregivers/Neurologists looking for support in using clot-busting drugs and don’t have intra arterial and/or mechanical interventions at their disposal. • In the right location…matchpatient needs to the appropriate services available.

  17. Telemedicine – Step 1: Access Connect with Cleveland Clinic stroke telemedicine. CCF staff stroke specialist links into local hospital. Patient arrives in ED.

  18. Telemedicine – Step 2: Physician to physician consult The stroke specialist assesses patient with attending ER provider. CT scans and lab results reviewed remotely; treatment recommendations discussed (IV tPA and/or alternative therapies).

  19. Step 3: Consult with patient & family Specialist can speak with the patient and/or family members to discuss treatment of care.

  20. Step IV – Admit or transfer? Decision is made to admit to local Critical Care Unit or transfer to a comprehensive stroke center.

  21. Patients in Stroke CarePath N=249 Last Known Well < 3 hours 15.7% (n=39) Last Known Well > 3 hours* Received IV tPA 15.4% (n= 6) Ineligibility documented discretely with Stroke CarePath 84.6% (n=33) IVtPA withheld without documentation 0% (n=0) Evidence - based carepaths * Includes patients with unknown LKW

  22. Change in neurological impairmentadmission to discharge 17.4% remained stable # Change in NIHSS from admission to discharge

  23. Value based bundling • Direct to employer contracting.

  24. HVI affiliation / consulting Assist partners develop and manage cardiovascular and neurological programs. Flexible offering to meet partner needs: Program assessment consulting, Implementation of clinical protocols, Branded management affiliations. Confidential - Do Not Copy - Do Not Distribute

  25. Consulting and affiliation summary Evaluation Quality data Cultural fit Strategic alignment Organizational Structure and Decision Making Physician readiness Site visits Recommendations Phase I: Assessment Typical Duration: 6 months Phase II: Implementation Typical Duration: about 1 year Phase III: Affiliation Typical Duration: 5–7 years • Implementation of recommendations • Tailored plan • Cardiovascular program performance management • Ongoing quality benchmarking • Clinical data management support • Service line co-branding • Marketing support • Physician recruitment

  26. CV Management services - impact • Decreased post surgical ALOS by .5 days. • Decreased deep sternal wound Infection from 8 in one year to 0 the next. • Decreasedmortality from 4.8% to 0.8%. Quality improvements • Increased OR throughput by 1 case per day. • Advice & support on supply/device appropriateness. Operational efficiencies • Enhanced market position relative to local players. • Brand may provide layer of defense against cannibalizationby regional AMCs Market differentiation • Access to Cleveland Clinic physicians. • Development of innovative and clinically meaningfulqualitymeasures. Shared best practices

  27. Collaborative Sessions Goals Gaps & MWI’s Tools Prep Kickoff (1.5 hour) Business Review (2 hour) Goal Setting and Measuring Results Session Gap Assessment& MWIGenerationSession Business Review Tools Collaborative Problem Solving Business Review Prep Plan and Practice the Business Review Discussion 5 hours 4 hours 2 hours 3 hours Date & Time 1 week later Date &Time 2 weeks later 1 week later 1 week later Maintaining a sustainable business model - business review process Monthly Review Cycle

  28. What does this mean to you? • Can you define your value proposition? • Who is it of value to? Physicians, patients, payors? • Are you focusing on episodic illness or population health? • Are your physicians as committed as you? Can you succeed under lower reimbursement and bundled payments? • Are you proactive or reactive in EBP and quality initiatives? • What kind of continuum do you have access to and how do you use it?

  29. Should this be part of your strategy? • Value based purchasing? • Accountable care? • Disease management/community health? • Physician alignment?

  30. Contact Cecily Lohmar, Principal New Heights Group 704 895 3410 cecily@reach-newheights.com Kathy Huffman, Cleveland Clinic HUFFMAK@ccf.org www.reach-newheights.com

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