Moving the Needle in Quality - Tom Evans, MD SCHA Transforming Health Symposium

1. Moving the Needle in Quality Tom Evans, MD SCHA Transforming Health Symposium April 7, 2016 100 E. Grand Ave., Ste. 360 • Des Moines, IA 50309-1835 Office: 515.283.9330 • Fax: 515.698.5130 www.ihconline.org

2. Objectives • Consider the transformation of clinical care introduced through Affordable Care Act (ACA) • Describe the Partnership for Patients campaign and efforts to improve quality and patient safety in Iowa • Explore the impact on clinical performance improvement and the future

4. The rate of growth in expenditures on hospital care and physician & clinical services is remarkable. And while that rate of growth has been on a steep upward curve for two decades, the curve becomes nearly vertical in the last five years. Health System Micro Economies Health Cost Trend 25% 60% Data shown is total, inflation adjusted dollars that are going into health care through commercial insurance, Medicare, and Medicaid Source: Neal C. Hogan, PhD. BDG Advisors, LLC. The End of the Third Bubble. Winter 2009. Carol Corp. / United Health Group October 2010

5. U.S. Lags Other Countries: Mortality Amenable to Health Care Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Analysis of World Health Organization mortality files and CDC mortality data for U.S. Source: Adapted from E. Nolte and M. McKee, “Variations in Amenable Mortality—Trends in 16 High-Income Nations,” Health Policy, published online Sept. 12, 2011.

6. National Health Care Reform

7. The Four Pillars for Health Care Transformation • Put the patient in the center • Transparency and openness • Elimination of waste and continuous improvement • Collaboration and partnership

8. A Whole New Sport

9. A Whole New Sport

10. Simplified Structure of Health Care Reform • Move away from classic fee-for-service payment • Pay health care providers in new ways to spur delivery system reform, enhance patient care, get rid of waste and slow the growth of health spending (ACOs, PCMHs, APMs, etc.) • Various pilot and demonstration projects, some new, some building on experiments tried in previous administrations

11. Partnership for Patients

12. How do we get ready? Partnership for Patients Campaign Nationwide over three years, reduce… • Preventable inpatient harm by 40% • Readmissions by 20%

13. Why this focus? If we have to bend the curve, where do we start to transform health care? • 20-30% of hospitalized patients experience some kind of harm… Improve Patient Safety • Around 20% of Medicare patients are readmitted within 30 days… Improve Care Coordination • The hospital is the health care community hub for the sickest patients… Start at the hospital

14. PfP Scope of Work Readmissions Adverse drug events Venous Thromboembolism (VTE) Falls Pressure Ulcers OB adverse events Catheter associated UTI Surgical Site Infection (SSI) Ventilator-associated Pneumonia (VAP) Central line infection

15. PFP-Measured HACs Pie Chart (2010)

16. Alignment of Federal Program Investments in Iowa Hospital Engagement Network (HEN)* Falls Pressure Ulcers Obstetrics HAI Cardiovascular VTE Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement March 3, 2015

17. IHC HEN Safety Across the Board HEN Baseline 2012

18. HACs for PfP Campaign 121 121 145 142 132 HACs/1000

19. Impacts of Major Improvements in Patient Safety: Compared to 2010 Baseline • 17% Reduction in HACs 2010-2014 • from 145 per 1,000 discharges to 121 per 1,000 discharges in 2013 and 2014 • 39% reduction in preventable HACs – nearly at 40% goal • $19.8B in Estimated Associated Cost Savings2010-2014 • $4B for 2011 and 2012 combined • $15B for 2013 and 2014 combined • 87,000 Lives Saved 2010-2014 • ~15,000 lives saved for 2011 and 2012 combined • ~72,000 lives saved for 2013 and 2015 combined * Final MPSMS-based 2013 HACs, Preliminary 2013 NHSN-based HACs, and extrapolation of 2012 Data for 2013 PSI-based HACs; Partnership for Patients 12/1/14 press release

20. Transforming Clinical Practice

21. Transforming Clinical Practice Initiative (TCPI) • “HEN for Docs” • Enhance outpatient skill in population-based care to “thrive in value-based reimbursement” • Multi-state application with rural focus • Five Phases of Transformation

22. Transforming Clinical Practice Initiative Phases of Transformation

23. Participating States and Lead Organizations State South Dakota State Partner Lead(s) HealthPOINT at Dakota State University Iowa Nebraska ENHANCE Health Network Iowa Healthcare Collaborative Dedicated Clinical & Operational Leads and Quality Improvement Advisors in each state to support participating clinicians and practices Kansas Kansas Healthcare Collaborative Georgia Oklahoma Georgia Hospital Association Research and Education Foundation OU Physicians and Telligen

24. Alignment of Federal Program Investments in Iowa Cardiovascular VTE Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement PQRS Measures Prevention (Tobacco, Obesity) Diabetes MU Measures Transforming Clinical Practice (TCPI)*

25. State Innovation Model

26. State Innovation Model (SIM) • Develop and test of state-led, multi-payer health care service delivery and payment models • Medicaid Modernization in Iowa

27. Statewide Strategies • Cardiovascular and Stroke • Palliative Care (IPOST) • Obstetrics • Healthcare-associated Infection • Diabetes (June ‘15) • Medication Safety (July ‘15)

28. Operational Focus (How) Social Determinants of Health Medication Safety and Effectiveness Patient and Family Engagement Community Care Coordination Clinical Focus (What) HAI Obstetrics Diabetes Obesity Tobacco State Innovation Model (SIM) Clinical Improvement

29. Statewide Strategies • Cardiovascular and Stroke • Palliative Care (IPOST) • Obstetrics • Healthcare-associated Infection • Diabetes (June ‘15) • Medication Safety (July ‘15) • Patient and Family Engagement (July ‘16) • Social Determinants of Health (July ’16)

30. Alignment of Federal Program Investments in Iowa Obstetrics HAI Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Social Determinants of Health Prevention (Tobacco, Obesity) Diabetes State Innovation Model (SIM)

31. Alignment of Federal Program Investments in Iowa Hospital Engagement Network (HEN)* Falls Pressure Ulcers Cardiovascular VTE Obstetrics HAI Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement PQRS Measures Social Determinants of Health MU Measures Prevention (Tobacco, Obesity) Diabetes State Innovation Model (SIM) Transforming Clinical Practice (TCPI)*

32. Hospital Engagement Network (HEN)* Population based, Community Applied Falls Pressure Ulcers Cardiovascular VTE Obstetrics HAI Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Social Determinants of Health Asthma Prevention (Tobacco, Obesity) Diabetes State Innovation Model (SIM) Transforming Clinical Practice (TCPI)*

33. Population-based, Community applied

34. The Ten Elements of Radical Redesign • Change the balance of power…co-production • Standardization • Customization • Promote well being • Joy in the work

35. The Ten Elements of Radical Redesign • Make it easier…Lean • Modernization • Collaboration • Assume abundance • Return the money