Accountable Care Transformation (ACT) Leadership May 20, 2011

1. Accountable Care Transformation (ACT) LeadershipMay 20, 2011 Georges Feghali, MD - Senior VP of Quality & Chief Medical Officer , TriHealth

2. INTRODUCTION We want to drive quality improvement for patients across the whole spectrum of care i.e. within the hospital and outside While care happens in the hospital setting a lot of what impacts the patient the most happens in the outpatient setting We recognize the need to work with physicians and community organizations on this common goal so we align our aims We will present some of the work happening on the hospital side and how we are engaging in a dialogue with the community so we can work together

3. HISTORY IN COLLABORATION Greater Cincinnati hospitals have a strong history of working together toward successful outcomes Under the Hospital Quality Improvement Project (HQIP), we worked together as a community of hospitals to drive results community wide: AMI from 82% to 97.4% CHF from 62% to 92.3% Pneumonia from 64% to 91.5%

4. ACT Purpose To drive measurable improvements in patient safety and quality through shared ACCOUNTABILITY for defining, monitoring and overseeing improvement metrics.

5. ACT Representation Hospital VPMAs, CMOs, Medical Directors, CEOs, Quality Directors, CNOs, Case Managers and Business Representatives Now Physician Practice Representation Who else?

6. ACT Goals •Reduce HF (all cause) readmission rates for the 18 years and older population by 10% by January 2012 [ i.e. from 23.63% to 21.27%] Goal represents approximately 7,500 patients per year Related Metrics Review and monitor data by Race, Ethnicity and Language data beginning in Summer 2011 Incorporate the Patient Experience measures

7. Using Data in new ways Quarterly readmission rate through the Ohio Hospital Association data Monthly rate submitted by hospitals for access to more timely results Reimbursement data is reviewed for better picture of the impact and potential loss Drilling down into the data to analyze patterns (by zip code, by discharge status etc.)

8. Data Overview Community Goal : 21.27% by January 2012 Quarterly OHA data – 23.7% (as of 3rd Quarter 2010) Monthly data – 21.7% (as of Feb 2011)

9. ACT Opportunities This committee is at the center of the health transformation work on the hospital side Better understanding of our readmission patients – who are they? What are the gaps? Learning from best practices everywhere like STAAR, Boost and local successes Playing a pivotal role in readying hospitals for ACOs Better coordination with the primary care physicians for cross learning – they are at the table Better understanding of community care coordination /transitions of care Opportunity to help shape IT needed to drive improvement

10. Other Transition in Care Work EMR Discharge Process Taskforce Goal is to standardize the hospital EMR discharge data elements for each patient AT time of discharge. Strong IT presence Collaboration of multiple community representatives such as: Primary Care Physicians Long Term Care Facilities Home Health Council on Aging Local hospitals

11. Conclusion We are constantly seeking new ways to improve and welcome any feedback – what can we do better? Who else should we partner with? What challenges/successes are you facing in the area of care coordination? Any lessons learned?

12. THANK YOU FOR YOUR TIME