The Sheba Journey Towards Value Measurement

1. The Sheba Journey Towards Value Measurement Eyal Zimlichman MD, MSc Ahuva Weiss-Meilik PhD Ari Shamiss MD, MPA Delegation of North America Hospital CEOs to Israel February 5, 2012

2. Sheba Road Map • Sheba Medical Center has developed since 2002 a balanced-score-card management systems – CHESS (“Clinical and Health Economy and Satisfaction Simulator”) measuring: • Clinical process • Clinical outcome • Patient level activity based costing • To allow for correlation between process and outcomes – both clinical and costs, SMC has been developing an approach that would allow through case-mix and correlation algorithms to optimize total value (Medilogica).

4. Measuring Cost… • To create value we need to relate quality to cost • Measuring cost using claims as proxies is insufficient • The $ value of an outcome is essential for comparative effectiveness or more accurately “comparative efficiency” • Therefore Patient-Level Costing is an important denominator

10. The Challenge • It is difficult to correlate between outcomes and process variability • Clinical leaders and clinicians are minimally involved in the efforts to maximize value Sheba Medical Center

11. Medilogica: Measuring and Optimizing Value

12. What is Medilogica? • A value (quality and cost) measurement and optimization system that allows redesigning care to maximize health care value • Allows clinicians and managers to identify process steps that would increase value (reducing costs of care while improving clinical outcomes) on a procedure/diagnosis level • Patient level costing data as well as clinical process and outcomes need to feed the Medilogica engine • Engine algorithms have been developed and tested individually. Sheba Medical Center is about to launch the full solution for the first time. Sheba Medical Center

13. Clinical Financial Patient oriented CRM/academic 8 Work Groups CHESS: Sheba’s Organizational Value Compass ORGANIZATIONAL GOALS Senior Steering Committee MEASURES Balanced Score Card ORGANIZATIONAL VALUE COMPASS “Clinical and Health Economy and Satisfaction Simulator” Sheba Medical Center

14. EMR PACS IRB Academic Lab CPOE HR Safety/RM ADT Infec. Dis. Financial Training Case-mix adjustment Overall – 86 quality indicators: 43 – clinical perspective 18 – financial perspective 11 – patient perspective 9 – Crew resource and academic perspective 5 – Case-mix measures Data analytics DATA WAREHOUSE CHESS measures SQL data General dashboard Nursing dashboard Dashboard presented on an organizational web portal (Microsoft office SharePoint) CHESS: IT Architecture Sheba Medical Center

15. Where does Medilogica fit? CHESS VALUE COMPASS MEDILOGICA

16. Principles of Medilogica • Measuring process and outcome alone is not sufficient to maximize health care value • Medilogica provides a correlation engine that allows clinical leaders to drive care processes according to expected clinical and financial outcomes • Medilogica’s case-mix clustering principle allows to group patients sharing similar clinical profiles – thus adjusting for case-mix Sheba Medical Center

17. Case-mix Clustering

18. The MedilogicaPlatform • Data collection: • Clinical, financial and administrative information systems • Smart pop-up dialogue boxes • Enterprise data warehouse Grouping of patients using the case-mix cluster algorithm • Segment similar cases leveraging case mix adjustment algorithm • Real time predictive modeling tools for clinicians • Assess the variation in outcomes and identify areas of potential improvement • Correlate financial and clinical outcomes • Optimize total value of the clinical product Sheba Medical Center

19. Data Platform and Solutions Sheba Medical Center

20. Patient Level Costing • Financial outcome data feeding the Medilogica system has to on a patient level, be activity based and time derived in as a real-time fashion as possible • Sheba Medical Center is operating an information technology – real time - activity based patient level costing system (TMR by Gomla). Sheba Medical Center

21. DEMO Sheba Medical Center

22. Dashboard: Clinical Orientation

23. Dashboard: Financial Orientation

24. Financial and Clinical OutcomeFracture of Hip

25. Correlating Outcome to Process:Defining Best Practice

26. Value Optimization EngineFracture of Hip

27. Value Optimization EngineFracture of Hip

28. Value Optimization EngineFracture of Hip

29. Current Status • Case-mix and correlation algorithms have been developed during the last 10 years at Sheba Medical Center (Dr. Ahuva Meilik-Weiss and Dr. Eyal Zimlichman). SMC owns the intellectual property for the algorithms • Sheba Medical Center is about to launch a full implementation of the system. Colon surgery was chosen as a pilot condition. • Sheba will be looking for partners to jointly develop the operational system. Sheba Medical Center

30. Planned Medilogica Pilot Develop and implement a fully operational value (quality and cost) measurement and optimization system for colon surgery patients, setting the stage for measurement and optimization of other conditions and procedures across the hospital. Sheba Medical Center

31. Piloting at other hospitals • Data collection in real-time (manual plus IS) • Report to managers Defining: process maps, clinical outcomes Enhancing costing system Validate case-mix cluster algorithm Develop preliminary dashboard Sheba Medical Center

32. Looking ahead… • How many conditions do we need to cover? Pareto rule, top 10-20 in terms of variation in costs and clinical outcomes would account for the vast majority of potential improvement • Looking across the continuum of care (did someone say ACO?...) Cross providers-patient level costing systems Patient centered longer-term outcomes (patient reported) Optimizing process across the continuum, following the patient Sheba Medical Center

33. THANK YOU MEDILOGICA Sheba Medical Center