5. 5
We deliver integrated,
quality care on a large scale
• Innovative care organizations
and services
• 18 million transactions/day in our
EMR
• More than 65,000 diabetic patients in
managed care
• Large virtual critical care
(e-ICU) programs
• 500+ behavioral health ED consults
conducted virtually per month
• Saved nearly $60 million in health
care-related costs over two years 5
6. 6
Fundamental: The Transition from
Volume to Value
6
Current
Strain
uncoordinated
facility based
variable
Silo work
volume-based
fee for service
Issue-focused
individual patient
focus
VOLUME
VALUE
team accountability
standardization
engaged physicians
cost containment
improved quality
safe
patient-centric
transparency
care coordination
innovation
team-based care
information technology
reactive
7. 7
Reflection on Transformation
Why are we pursuing quality?
Are we willing to change?
Do we have a model that increases
access to care and leverages integration?
Have we made a commitment to embrace
technology and be excellent in its
application?
Are we actively moving to a value-based
system ahead of external drivers?
Are we willing to be accountable and
transparent?
1
2
3
4
5
6
8. 8
Role of Quality Pursuit
• Performance
• Unification
• Engagement
• Accountability
• Culture
• Differentiation
• “Value”
10. 10
Integration Maturity Model Criteria
1. Clinical Integration Priority Tool used
2. One and three-year Cross continuum/geographies plans
3. Specialty “Principle Coordinator of Care” criteria developed
4. Integration with palliative care, home health, etc.
5. Service line work influencing primary care, continuing care and/or acute care
6. Method to stratify patients is developed and deployed
7. Chronic Disease Management Model for key conditions and chronic populations
8. Navigator/Coordinator connected to the medical home
9. Action plan for readmission reduction is in place
10. Goals articulated in all three dimensions of value
11. Cross continuum value dashboards are developed
12. Care coordination models, clinical pathways, transitions developed and executed
13. Physician leaders engaged in strategy and tactics through physician colleagues
14. Physicians ensure compliance with cross continuum care pathways/protocols
15. Team-based care models are developed
16. Access leverage
17. Action plan positively impacting our employee population is developed/executed
18. Action plans: high drug costs utilization; unnecessary lab testing; high cost test settings; avoidable
ED visits
11. 11
Driving Change
Integrated System
of Care: Work differently
and do different work
• Integration across service
lines and points of care
• Navigator connected to
medical home
• Readmission reduction
action plan
• Team-based care models
• New training approaches
11
CHS Maturity Model
0%
20%
40%
60%
80%
100%
Orthopaedics
SNF
Children's
Behavioral
Health
Emergent Care
Hospice &
Palliative Care
Hospitalist Care
Neurosciences
Home Health
Rehabilitative
Care
Cardiovascular
Trauma
Cancer
Critical Care
Primary Care
Respiratory
Health
2013 2014 2015
12. 12
Broad Array of Results
12
175HOME HEALTH TRANSFERS
to acute care
have been avoided
954READMISSIONS
have been avoided
9,844PATIENT SAFETY EVENTS
AVOIDED THROUGH OUR
Hospital Engagement Network
25,614
PATIENTS
Received documented
APPROPRIATE CARE
28,094MORE PATIENTS WERE
discharged from emergency
departments in fewer than
180 MINUTES
THAN IN 2012
$60 million
savings in related health care
costs from quality programs
Everything – even an introduction – is influenced by the new health care landscape.
10 years ago, what I would tell you is this
39 hospitals, more than 180 primary care offices and 900+ care locations including urgent care and free-standing Eds
30,000 employees including nearly 3,000 physicians/ACPs and 15,000 nurses
Full continuum of care including several nationally recognized specialty services
Geographic footprint that spans South Carolina and North Carolina and reaches into Georgia
More than 11 million patient encounters every year
More than $8 billion in annual revenue
But it’s not 2005. And while we do describe ourselves in these terms still today, we no longer define ourselves by these terms.
Why?
Big only matters if big = access to care.
full continuum of care matters if care is integrated and produces value
Today, I’ll introduce CHS this way…
Innovative care organizations and services
One of the most comprehensive electronic medical records systems in the country
More than 60,000 diabetic patients in managed care
One of the largest virtual critical care (e-ICU) programs in the nation
More than 500 behavioral health ED consults conducted virtually per month
Patient safety initiatives prevented more than 9,800 patient safety incidents and saved nearly $60 million related health care costs over two years
Why is this our we describe ourselves today?
Up until now providers could have had and/or position when it comes to volume or value. But in today’s world the conversation about value is a conversation about strategy. Quality is the driver of evolving integrated delivery networks and moves beyond what is just transactional.
Surgeons, like all providers, have a decision to make. The question is what do you want your role to be? Is it a narrow role? In the case of surgeons, just a procedural role? Or is it broader, with more responsibility? There are positives and negatives to both. The burden is educating yourselves to make strategic choices and asking the right questions.
FROM VOLUME TO VALUE
Volume: Facility based, Individual patient focus, variable, Issue-focused, Silo work, Fee for Service, Uncoordinated
Value: Team-based care, Safe, Improved Quality, Engaged Physicians, Transparency, Care Coordination, Team Accountability, Standardization, Innovation, Cost Containment, Patient-centric, Reactive, Information Technology
Our system faces many of the same issues and questions that you do. And as we look at these areas and see the overlap and understand how the landscape is changing for both us as providers we have asked ourselves hard questions about our direction and our focus. How we are able to answer those questions drives how we redefine ourselves and how we create a high-quality, high-value, high-performing system that is positioned to thrive in a new economic reality. These are six questions that our organization had to ask of ourselves as we began to decide what our role would be in the transformation. How would be move from a service model to a performance model? As went about answering these questions we uncovered the challenges and the opportunities facing us.
Pursuit of quality is a long journey
Not directly about revenue – though they are related.
These five words represent many of the challenges we face as we go through our particular journey.
Performance
Unification
Accountability
Culture
Differentiation
From a system standpoint, we can no longer look at treatment as episodic. What happens before the OR and what happens after the OR impact outcomes and therefore impact performance
Never easy, never quick but necessary
Work different & do different work
ISOC
Maturity Model
A whole new way of thinking: deconstruct to reconstruct
Provides roadmap
Aligned with our cause for change
Training: One example Carolinas Simulation Center
Only one in region ACS accredited Level I and Society for Simulation in Health ARTE accredited
Three year study developing a mental skills curriculum to help surgeons remain focused in the OR (being led by Dr. Stefanidis, using a grant from AHRQ)
Strategy to enhance safety and performance – training not typically offered but a necessary change in part to adapt to new payment pressures
Among our results
25,614 patients received appropriate care
9,844 patient safety events avoided
$60 million in related health costs avoided
Nearly 1,000 readmission avoided
More than 28,000 patients discharged from the ED in under 180 minutes
Overall strategy of collaboratives, coaching and cultural improvement achieved transformative results:
One of the first systems to form a Patient Safety Organization
Federal PSO designation provides to improved information sharing across the System
One of 27 healthcare organizations selected for CMS’ Partnership for Patients Hospital Engagement Network (HEN)
One of just two healthcare systems to receive HEN contract modification: Leading Edge Advanced Practice Topics
Aggressively reduce harm in five areas: Sepsis, Antibiotic Stewardship, Procedural Harm, HACs, Readmission and Community Care
Culture is impacted by two key themes: patient and family engagement and safety across the board:
Identified as a leader and recognized by the Caregiver Action Network (CAN) as one of the national top 25 patient and family engagement best practices for the “Carolinas approach” of obtaining a deep understanding of each hospital’s genuine performance and establishing and sharing linkages between patient and family engagement and HEN outcomes
Achieved significant milestones in the transformation of our culture towards engaging patients and families as partners, including:
Family member voice keynoting annual HEN leadership meeting to discuss patient harm event
Significant increase in the number of hospitals in our HEN who have established Patient and Family Advisory Councils
Patient and family engagement as the central topic for our quarterly Leadership Development Institute, a gathering of approximately 1,400 leaders representing the entire care continuum
Patient keynote during our Quality and Service Sharing Day, a gathering of nearly 1,000 to celebrate the best projects in safety, quality and service
Overall strategy of collaboratives, coaching and cultural improvement achieved transformative results:
One of the first systems to form a Patient Safety Organization
Federal PSO designation provides to improved information sharing across the System
One of 27 healthcare organizations selected for CMS’ Partnership for Patients Hospital Engagement Network (HEN)
One of just two healthcare systems to receive HEN contract modification: Leading Edge Advanced Practice Topics
Aggressively reduce harm in five areas: Sepsis, Antibiotic Stewardship, Procedural Harm, HACs, Readmission and Community Care
Culture is impacted by two key themes: patient and family engagement and safety across the board:
Identified as a leader and recognized by the Caregiver Action Network (CAN) as one of the national top 25 patient and family engagement best practices for the “Carolinas approach” of obtaining a deep understanding of each hospital’s genuine performance and establishing and sharing linkages between patient and family engagement and HEN outcomes
Achieved significant milestones in the transformation of our culture towards engaging patients and families as partners, including:
Family member voice keynoting annual HEN leadership meeting to discuss patient harm event
Significant increase in the number of hospitals in our HEN who have established Patient and Family Advisory Councils
Patient and family engagement as the central topic for our quarterly Leadership Development Institute, a gathering of approximately 1,400 leaders representing the entire care continuum
Patient keynote during our Quality and Service Sharing Day, a gathering of nearly 1,000 to celebrate the best projects in safety, quality and service
Transparency is being demanded by consumers and forced by third-party rating systems – there will only be more
Last year Consumer Reports released it’s first ranking of CV care
US News & World Report is about to release data on five common hospital diagnoses: heart bypass, heart failure, knee replacement, hip replacement and COPD
Metrics include safety and performance – people will have more data and ask more questions
Even if payments aren’t directly linked to performance, public perception of performance can impact volumes
Efforts to be transparent
Value Report
Past two years published extensive report on quality
Online
Building out quality sections of website
Engaging with the media to discuss our programs talk about quality
TAKEAWAYS
The landscape is changing … changing to what, we don’t exactly know.
We know directionally but the journey isn’t fully mapped out.
We are all going to have to be more integrated, more connected and more collaborative.
New care models depend on an management structure that allow integration to occur
Providers need to have a vision to change and a strategy to get them there.
TAKEAWAYS
The landscape is changing … changing to what, we don’t exactly know.
We know directionally but the journey isn’t fully mapped out.
We are all going to have to be more integrated, more connected and more collaborative.
New care models depend on an management structure that allow integration to occur
Providers need to have a vision to change and a strategy to get them there.
