North Highland's Ricardo Martinez and Donna Houlne's presentation on "Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician-Directed Transformation"

1. Proprietary & Confidential1
HIMSS 2015
Chicago
Hardwiring Clinical and Financial
Performance Through
Patient-Centered, Physician-
Directed Transformation
Ricardo Martinez, MD, FACEP
Chief Medical Officer
Donna Houlne, RN,BSN,MHA,MHRM
Clinical Transformation Lead

2. Proprietary & Confidential2
Opportunity Knocks
• Are we leveraging or drowning in data?
• Are the right HIT systems being used by the right
people?
• How do you maintain clinical quality and cut costs?
• What is the role of the physician and the patient in the
transformation to value-based care?
• How do you increase adoption and use of HIT by
physicians?

3. • Market Drivers for Value-Based Care
• Clinical Transformation
• Physician Engagement
• Patient Activation and Engagement
• Key Takeaways for Healthcare IT
Today’s Agenda

4. Market Drivers

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Market Drivers of Value-Based Care
Drivers of
Healthcare TrendsCurrent Future
• Responds with
patient need
arises
• Centered around
provider practice
& schedules
• Volume-based
• High utilization =
revenue
• Margins
dependent upon
reimbursement
Financial
Technology
Social Healthcare
Reform
• Identifies unmet
needs &
responds
proactively
• Centered around
patient needs &
schedules
• Value-based
• Utilization =
costs
• Margins
dependent upon
costs
Activity-Based
Care Fading Away
Value-Based Care
Emerging

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Change is Coming
Payment reforms
will affect
financial viability
Preserve or
improve margins
Reduce
unnecessary
utilization
Compete in new
risk-based
payment models
Clinical and
quality
performance will
drive contracting
Based on
measurable
outcomes
Data-driven
decision making
Market forces are
squeezing
margins
Larger players
expanding
market share
Geographic
expansion may be
needed to create
clinically integrated
network
Change must be
sustained
Transformation
to value-based
delivery
Rapid adoption
of “best” practice
patterns and
processes
Evolving roles
and relationships

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Designing &
Implementing
New Care Models
Changing Provider &
Patient Roles
Optimizing Care Value
and
Quantifying Risk
Addressing these items greatly increases the likelihood of success during
the transition to High Performance Healthcare
Key Issues Affecting Clients
How do we evaluate the financial impact of these
changes?
What changes are we making to the delivery model?
How do we decrease cost without sacrificing quality?

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 Patient-centered,
physician-directed teams
 Value-driven: high
quality at lowest cost
 Delivers measurable
quality healthcare with
the use of meaningful
metrics, dashboards,
etc.
 Data-driven performance
integrating Business
Intelligence and is
constantly learning
 Connected and
integrated, both
culturally and digitally
Essential Changes
The Road to High Performance Healthcare
Organizational
Transformation
Financial
Transformation
Clinical
Transformation
Digital
Transformation
Our Vision

9. Clinical Transformation

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What is Clinical Transformation?
• A comprehensive, interdisciplinary approach to redesign care delivery to
achieve clinical excellence and better value throughout the care
continuum
Reduce
total cost of
care
Enhance
operational
efficiency
Align clinical
delivery
across
settings &
providers
Improve
financial and
clinical
performance
Data Analytics & Clinical Information TechnologyBI, Data Analytics & Clinical Information Technology
Data Analytics & Clinical Information TechnologyProvider Engagement/Patient Activation

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Clinical Transformation: Core Components
• Meaningful metrics
• Enterprise dashboards
• Gain insights & make decisions
• Monitor/manage costs per unit of service
BI/Analytics
• Care redesign driven by value over efficiency
• Physician-directed, team-powered design,
implementation and oversight
• Dyad governance structure
Value-Based
Care Design
• Optimize efficiency and minimize variation in
process
• Strengthen handoffs & transitions across settings
• Patient activation & engagement to improve care
Care
Management
Across Settings

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Decreasing Costs of Care Delivery
• Provider substitution
• Diagnostic/treatment substitution
• Setting substitution
• Process redesign:
 Eliminate steps and processes
 Add missing steps and processes
 Re-engineer process
• Offload costs to patient and family

13. Physician Engagement

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Physician Decisions Directly Affect
Organizational Health
• Physicians influence the majority of decisions regarding
healthcare utilization
• Physician practice variation accounts for almost one third of
wasted cost in the healthcare industry (Institute of Medicine
2011)
• Research shows that evidenced based clinical pathways are
associated with improved outcomes at lower costs, i.e. stroke
and STEMI
• Only 36% of practicing physicians believe they have a major
responsibility for reducing healthcare costs (JAMA)
• Organizations with high physician engagement demonstrate
higher productivity and profitability (Gallup)

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Key Factors Affecting Physician Satisfaction
Source: RAND/AMA
Quality of Care
Electronic Health
Records
Practice
Leadership
Work Content,
Quantity and Pace

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Physician Integration is not Physician
Engagement
• Market segmentation /
service line selection
• Business models / structures
• Contracting
• Offerings and client targets
• Recruiting, credentialing, and
scheduling
• Onboarding and retention
• Physician services
Physician Integration
Strategies include:
• Physician governance
• Physician leadership
• Physician alignment
• Physician adoption
Physician Engagement
Strategies focus on:
Physician Engagement Drives Change

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The Difference Between Physicians vs. Non-
Physicians
Understanding physicians requires understanding how physicians think
Logical
Reasoning
Use of
Science
Evidence-
Based
Thinking
Deduction
Focus on
Observation
Detail
Oriented
Sherlock
Holmes

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Physician Engagement Methodology
Adoption CSFs
How does this help
my patients?
Where is the
evidence that
this helps?
Is this
supported by
our senior
physicians?
How does this fit
into my workflow?
Will it slow me
down?
How do I get help?
• Institute physician governance
and communication program
• Establish visible, involved
physician champion
• Frame in clinical context, with
clear examples and/or data, e.g.
• Support clinical workflow
• Highlight a clear migration
path to success
• Make training time-sensitive
with consistent readily-
available support
• Provide feedback and data to
measure success
Concerns

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What Physicians Value
Meaningful metrics and information
Data analytics with clinical insights
Tools that enhance collaboration/care
Remote access to needed information
HIT properly embedded into workflow
User-designed interfaces

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Example: Benefits of EMR Redesign By Clinical
Team
Improved workflow
~41% more efficient
Saved 23.9 hours a day of
staff time
Decreased “cognitive distraction”;
interface time; clicks
Improved staff satisfaction
ROI in 50 days
1
2
3
4
5
6

21. Patient Activation & Engagement

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Increasing Recognition of Patient Role in Outcomes
50% of patients
with chronic
disease don’t
take their
medication
~30% of newly
diagnosed
patients don’t get
their medication
filled
Increasing
number of
patients with
preventable
diseases related
to obesity and
unhealthy habits
Behavioral and
social factors
attribute to ~ 50%
of outcomes
variance

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Empowering Patients
Patient Activation & Engagement
“By empowering patients to understand that providers are not merely professionals
to see when one gets “sick”, but valuable partners that can help provide advice
and tools for individuals to take charge and achieve health outside the clinical
setting. To realize the value this partnership can bring we first need to understand
how to activate and maintain our engagement. That’s the hardest part of all.”
- Holly Korda, Ph.D.
“To move from a health care system that primarily treats the sick in America to one
that actively promotes wellness in America…first listen to patients….They will be
our guides in designing a health care system that supports meaningful patient
partnerships and true patient-centered care.”
- Susan Frampton, PhD, President Planetree

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Activation is developmental
Patient Activation – A Patient Assessment
Consists of 13 self-reported questions, that build upon one another. Correlates with
patient outcomes, experience and costs.
Level 1: Starting to
take a role
• Patients do not
yet grasp that
they must play an
active role in their
own health; they
are being
disposed to being
passive recipients
of care
Level 2: Building
knowledge &
confidence
• Patients lack the
basic health-
related facts or
have not yet
connected these
facts into larger
understanding of
their health or
recommended
health regimen
Level 3: Taking
action
• Patients have the
key facts and are
beginning to take
action but may
lack the
confidence and
the skill to support
their behaviors
Level 4:
Maintaining
behaviors
• Patients have
adopted new
behaviors but may
not be able to
maintain them in
the face of stress
or health crises
Increasing Level of Activation

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Optimizing Clinical, Operational and Financial
Virtual or
Group
Support
Associate
Provider
Active
Coaching
Physician-
Nurse
Team
High Patient Activation
Low Patient Activation
Low Care Burden High Care Burden

26. Health Affairs, 2013
What is Patient- and Family-
Engagement?
“Patients, families, their representatives,
and health professionals working in
active partnership at various levels
across the health care system – direct
care, organizational design and
governance, and policy making – to
improve health and healthcare.”

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Patients are asked
about their
preferences in
treatment plan
Framework for Engagement
Direct Care
Organizational
Design and
Governance
Policy
Making
Factors Influencing Engagement:
• Patient (beliefs about patient role, health literacy, education)
• Organization (policies and practices, culture)
• Society (social norms, regulations, policy
Treatment decisions
are made based on
patients’ preferences,
medical evidence,
and clinical judgment
Patients receive
information about a
diagnosis
Organization surveys
patients about their
care experiences
Hospital involves
patients as advisers
or advisory council
members
Patients co-lead
hospital safety and
quality improvement
committees
Patients have equal
representation on
agency committee
that makes decisions
about how to allocate
resources to health
programs
Patients’
recommendations
about research
priorities are used by
public agency to
make funding
decisions
Public agency
conducts focus
groups with patients
to ask opinions about
a healthcare issue
Levels of
Engagement
Consultation Involvement
Partnership and
shared leadership
Continuum of Engagement

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Outcomes of Patient Engagement and
Activation
Patient starts to take a role
Patient builds confidence and
knowledge
Patient takes action
Patient maintains behaviors

29. Key Takeaways for Health IT

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Healthcare Data Supply & Demand is Exploding
In These Settings…
• Hospitals
• Nursing Homes
• Clinics
• Patient Homes
• On-the-go
Are Data Creators…
• Physicians
• Nurses
• Specialists (RTs, etc.)
• Patients
• Care / Case Managers
• Pharmacists
• Medical Devices
• Labs
Creating Information…
• Patient Demographics
• Symptoms
• Diagnoses
• Procedures
• Medications
• Metrics / Parameters
• Lab Results
• Radiology / Scans
In These Destinations…
• Clinical Applications / EMR
• Data Warehouse
• Decision Support Systems
• Patient Portals
• Claims Recipients
For These Data Consumers
• Physicians
• Nurses
• Specialists (RTs, etc.)
• Patients
• Family Members
• Hospital Executives
• Care / Case Managers
• Employers
• Pharmacists
• State Governments
• Federal Government
• Insurers / Payers
• Nursing Home Executives
• Clinic Executives
• Pharmaceutical Companies
• PBMs
• Medical Device Companies
Managing Both Effectively Is Critical

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Leveraging Data Effectively Means…
• Deliver the right
information
• To the right person
• In the context of their
daily workflow
• That allows them to
make the best
possible decision
Step
1
Step
2
Right
Info
Step
3
Step
4

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What Success Looks Like
• Data spans the
clinical,
operational and
financial
spectrums
• Tied together to
help people
understand how
levers in one
area impact
another
• Customized for
the user
• Relevant – tied
to metrics that
are meaningful
to the role they
play
• Intuitive – user
involved in the
design
• Real-time or
near real time
• Interactive
(ability
to answer “why”
questions on
their own)
INTEGRATED PERSONALIZED ACTIVE

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Progressive Strategies Enabled by Healthcare IT

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The Patient-Centered, Physician-Led
Transformation will Create…
1
2
3
A Shared View of Performance
Sustainable, Measurable Change
A Structure for Continuous Improvement

35. Q&A

36. Thank you!
Come visit us at the Clinical &
Business Pavilion – Booth 5484,
Kiosk # 5. Bring your voucher
to receive your free giveaway!