Healthcare Transformation: The Journey of High-Value Healthcare

© 2012 Health Catalyst | www.healthcatalyst.com © 2012 Health Catalyst | www.healthcatalyst.com

Healthcare Transformation:

A Guide to Success in the Journey to High-Value Healthcare John L. Haughom, MD

October 2013

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© 2012 Health Catalyst | www.healthcatalyst.com

Some Important Points

• Most American hospitals and caregivers provide safe and effective care for the vast majority of patients, the vast majority of the time

• The vast majority of caregivers are well trained and conscientious

• Western medicine’s ability to save and extend life, and to improve the quality of life for the ill and injured is nothing short of miraculous


…but that does not change a harsh reality…

…care is far too unsafe…

…quality is too inconsistent…

…and costs are too high…


American healthcare "gets it right”

54.9% of the time.

McGlynn EA, Asch SM, Adams J, et al. The quality of healthcare delivered to adults in the United States. N Engl J Med; 2003;2635-2645


U.S. Comptroller General David Walker, 2006

Medicare ~$30 trillion

U.S. Net worth ~$48 trillion

$45.6 trillion $60


30% to 50% waste

(Anderson C, 1991, and James B, et al 2006)


Feeling vulnerable?


Quality improvement

is the

science of process management

(healthcare delivery is a system made up of thousands of interlinked processes)

Deming 101…


If you cannot measure it…

…you cannot improve it…

Deming 101…


“In God we trust…

…all others must bring data.”

W. Edward Deming

Deming 101…


“Managed care” means

“managing processes of care” ...

…not managing physicians and nurses.

(clinicians are the ones who manage the process of care)

Brent James, MD, 101…

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…the right data …in the right format …at the right time (and place)

…in the right hands (the clinicians who operate the process)

Deming 101…


…engaging the “smart cogs”

of healthcare…

Deming 101…


“…historically encumbered and

demoralized…”


Are Physicians Willing to Change?

Yes…

Source: McKinsey Physician Survey, 2011

Physician Willingness to Change

84% Willing

16% Unwilling


“…historically encumbered and demoralized…”

...inform, engage and inspire…

…ENLIGHTENMENT…


Innovation Roger’s Diffusion of Innovation Model

2º Many studies have looked at how these groups differ:

• Innovators are highly cosmopolite and open to new things.

• Early adopters tend to be opinion leaders.

• Early majority provide “legitimization” of the innovation.

• Late majority are skeptical.

• Laggards put trust in the status quo.

Innovations do

not spread

equally over

different society

segments (social

groups) but

through 5 stages

with particular

profile of

reaction

Tipping point at 15-20% adoption

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You can buy the piano (EHR, EDW), but you will have to learn to use it effectively to produce great music (greater safety, improved outcomes, lower costs, etc.)…

Who is responsible for producing great music

in healthcare?

© 2013 Health Catalyst www.healthcatalyst.com Proprietary and Confidential

Metadata: EDW Atlas Security and Auditing

Common, Linkable Vocabulary

Financial Source Marts

Administrative Source Marts

Departmental Source Marts

Patient Source Marts

EMR Source Marts

HR Source Mart

Surgery

KPA Cohort Finder

Cardiovascular Valves

Departmental Sources

(e.g., Apollo)

Patient Satisfaction Sources

(e.g., NRC Picker, Press Ganey)

Human Resources (e.g., PeopleSoft)

Financial Sources (e.g., EPSi,

Peoplesoft, Lawson)

Administrative Sources

(e.g., API Time Tracking)

EMR Source (e.g., Epic, Cerner)

Less Transformation More Transformation

Unlock Your data will be integrated, cataloged, and secured in the Catalyst platform

Source: Catalyst’s Adaptive Model


What will success look like?


North Memorial Women’s and Newborn: Elective Inductions

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Objective

• Define existing workflows and identify improvement opportunities

• Establish baseline measures

• Define evidence based standards for elective inductions

• Reduce rates of pre-39 week deliveries from 1.2% to 0.6% to qualify for a payer partner bonus

Health Catalyst Solution

• Late-bindingTM Data Warehouse Platform

• Cohort Finder

• Key Process Analysis Application

• Population Advanced Application Module, Early Induction Application

• Installation Services

• Clinical Improvement Services

Results to date

• Standardized workflows to improve data reliability

• Established elective delivery baseline measurements to track quality improvement gains

• Reduced early-term deliveries from 1.2% to 0.3%

• Payer partner bonus payment

“We wouldn’t have had a chance to do some of the things we’ve done in last 18 months to enhance care, reduce waste and lower costs without Catalyst. It’s amazing how differently and effectively we can gather and use data now.”

-Jon Nielsen, MD, Medical Director Women and Children’s Services at North Memorial Health Care


HF Readmissions Large Medical Center

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Objective

• Define Congestive Heart Failure (CHF) baseline measures for 30 and 90-day readmissions rates

• Implement evidence-based practice interventions to drive CHF readmission rate reductions

• Establish balance metrics including ED visits, observation days and patient satisfaction

• Develop sustaining processes for evaluating readmission rates to ensure continuous process improvement


• Late-bindingTM data warehouse that enables faster time-to-value

• Integration of clinical, patient satisfaction and financial data to establish baseline, ongoing and balance measures

• Discovery, Foundational and Advanced HF applications including cohort finder, registry and evidence- based clinical content

• Healthcare analytic visualization including gauges and trend lines for at-a-glance view

Results to date

• Seasonally adjusted rate reduction of 21% in 30-day and 14% in 90-day CHF readmissions

• 2X increase in the number of phone calls made to patients within 48 hours of discharge

• Average of 63 % increase in physician medication reconciliation within 48 hours of discharge

• Follow-up appointment intervention baseline and balance measures established


Improving Outcomes and Reducing Waste in Asthma Healthcare: The Impact of Data

Objective

• Improve clinical outcome for asthma patients across the care continue

• Better manage populations in a new Valued Based Purchasing environment

• Measure and ensure sustained clinical quality improvements


• Late-Binding™ Data Warehouse

• Key Process Analysis (KPA) Application

• Population Analytics Advanced Application- Asthma Module

• Installation Services

• Clinical Improvement Services

Results to date

• Decreased average LOS by 11 hours

• Achieved and sustained a 49% decrease in unnecessary Chest X-rays over 16 months

• 80% order set utilization …67% sustained increase over 8 months

• 90% usage of asthma action plan by providers

“It’s one thing to establish an order set and another to actually drive its adoption. Seeing how well this process works—how well and how quickly our clinical improvement teams and evidence-based care experts are able to encourage clinicians across our organization to standardize processes—is very gratifying..”

- Dr. Charles Macias, TCH Attending Physician and Director, Evidence Based Outcome Center.

Winner CHIME-AHA Transformational Leadership Award!


Adversity

…is hard…

…and an opportunity…

…lean into it!


“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

Theodore Roosevelt, 1910


“To have lived through a revolution, to have seen a new birth of science, a new dispensation of health, reorganized medical schools, remodeled hospitals, a new outlook for humanity, is an opportunity not given to every generation.”

Sir William Osler (1849-1919)


Healthcare Transformation

An Opportunity Not Often Given

Participating in the Creation of a New Era in Healthcare

By John L. Haughom, MD

2013 FREE Book!

Available online January, 2014


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Healthcare Transformation: The Journey of High-Value Healthcare

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