Wages, Fringe Benefits, and Turnover for Direct Care Workers ...
Value-Based Health Care Delivery: Core Concepts · Health Care Problem Remains a Global Issue....
Transcript of Value-Based Health Care Delivery: Core Concepts · Health Care Problem Remains a Global Issue....
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This presentation draws heavily on Professor Porter’s research in health care delivery including Redefining Health Care (with Elizabeth Teisberg), What is Value in Health Care, NEJM, and The Strategy That Will Fix Health Care, HBR (with Thomas Lee).A fuller bibliography is attached. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means — electronic, mechanical, photocopying, recording, or otherwise — without the permission of MichaelE. Porter. For further background and references on value-based health care, see the website of the Institute for Strategy and Competitiveness.
Value-Based Health Care Delivery: Core Concepts
Professor Michael E. PorterHarvard Business School
Partners HealthCare Residents and Fellows CourseBoston, MA
Wednesday, January 15, 2020
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Copyright 2020 © Professor Michael E. Porter
Disclosure
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Michael Porter
I have a relevant financial relationship with the following companies:
Company RoleAllscripts AdvisorAZTherapies Advisor, InvestorAmerican College of Surgeons Speaker, HonorariumAscent Biomedical Ventures InvestorBiopharma Credit Investments InvestorAdvanced Aesthetic Tech. InvestorMerck & Co. InvestorMerrimack Pharmaceuticals Former Board Member, InvestorMolina Healthcare Advisor, InvestorRoyalty Pharma InvestorThermo Fisher Scientific Former Board Member, Investor
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Copyright 2020 © Professor Michael E. Porter
Health Care Problem Remains a Global IssueHealth Care Spending vs GDP and Income
Wages: Average annual wages per full-time and full-year equivalent employee in the total economySource: EIU GDP (USD), Average Wages (USD) and Healthcare expenditure (USD) from 1990-2018; ECIPE Article 2011
Average Wage Gross Domestic Product (GDP) Health Care Spending
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USIndex(1990=100) HC expenditure 2018:17.2% of GDP
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HC expenditure 2018:9.8% of GDP
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HC expenditure 2018:8.9% of GDP
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HC expenditure 2018:11.2% of GDP
HC expenditure 2018:11.5% of GDP
HC expenditure 2018:9.3% of GDP
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Copyright 2020 © Professor Michael E. Porter4
Incremental “Solutions” Have Had Limited Impact
Restructuring health care delivery is needed, not incremental improvements
• Evidence-based medicine• Accountability for process metrics• Safety/eliminating errors• Prior authorization• Patients as paying customers• Electronic medical records• “Lean” process improvements
• Care coordinators• Retail clinics / urgent care• Programs to address high cost areas• Mergers and consolidation• Personalized medicine• Population health• Analytics and big data
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Copyright 2020 © Professor Michael E. Porter
Solving the Health Care Problem
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Value =Health outcomes that matter to patients
Costs of delivering these outcomes
• The fundamental goal and purpose of health care is to deliver high and rising value for patients
• Delivering high value health care is the definition of success
• Value is the only goal that can unite the interests of all system participants
• Improving value is the only real solution to reducing the burden of health care on citizens and governments
• The questions are how to design a health care delivery system that substantially improves patient value, and to shift competition to competing on value
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Copyright 2020 © Professor Michael E. Porter
1. Re-organize care around patient conditions (or groups of related conditions) into integrated practice units (IPUs), covering the full cycle of care
− For primary and preventive care, IPUs should serve distinct patient segments
2. Measure outcomes and costs for every patient, in the line of care
3. Move to value-based reimbursement models, and ultimately bundled payments for conditions
4. Integrate and coordinate care across multi-site care delivery systems
5. Expand or affiliate across geography to reinforce excellence
6. Build an enabling information technology platform 6
Creating a Value-Based Health Care Delivery SystemThe Strategic Agenda
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Copyright 2020 © Professor Michael E. Porter
Organize around the patient’s condition, or family of related conditions, over the full care
cycle into an Integrated Practice Unit (IPU)
Affiliated Imaging Unit
West GermanHeadache Center
NeurologistsPsychologists
Physical Therapists“Day Hospital”
Essen Univ.
HospitalInpatient
Unit
PrimaryCare
Physicians
Affiliated “NetworkNeurologists”
Source: Porter, Michael E., Clemens Guth, and Elisa Dannemiller, The West German Headache Center: Integrated Migraine Care, Harvard Business School Case 9-707-559, September 13, 2007
Organize by department, specialty, and discrete service
Re-organize Care Around Patient Medical ConditionsHeadache Care in Germany
Care by Individuals
ImaginingCenters
OutpatientPhysical
Therapists
OutpatientNeurologists
OutpatientPsychologists
Primary Care
Physicians
Inpatient Treatmentand Detox
Units
Care by a Team 7
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Copyright 2020 © Professor Michael E. Porter8
Integrating Across the Care CycleRole of Surgeons Beyond the Operating Room
Medical Management
Preoperative Care
Surgical Intervention Postoperative
Care Rehabilitation Surveillance
• Partner with medical specialists to manage complex cases and the ongoing evaluation of need for surgery
• Develop non-surgical options with other providers (e.g. physical therapists)
• Collaborate with primary care &anesthesiologist to prepare the patient for successful surgery
• Be accessible to patient and primary care team for pre-operative care questions
• Optimize the surgical process and results
• Co-develop best practices with PACU team
• Lead integrated multidisciplinarypost-operative teams to optimize the hospital stay
• Shift post-acute care to the appropriate setting (e.g. home, rehab)
• Extended clinic hours and after-hours hotline
• Educate home health providers and PTs on best practices
• Ongoing monitoring of patients for recurrence
• Measure longer term outcomes
Prevention & Detection
• Work with primary care to slow/manage disease progression
• Advise primary care on accurate diagnoses and timely referrals
DownstreamUpstream
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Copyright 2020 © Professor Michael E. Porter
The Playbook for Integrated Practice Units (IPUs)9
1. Organized around a medical condition, or groups of closely related conditions.
2. Care is delivered by a dedicated,multidisciplinary team devoting a significant portion of their time to the condition− Involved dedicated staff and affiliated staff with
strong working relationships3. ͏Co-located in dedicated facilities.
4. Takes responsibility for the full cycle of care
5. A hub and spoke structure with that allocates care to the right site
6. Addressing common complications and comorbidities, as well as patient education, engagement, adherence, follow-up, and prevention are integrated into the care process
7. The IPU has a clear clinical leader, a common scheduling and intake process, and a unified financial structure (single P + L)
8. A physician team captain, clinical care manager or both oversees each patient’s care
9. The IPU routinely measures outcomes, costs, care processes, and patient experience using a common platform
10. The team accepts joint accountability foroutcomes and costs
11. The team regularly meets formally and informally to discuss individual patient care plans, process improvements, and how to improve results.
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Copyright 2020 © Professor Michael E. Porter10
• Patient segment: older adults with lower-income, living in under-servedurban communities
• Co-located in dedicated facilities
• Explicit processes to engage patients, address social and economic determinants of health, and provide free rides/home-visits, in-house pharmacy and selected events for community residents
• Selected in-house services in the most relevant specialties for this patient segment such as behavioral health and podiatry and close relationships with outside specialists
• Meet daily and weekly to discuss each patient’s care plans, and process improvement
• Measurement and accountability for outcomes, cost, and patient experience
• Single full-risk value-based payment covering overall care– Including specialty and post-acute care– Medicare Advantage
Value-Based Primary CareOak Street Health
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Copyright 2020 © Professor Michael E. Porter
IPU Volume Enhances Value
Better Outcomes, Adjusted for Risk
Rapidly AccumulatingExperience
Rising Process Efficiency
Better Information/Clinical Data
More Tailored Facilities
Rising Capacity for
Sub-Specialization
More Fully Dedicated Teams
Faster Innovation
Greater Patient Volume with the
Medical Condition
Improving Reputation
Costs of IT, Measure-ment, and ProcessImprovement Spread
over More Patients
Wider Capabilities in the Care Cycle, Including Patient Engagement
Mechanisms
The Virtuous Circle of Value
Greater Leverage in Purchasing, Securing
Value-Based Payments
Better Utilization of Capacity
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Copyright 2020 © Professor Michael E. Porter
Patient Experience/
Engagement/ Adherence
E.g., PSA, Gleason score, surgical margin
Protocols/Guidelines
Patient Initial Conditions,Risk Factors
Processes Indicators
Structure
E.g., Staff certification, facilities standards
Measure Outcomes for Every PatientThe Quality Measurement Landscape
Outcomes
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Copyright 2020 © Professor Michael E. Porter
Patient Experience/
Engagement/ Adherence
E.g., PSA, Gleason score, surgical margin
Protocols/Guidelines
Patient Initial Conditions,Risk Factors
Processes Indicators
Structure
E.g., Staff certification, facilities standards
Measure Outcomes for Every PatientThe Quality Measurement Landscape
Outcomes
Without outcomes measurement, the value of
measuring other quality dimensions is greatly
diminished
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Copyright 2020 © Professor Michael E. Porter
Principles of Outcome Measurement• Outcomes should be measured by condition or primary care
segment– Not for specialties, procedures, or interventions
• Outcomes cover the full cycle of care • Outcomes are always multi-dimensional and include what matters
most to patients (and families), not just to clinicians – Patient reported outcomes are important in every condition
• Outcome measurement includes initial conditions/risk factors to control for patient differences
• Outcomes should be standardized for each condition, to maximize comparison, learning, and improvement
• Outcomes should be measured in the line of care
• Value-based measurement differs from the historical focus on measuring provider behavior and overall patient success
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Copyright 2020 © Professor Michael E. Porter
Survival
Degree of health/recovery
Time to recovery and return to normal activities
Sustainability of health/recovery and nature of recurrences
Disutility of the care or treatment process (e.g., diagnostic errors and ineffective care, treatment-related discomfort, complications, or adverse effects, treatment
errors and their consequences in terms of additional treatment)
Long-term consequences of therapy (e.g., care-induced illnesses)
Tier1
Tier2
Tier3
Health Status Achieved
or Retained
Process of Recovery
Sustainability of Health
Source: NEJM Dec 2010
• Achieved clinical status• Achieved functional status
• Care-related pain/discomfort• Complications• Re-intervention/readmissions
• Long-term clinical status• Long-term functional status
• Time to diagnosis and treatment • Time to return home• Time to return to normal activities
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The Outcome Measures Hierarchy
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Copyright 2020 © Professor Michael E. Porter
Source: ICHOM
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9.2%
17.4%
95%
43.3%
75.5%
94%
Incontinence after one year
Severe erectile dysfunction after one year
5 year disease specific survival
Average hospital Best hospital
Measuring Multiple Outcomes Prostate Cancer Care in Germany
Source: ICHOM
Source: ICHOM
Chart1
Incontinence after one yearIncontinence after one year
Severe erectile dysfunction after one yearSevere erectile dysfunction after one year
5 year disease specific survival5 year disease specific survival
Best hospital
Average hospital
0.092
0.433
0.174
0.755
0.95
0.94
Sheet1
Best hospitalAverage hospital
Incontinence after one year9.2%43.3%
Severe erectile dysfunction after one year17.4%75.5%
5 year disease specific survival95%94%
To update the chart, enter data into this table. The data is automatically saved in the chart.
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Copyright 2020 © Professor Michael E. Porter
Source: ICHOM
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9.2%
17.4%
95%
43.3%
75.5%
94%
Incontinence after one year
Severe erectile dysfunction after one year
5 year disease specific survival
Average hospital Best hospital
Measuring Multiple Outcomes Prostate Cancer Care in Germany
Source: ICHOM
Source: ICHOM
Chart1
Incontinence after one yearIncontinence after one year
Severe erectile dysfunction after one yearSevere erectile dysfunction after one year
5 year disease specific survival5 year disease specific survival
Best hospital
Average hospital
0.092
0.433
0.174
0.755
0.95
0.94
Sheet1
Best hospitalAverage hospital
Incontinence after one year9.2%43.3%
Severe erectile dysfunction after one year17.4%75.5%
5 year disease specific survival95%94%
To update the chart, enter data into this table. The data is automatically saved in the chart.
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Copyright 2020 © Professor Michael E. Porter
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Source: Scientific Registry of Transplant Recipients, http://www.srtr.org
Adult Kidney Transplant Outcomes1987 - 1989
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Percent 1-year Graft
Survival
Number of Transplants 1987 – 1989 (Three Year Period)
Number of centers: 219Number of transplants: 19,5881 Year Graft Survival: 79.6%
16 Greater than expected graft survival (7%)20 Worse than expected graft survival (10%)
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Copyright 2020 © Professor Michael E. Porter
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0 200 400 600 800 1000
94.7%
Number of programs included: 209Number of transplants: 38,3701 Year Graft Survival:
4 Greater than expected graft survival (1.9%)5 Worse than expected graft survival (2.4%)
Percent 1-year Graft
Survival
Number of Transplants 2011 – 2013 (Three Year Period)
Adult Kidney Transplant Outcomes2011 - 2013
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Copyright 2020 © Professor Michael E. Porter
30. Overall Adult Health31. Pediatric Health32. Hand and Wrist33. Neonates34. Congenital Heart Disease35. Depression and Anxiety in
Children and Young People36. Psychotic Disorders 37. Personality Disorders38. Substance Misuse39. Autism Spectrum Disorder
* Published Thus Far in Peer-Reviewed
Journals (19)
1. Localized Prostate Cancer *2. Lower Back Pain *3. Coronary Artery Disease *4. Cataracts *5. Parkinson’s Disease *6. Cleft Lip and Palate *7. Stroke *8. Hip and Knee Osteoarthritis *9. Macular Degeneration *10.Lung Cancer *11.Depression and Anxiety *12.Advanced Prostate Cancer *
Completed Standard Sets(2013-14)
13. Breast Cancer *14. Dementia15. Frail Elderly16. Heart Failure17. Pregnancy and Childbirth
18. Colorectal Cancer *19. Overactive Bladder20. Craniofacial Microsomia21. Inflammatory Bowel
Disease *
Completed Standard Sets(2015-16)
22. Chronic Kidney Disease *23. Congenital Upper Limb
Malformations
24. Pediatric Facial Palsy *25. Inflammatory Arthritis *26. Hypertension *27. Oral Health28. Diabetes29. Atrial Fibrillation
Completed Standard Sets (2017-19)
Committed/In Process
Standardizing Outcome SetsICHOM
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Copyright 2020 © Professor Michael E. Porter21Source: Kaplan, Robert and Michael E. Porter, “The Big Idea: How to Solve the Cost Crisis in Health Care”, Harvard Business Review, September 1. 2011
Measure Cost for Every Patient Principles
• Cost is the actual expense of patient care, not the sum of charges billed or collected
• Properly measuring the cost of care requires different cost accounting methods than prevailing approaches in health care, such as departmental, charge-based, or RVU-based costing
• Cost should be measured for each patient by condition, over the full cycle of care
• Cost is created by the use of the resources involved in a patient’s care (people, facilities, supplies, and support services)
– Cost depends on time and actual costs of resource use, not arbitrary allocations
• Understanding costs requires mapping the care process
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Copyright 2020 © Professor Michael E. Porter22
Mapping Resource UtilizationMD Anderson Cancer Center – New Patient Visit
Registration and VerificationReceptionist, Patient Access
Specialist, Interpreter
IntakeNurse,
Receptionist
Clinician VisitMD, mid-level provider, medical
assistant, patient service coordinator, RN
Plan of Care DiscussionRN/LVN, MD, mid-
level provider, patient service coordinator
Plan of Care Scheduling
Patient Service Coordinator
Decision Point
Time (minutes)
Source: HBS, MD Anderson Cancer Center
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Copyright 2020 © Professor Michael E. Porter
Major Cost Reduction Opportunities in Health Care• Utilize physicians and skilled staff at the top of their licenses (people ~65% of costs)• Reduce process variation that increases complexity and raises cost• Eliminate low- or non-value added services or tests• Reduce cycle times across the care cycle, which expands capacity• Invest in additional services (e.g. extra visits, telemedicine), or higher costs inputs that will
lower overall care cycle cost• Reduce service duplication and volume fragmentation across sites• Rationalize redundant administrative and scheduling units• Move uncomplicated services out of highly-resourced facilities• Increase cost awareness in clinical teams, (e.g. costs of inputs (sutures vs. staples))• Improve the efficiency and automation of claims management and billing processes• The number one way to reduce costs is through better outcomes• Many cost improvements also improve outcomes
• Our work with numerous providers reveals typical cost reduction opportunities of 30+%23
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Copyright 2020 © Professor Michael E. Porter
Move to Value-Based Payment Models
Capitation/Population Based Payments
Bundled Payment
Pay for care for a life
Pay for care for conditions(acute, chronic) or for primary care patient segments
• Both approaches create positive incentives for reducing costs and separate payment from performing particular services
• Capitation at the hospital or system level can coexist with bundle payment at the condition level
Fee for Service
Global Budgets
Volume Value
Budget for a defined period of time that covers all presenting service needs
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Copyright 2020 © Professor Michael E. Porter
• Accountable for costs and outcomes patient by patient, and condition by condition
• A single risk-adjusted payment for the overall care for a life
Emerging Value-Based Payment ModelsCapitation (Population-Based) Bundled Payment
• Responsible for all needed care in the covered population
• Accountable for population level quality metrics
• At risk for the difference between the sum of payments for the population and overall spending
− Providers take on disease incidence risk, not just execution/outlier risk
• Accountable for overall cost and population level quality measures
• A single risk adjusted payment for the overall care for a condition− Not for a specialty, procedure, or short
episode
• Covers the full set of services needed over an acute care cycle, or a defined time period for chronic care or primary care
• Contingent on condition-specificoutcomes− Including responsibility for avoidable
complications
• At risk for the difference between the bundled price and the actual cost of all included services− Limits of responsibility for unrelated care
and outliers
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Copyright 2020 © Professor Michael E. Porter
Partnerships:Cleveland Clinic (OH)
Geisinger (PA)
Kaiser Permanente (CA)
Johns Hopkins (MD)
Mayo Clinic (MN)
Memorial Hermann (TX)
Northeast Baptist (TX)
Virginia Mason (WA)
Emory (GA)
Bundled Payments: Walmart Centers of Excellence
Conditions:• Cardiac Surgery• Cancer• Joint replacement
• Spine• Organ Transplant• Weight loss
Source: Compiled from news.Walmart.com and through publically available news and press releases . 26
Note: Not all providers participate in every Walmart condition
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Copyright 2020 © Professor Michael E. Porter
Shifting The Strategic Logic of Health Systems
Clinically Integrated Care Delivery
System
Confederation of Standalone
Units/Facilities
• Increase volume
• More clout in contracting and purchasing
• Spreading “fixed overhead” costs
• Use owned or affiliated primary care practices to “guarantee” referrals
• Increase value
• Value-based delivery models
• Concentrate, allocate, and integrate care across appropriate sites
• The system is more than the sum of its parts
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Copyright 2020 © Professor Michael E. Porter
The Geography of Care and Value • The Traditional Care Geography Model− Care organized around specialties and interventions at each site− Duplication of services across sites/facilities− Sites provide care for multiple acuity levels− Limited integration of care across sites− Traditional Model reinforced by fee-for-service payments and siloed IT
systems• Geography and Value: Strategic Principles− Organize care by condition in IPUs (the hubs)
− Multi-disciplinary teams− Responsibility for full care cycle
− IPUs allocate services across the care cycle to sites based on: site capabilities, care complexity, patient risk, cost, and patient convenience
− Incorporating telemedicine, home services, and affiliated provider sites into the care cycle
− IPUs developing formal systems to direct patients to the most appropriate site28
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Copyright 2020 © Professor Michael E. Porter
Delivering the Right Care at the Right LocationRothman Institute, Philadelphia
Lowest ComplexityLow ComplexityMedium ComplexityHighest Complexity
Facility Capability
Price of Total Hip Replacement: ~$12,000 USD
Price of Total Hip
Replacement ~$45,000 USD
Patient Risk Factors: Age, Weight, Expected Activity, General Health, and Bone Quality
Ambulatory Surgery Center
Rothman Orthopaedic Specialty Hospital
Bryn MawrCommunity Hospital
Jefferson University Academic Medical Center
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Primary Care Practices
Specialty Care Centers
Specialty Care Center, Surgery Center & After-Hours Urgent Care
Specialty Care & Surgery Centers
Specialty Care Center, Surgery Center, After-Hours Urgent Care & Home Care
Wholly-Owned Outpatient Units
Community Inpatient PartnershipsCHOP Newborn Care
CHOP Pediatric Care
CHOP Newborn & Pediatric Care
Hospital & Integrated Specialty Program
Allocate and Integrate Care Across Sites Children’s Hospital of Philadelphia Care Network
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Build an Enabling IT PlatformAttributes of a Value-Based IT Platform
1. Combines all types of data for each patient’s condition across the full care cycle (notes, lab tests, imaging, costs) using standard definitions and terminology
2. Tools to capture, store, and extract structured data and eliminate free text
3. Data is captured in the clinical and administrative workflow
4. Data is stored and easily extractable from a common warehouse. Capability to aggregate, extract, run analytics and display data by condition and over time
5. Platform is structured to enable the capture and aggregation of outcomes, costing parameters, and bundled payment eligibility/billing
6. Leverages mobile technology for scheduling, PROMs collection, secure patient communication and monitoring, virtual visits, access to clinical notes, and patient education
7. ͏Full interoperability allowing data sharing within and across networks, EMR platforms, referring clinicians, and health plans31
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Copyright 2020 © Professor Michael E. Porter
A Mutually Reinforcing Strategic Agenda
Organize into Integrated Practice
Units (IPUs)
Measure Outcomes
and Cost For Every Patient
Move to Bundled
Payments for Care Cycles
Integrate Care
Delivery Systems
Expand Geographic
Reach
Build an Integrated Information Technology Platform
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Copyright 2020 © Professor Michael E. Porter
The Health Care Transformation is Well Underway• We know the path forward
• Value for patients is True North
• Value based thinking is restructuring care organization, outcome measurement, payment models, and health system strategy
• Standardized outcome measure sets and new costing practices are beginning to accelerate value improvement
• Employers, suppliers, and insurers can be the next accelerators
• Government policy is beginning to reinforce value improvement in many countries
• We are excited to work with all of you in accelerating this transformation• We invite every one of you to get started on this path
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y = 7E-214e0.248xR² = 0.9751
0
2,000
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8,000
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1990 1995 2000 2005 2010 2015 2020
Journal Articles
Related to Value-Based Health Care
Year
From: PubMed; accessed December 2019, Patrick Clapp, Baker Research Services, Harvard Business School
2019Redefining Healthcare
ICHOM Founded
Value-Based Health Care Thinking and Practice Are Rapidly Diffusing Peer Reviewed Literature 1990-2019
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Copyright 2020 © Professor Michael E. Porter
NEJM Catalyst Innovations in Care Delivery is a new digital, peer-reviewed journal from NEJM Group, the publisher of The New England Journal of Medicine.
Publishing six issues each year, NEJM Catalyst Innovations in Care Delivery aims to accelerate health care delivery transformation by publishing real-world examples and practical solutions so that health care leaders can address today’s urgent care delivery challenges and shape the future of health care delivery across the globe.
Quick Facts:Frequency: Bimonthly (6x/year)Launch Date: January 2020Format: Online onlyIndexed: Anticipate indexing in
PubMed and MEDLINEAudience: Health care executives, clinical
leaders, clinicians, academics,industry analysts, consultants, policy makers, government officials
Editorial Leadership:Co-Chair —Michael Porter, PhD, Bishop William Lawrence University Professor, Harvard Business School
Co-Chair and Editor-in-Chief —Tom Lee, MD, MSc, Chief Medical Officer, Press Ganey; Professor, Harvard Medical School, TH Chan School of Public Health; Internist, Brigham & Women’s Hospital
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@[email protected] @meporter.hbs
www.isc.hbs.edu
Follow on Social Media
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Presentation Posted At:
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Copyright 2020 © Professor Michael E. Porter
Selected References on Value-Based Health CareValue-Based Health Care• Porter, M.E., Teisberg, E. (2006). Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business Publishing
Integrated Practice Units and Primary Care• Porter, ME, Lee T. (2018) What 21st Century Health Care Should Learn from 20th Century Business. New England Journal of Medicine Catalyst (September 5, 2018)
• Ying A., Feeley T., Porter M. (2016) Value-based Health Care: Implications for Thyroid Cancer. International Journal of Endocrine Oncology 3:115–129, 2016.
• Porter, M.E. and Lee, T.H. (2013). The Strategy that Will Fix Health Care. Harvard Business Review. October 2013.
• Porter, M.E., Pabo, E.A., Lee, T.H. (2013). Redesigning Primary Care: A Strategic Vision To Improve Value By Organizing Around Patients’ Needs. Health Affairs; 32: 516‐525
Outcome Measurement• Porter M.E., Larsson S., Lee, T.H. (2016). Standardizing Patient Outcomes Measurement. New England Journal of Medicine 374:504-506, 2016.
• Porter, M.E. (2010). What Is Value in Health Care? New England Journal of Medicine 363:2477-81, 2010. and Measuring Health Outcomes, in Supplementary Appendix 2
Cost Measurement• Tseng P, Kaplan RS , Richman B, Shah MA, and Schulman KA. (2018) Administrative Costs Associated With Physician Billing and Insurance-Related Activities
at an Academic Health Care System. Journal of American Medical Association 319:691-97, 2018.
• Kaplan, R S., Witkowski ML, Abbott M, Guzman A, Higgins L , Meara J, Padden E, Shah A, Waters P, Weidemeier M, Wertheimer S, and Feeley TW. (2014)"Using Time-Driven Activity-Based Costing to Identify Value-Improvement Opportunities in Healthcare." Journal of Healthcare Management 59:399–413, 2014
• Kaplan, R.S and Porter, M.E. (2011). How to Solve the Cost Crisis in Health Care. Harvard Business Review. September 2011
Reimbursement • Feeley, TW., and Mohta N. (2018) "Transitioning Payment Models: Fee-for-Service to Value-Based Care." (2018) New England Journal of Medicine Catalyst (November 8, 2018).
• Spinks T, Walters R, Hanna E, Weber R, Newcomer L, and Feeley TW.(2018) Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program." Journal of Oncology Practice 14:e103–e121, 2018
• Porter M.E. and Kaplan R.S. (2016) How to Pay for Health Care. Harvard Business Review. July 2016
• Witkowski M., Hernandez A., Lee T.H., Chandra A., Feeley T.W., Kaplan R.S. and Porter, M. E. The State of Bundled Payments, Working Paper. Unpublished. May 2017.
Regional and National Expansion• Cosgrove T. The Cleveland Clinic Way. McGrawHill, New York, 2014
Information Technology• Feeley TW. Landman Z, and Porter ME. (2019) Moving to value-based health care: The agenda for information technology. New England Journal of Medicine Catalyst (In press)
• French K, Frenzel J, and Feeley T. (2018) Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost." New England Journal of Medicine Catalyst (August 23, 2018).
• Carberry K., Landman Z., Xie M., Feeley T. (2015) Incorporating Longitudinal Pediatric Patient-Centered Outcome Measurement into the Clinical Workflow using a Commercial Electronic Health Record: a Step toward Increasing Value for the Patient. Journal of American Medical Informatics Association
HBS Case• Porter M.E. and Teisberg E.O. ”Cleveland Clinic: Transformation and Growth 2015.” HBS Case No. 709-473. Boston: Harvard Business School Publishing, 2019.
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https://catalyst.nejm.org/sbus-ipus-21st-century-health-care/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839285/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839285/http://www.hbs.edu/faculty/product/48462https://catalyst.nejm.org/transitioning-fee-for-service-value-based-care/http://ascopubs.org/doi/full/10.1200/JOP.2017.027029#affiliationsContainerhttp://ascopubs.org/doi/full/10.1200/JOP.2017.027029#affiliationsContainerhttps://catalyst.nejm.org/new-ehr-health-information-system/
Slide Number 1Slide Number 2Slide Number 3Incremental “Solutions” Have Had Limited ImpactSlide Number 5Creating a Value-Based Health Care Delivery System�The Strategic AgendaSlide Number 7Integrating Across the Care Cycle�Role of Surgeons Beyond the Operating RoomSlide Number 9Value-Based Primary Care�Oak Street HealthIPU Volume Enhances ValueSlide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Mapping Resource Utilization�MD Anderson Cancer Center – New Patient VisitMajor Cost Reduction Opportunities in Health CareMove to Value-Based Payment ModelsSlide Number 25Bundled Payments: Walmart Centers of ExcellenceSlide Number 27Slide Number 28Delivering the Right Care at the Right Location�Rothman Institute, PhiladelphiaSlide Number 30Build an Enabling IT Platform�Attributes of a Value-Based IT PlatformA Mutually Reinforcing Strategic AgendaThe Health Care Transformation is Well UnderwayValue-Based Health Care Thinking and Practice Are Rapidly Diffusing �Peer Reviewed Literature 1990-2019Slide Number 35Slide Number 36Selected References on Value-Based Health Care