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Transforming the Future of UI Health Care
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“Because things are the way they are, things will not stay the way they are.”
—Bertolt Brecht
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Where were we in this transformation process?
What challenges are we facing?
How are we to tackle these challenges?
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Our Three Missions
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One Vision, One Future: Value of Integration
● Integration has numerous benefits: ● Provides for highly aligned and streamlined management
● Shared enterprise team for strategic planning, communications, information technology services, human resources, finance and other services
● Well-established collaborative decision-making ● Eliminates territoriality
● Facilitates major initiatives and partnerships ● Enables stronger presence across the region ● Supports a sustainable financial model
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Patient Care: Examples of Service in Action
● 30,344 Admissions ● 196,323 Days of Care ● 997,243 Clinic Visits ● 61,000 Emergency Visits
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UIHC Patient Care Outreach to Iowa, 2012-2013 Lyon Osceola Dickinso
n Emmet Winnebag
o Worth Mitchell Howard Winnesh
iek Allamak
ee
Sioux O’Brien Clay Palo Alto
Hancock
Cerro Gordo Floyd Chickasa
w Fayette Clayton
Plymouth
Cherokee
Buena Vista
Pocahontas
Humboldt
Wright Butler Bremer
Woodbury
Sac Calhoun Webster
Hamilton
Hardin Grundy Black Hawk
Buchanan
Delaware
Dubuque
Monona Crawford
Carroll Greene
Dallas
Story Marshall Tama Benton Linn Jones
Harrison Shelby Audubon
Guthrie
Boone
Polk Jasper Poweshiek
Kossuth
Franklin
Ida
Jackson
Clinton
Iowa Johnson Cedar
Scott
Pottawattamie
Cass Adair Madison
Warren
Marion Mahaska Keokuk Washington
Muscatine
Louisa
Mills Montgomery
Union Clarke Lucas Monroe
Wapello
Jefferson Des
Moines
Henry Adams
Fremont Page Taylor Ringgold Decatur Wayne Appanoose
Davis Van Buren Lee
Lyon Osceola Dickinson
Emmet Winnebago
Worth Mitchell Howard Winneshiek
Allamakee
Sioux O’Brien Clay Palo Alto
Hancock
Cerro Gordo Floyd Chickasa
w Fayette Clayton
Plymouth
Cherokee
Buena Vista
Pocahontas
Humboldt
Wright Butler Bremer
Woodbury
Sac Calhoun Webster
Hamilton
Hardin Grundy Black Hawk
Buchanan
Delaware
Dubuque
Monona Crawford
Carroll Greene
Dallas
Story Marshall Tama Benton Linn Jones
Harrison Shelby Audubon
Guthrie
Boone
Polk Jasper Poweshiek
Kossuth
Franklin
Ida
Jackson
Clinton
Iowa Johnson Cedar
Scott
Pottawattamie
Cass Adair Madison
Warren
Marion Mahaska Keokuk Washington
Muscatine
Louisa
Mills Montgomery
Union Clarke Lucas Monroe
Wapello
Jefferson Des
Moines
Henry Adams
Fremont Page Taylor Ringgold Decatur Wayne Appanoose
Davis Van Buren Lee
60 COMMUNITIES 190 CLINICS
41,750 PATIENT VISITS
Sioux City
Council Bluffs
Carroll
Creston
Shenandoah
Ames
Keosauqua
Fairfield
Keokuk
Ft. Madison
West Burlington
Marengo
Muscatine
Davenport
Clinton
Des Moines
Anamosa
Pella
Waterloo
Spencer
Columbus Junction
Vinton
Johnson
Coralville
North Liberty Iowa City
Solon
Hills
Oakdale
Wapello
PEDIATRIC SPECIALTY CONSULTATION CLINICS. ……………………………8,851 ADULT SPECIALTY CONSULTATION CLINICS ……....……………………….32,899
Sioux Falls, SD
Dubuque
Oelwein
Mt. Pleasant
Winfield
Mason City
Centerville
Washington
Clive Grinnell
Storm Lake
Fort Dodge
Decorah
Amana
5
9 6 2
2
3
4
3
5
74
5
32
2
12
4
3
5 2
2
3
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2 17
Sigourney
Kalona 4 Welman
Decatur
Manchester
Burlington 2
5
UI Health Care
Cedar Rapids
Ottumwa
West Liberty 2
3
3
Clarinda
Johnston 4
3 2Mitchellville
Newton
9
3
Williamsburg Bettendorf
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Research Funding
● $225 million in research funding
● 168 RO1 Grants ● 445 active patents
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● 1,000 Faculty
● 583 Medical Students
● 51 PA Students
● 119 PT Students
● 370 Graduate Students
● 5,000 Undergraduates
Education
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Iowa River Landing From pediatrics and women’s
health to cardiology and rou<ne exams, world class health care is
now available at a new, convenient loca<on in Coralville.
Opened 2012
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What challenges are we facing?
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Understanding our Future
● The Transformation of Academic Medicine: This Time is Really Different
● Our Roadmap: Leading the Challenge for Change
● Renewal of Purpose: Taking Charge of the Future
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Transformation of Academic Medicine ● This Time Is Really Different
1. The Worst Recession
Indexed job loss for prior four recessions
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Transformation of Academic Medicine ● This Time Is Really Different
1. The Worst Recession 2. The Sequester
• Clinical spending: Cut $109.3 billion per year for the next eight years—resulEng in an annual 2% reducEon in Medicare hospital and physician payments alone
• Research funding: NIH to cut 5% or $1.55 billion of its fiscal year 2013 budget
– The result was that approximately 700 fewer compeEEve research project grants were awarded in FY 2013
• NSF support: This is subject to a $2.1 billion reducEon in funding over five years
• Military research and development (R&D): Under the best scenario, the Pentagon faces a reducEon of up to 20% of its procurement and R&D budget—more than $33 billion—through 2017
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Transformation of Academic Medicine ● This Time Is Really Different
1. The Worst Recession 2. The Sequester 3. Affordable Care Act
Five key provisions: -‐ Coverage expansion -‐ Insurance market reform -‐ Payment and delivery reform -‐ Quality and safety improvement -‐ Cost control
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Transformation of Academic Medicine ● This Time Is Really Different
1. The Worst Recession 2. The Sequester 3. Affordable Care Act 4. Major decrease in public-‐
sector health spending
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How are we to tackle these challenges?
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Research: The Key Differentiator
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Transforming Our Research Mission
● Challenge is opportunity ● We must aggressively pursue NIH funding—despite
sequestration, there is still $30+ billion available! ● BRAIN Initiative ● BD2K Initiative
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Examples of Groundbreaking Research
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UI Pappajohn Biomedical Discovery Building
On schedule to open June 2014
A world-class setting in which scientists from across the University will collaborate to explore high-risk/high-yield scientific questions in the life sciences with the goal of advancing treatments for a wide array of human diseases.
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Plan for Research Investment
● UI Health Care recognizes that the research mission is critical
● Support for research through comprehensive development plan ● Recruitment of outstanding researchers
● Infrastructure needs
● Investment requirements
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Building on a Strong Educational Foundation
● New curriculum ● FUTURE in Biomedicine ● CCOM Rural Iowa Scholars Program ● Distinction tracks ● Master in Medical Education Degree ● Residency and fellowship training programs
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Transforming Our Education Model
● Emerging focus on interprofessional education ● Changing healthcare environment focused on multi-
disciplinary teamwork ● Optimize each and every team member
● Enable each to play his/her patient care role to the maximum extent allowed by license
● Train each learner to function in the new world of health care
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Interprofessional Skills and Team Based Healthcare
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Leading with Interprofessional Education
The Sydney Interprofessional Declaration
• We the participants of the All Together Better Health 5 International
Conference believe that a common global understanding of
Interprofessional Collaborative Practice and Care, brought about through
interprofessional education and learning, is of fundamental importance to
health care providers and users for the provision of high quality health care
and better health outcomes.
• The Sydney Interprofessional Declaration is premised on The World Health
Organization’s definition of Health, that health is a state of complete
physical, mental and social well-being and not merely the absence of
disease or infirmity.
• It underpins the call for action from the WHO Framework for Action
on Interprofessional Education and Collaborative Practice.
• Through the following articles the Sydney Interprofessional Declaration will
advance and strengthen the cause of Interprofessional Collaborative
Practice across the globe. It was approved by and is issued on behalf of
delegates present at the final plenary session of the All Together Better
Health 5 Conference held in Sydney, Australia, 6th-9th April 2010.
Article 1 All users of health and human services shall be entitled to fully integrated, interprofessional collaborative health
and human services.
Article 2
All health and human services work to create and strengthen a culture that promotes the delivery of contextual
opportunities for interprofessional learning and collaborative team training. Interprofessional education and
training for collaborative practice should be a core element of continuing professional development.
Article 3 Health worker education and training prior to practice shall contain significant core elements/learning domains of
interprofessional education. These core elements/learning domains shall contain practical experiences, for
example simulation. These core elements/learning domains for interprofessional education will be formally
assessed.
Article 4 Between ATBH5 and ATBH6 the global interprofessional community will undertake to develop a globally agreed
upon set of definitions and descriptions that capture interprofessional education, learning, practice and care.
Article 5 The global interprofessional community will work with the World Health Organization to implement the
Framework for Action on Interprofessional Education and Collaborative Practice.
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Transforming our Clinical Enterprise
● Continue to generate high levels of patient care activity
● Work together to create the high value health care delivery organization of the future
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Shaping the New Value Proposition
● Improving population health ● Offering better care and outcomes ● Decreasing costs
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Patients at the Center
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Patients at the Center
● Patients are now firmly at the center and driving their own value equation ● Making informed decisions about their care ● Demanding holistic, integrated, personalized care ● Controlling the dollars – being intelligent consumers
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An Example from Our NICU
Survival of Inborn VLBW Infants 22 -‐ 27 weeks EGA
0%10%20%30%40%50%60%70%80%90%
100%
22 wks 23 wks 24 wks 25 wks 26 wks 27 wks
Iowa 06 - 12VON 2012
0
1
2
3
4
5
6
7
8
9
10
2008 2009 2010 2011 2012
% o
f all
VL
BW
Severe ROP
Iowa VON
Reduction in Severe ROP in VLBW Infants
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UI Health Care: Responding to the Challenge
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Critical Success Factors
1. Creating beneficial relationships 2. Developing ACOs 3. Participating in new insurance products 4. Implementing a $100 million initiative
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University of Iowa Health Alliance
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1. Creating Beneficial Relationships ● University of Iowa Health Alliance
● Expansion – now five major members
● Now includes 60% of Iowa’s hospitals ● Other Collaborations
● Pediatric Associates
● Future focus: ● Clinical integration
● Single-signature contracting ● Population risk management
● Deploying e-health connectivity
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2. Developing our ACOs
● UI Health Care is involved in three (3) Accountable Care Organizations: ● Medicare Shared Savings Plan (established 2012)
● with Mercy-Cedar Rapids
● Wellmark ACO (established 2013) ● with Mercy-Cedar Rapids
● Medicaid ACO (established 2014) ● with University of Iowa Health Alliance
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3. Moving into New Insurance Products
● From IowaCare to Iowa Health and Wellness Plan
● Enrollment in the Iowa Health and Wellness Plan now exceeds the IowaCare total ● 69,744 in the Iowa Wellness Plan (0%-100% of FPL) ● 17,783 in the Marketplace Choice Plan (101%-138% of FPL) ● 87,527 total
Enrollment in IowaCare at the end of June 2013 was 71,002.
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CoOportunity Health
● CoOportunity Health has successfully enrolled over 70,000 members
● CoOportunity health is one of only two Co-Ops (out of 23) with more than 50,000 members
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4. $100 Million Initiative
● Achieve $100 million in savings and/or new revenues over the next three years
Why? ● UI Health Care continually looks for opportunities to increase
revenues and decrease costs. ● The opening of the new UI Children’s Hospital in 2016 will
add an estimated $30M in new operating costs. ● Taking steps now to prepare for this change will help to make
this transition seamless
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The New UI Children’s Hospital
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Five Priorities
● Develop Primary Care & Outreach Strategies ● Improve Coordination of Care ● Improve Access ● Ensure Full & Complete Documentation & Coding ● Right-size Programs (GME, Clinical and Research/Education)
Mark Hingtgen & Sabi Singh are tracking progress on the $100M ini<a<ve & its projects
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IowaFirst: Our Campaign for Breakthrough Medicine
● Surpassed our $500 Million goal
● “We Are Phil” faculty/staff giving program launched October 2013
● IowaFirst wrapped into “For Iowa. Forever More: The Campaign for the University of Iowa”
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“Effort and courage are not enough without purpose and direc<on.”
—John F. Kennedy
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Questions and Answers
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