University of Utah HealthcareValue Management System

Bob Pendleton MD FACPChief Medical Quality Officer

Goal: Exceptional Value

INPATIENT: Rate this Hospital 1-10 (% total patients choosing 9-10)UHC National %tile Rank

UUHC: Becoming the Provider of Choice

UHC

Natio

nal %

tile R

ank

2008 2009 2010 2011 2012 2013 2014YTD0

25

50

75

100

18

39

65 6478 75

94

UUHC: Nationally Ranked Outcomes

* UHC Quality & Accountability Annual Scorecard

2008 2009 2010 2011 2012 2013

947

1

37

50

*Ranking out of >98 National AcademicMedical Centers

Use of ColorPayers of Healthcare & a sample of Value related Initiatives

EmployersGovernment Insurers (e.g. Regence, etc.)

Medicare(CMS) Medicaid

IPPS OPPS

PQRI

CMMI

IQR VBP HAC HRRP MU

OQR MU

HEDIS

Public

Direct &Rankings

Direct Contract

ACO

PQRS MU

277 measures

402 measures

464 measures

614 measures

700Measures

& counting…

Growth of National Value Metrics

Value Management System:

Service Delivery

System Management

Resource Management

Measure, Analyze, Improve

Inputs OutputsService DeliveryService Delivery

Safety Committee (QM.8)

QMOC (QM7)

Document Control Cmt

Value Creation Team

Support Services

Value Council (GB.1)

HCEC

Medical Board

Hospital Board

Clinical Services

Management Review:Audit resultsCorrective actionsMeasurementAnalysis

Governing Body:Operational oversight of clinical delivery system

Basic Structure of our VMS

Value Core (QM.7)

Clinical Services

Value Council (GB.1)

Chief Value OfficersRob Glasgow - SurgeryPeter Yarbrough - MedicineChris Pelt- OrthopedicsSusan Baggaley - NeurologyMeic Schmidt - NeurosurgeryJohn Bohnsack -PediatricsJerry Hussong- PathologyHoward Sharp – OB GYNBernadette Kiraly – Family MedicineMark Eliason - DermatologyJim Ashworth- Psychiatry Dave Gaffney- Rad Oncology

GMEValue Council

• System alignment• System goals• System mgt.

Measure & Analyze at the Department level…

Standard value

Entitlement

• Typical approach to system performance & improvement:

• BUT- isn't every patient entitled to optimal performance?

Poor value Optimal value

Average value

Value Management System: Focus on Improving Processes

• Focus on Results Problem Solving (Reaction)

• Focus on Process Problem Prevention

Fix Problem 1

Fix Problem 2

Fix Problem 3

Redesign Process to Prevent Problem 1

Build Standard Work & Forcing Functions Monitor Results Improve Process

Further

Redesign Process to Prevent Problem 2

Build Standard Work & Forcing Functions Monitor Results

Redesign Process to Prevent Problem 3

Build Standard Work & Forcing Functions

How?

Value Improvement Methodology:1. (re-)Define2. Problem & Goals3. Analyze & Investigate4. Design & Implement5. Impact

Improve Value

1

2

3 4

5

Improve Value

1

2

3 4

5

Improve Value

1

2

3 4

5

Improve Value

1

2

3 4

5

VALUE SUMMARY

YOU (& your residents) voice & input is critical:

GMEC sponsored group to facilitate two-way input on UUHC value efforts

Coordination with the CVO in your Departments Should CRIT (empowered CMRs) remain a vehicle? System use of Value Summary Core training from Value U Safety event reporting & subsequent management