Download pdf - 01. Welcome and Introductions - IHIapp.ihi.org/.../Document-3043/01_Welcome_and_Introductions.pdf · Welcome and Introductions 8:00–8:30 am ... copies of the Home Team worksheets,

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WelcomeJoint Replacement Learning Community

January 9, 2014

The Charles Hotel, Cambridge, MA

1st In-Person Meeting

Welcome to Boston

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8:00 – 8:30 AM

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Thank you

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Who is in the room? 4

Adventist Medical Center Hospital Alvorada, Brazil Providence Alaska Medical Center

Advocate Health Care Hvidovre Hospital, University of

CopenhagenProvidence Sacred Heart Medical

Center

Central Dupage Hospital of

Cadence Health Jewish General Hospital, Montreal Regional Hospital of Scranton

Connecticut Joint Replacement

InstituteJohns Hopkins Bayview Medical

Center

Sierra Medical Center

Delnor Hospital of Cadence

Health Kadlec Regional Medical Center Straub Clinic and Hospital

Evergreen Health Montefiore Medical Center UMass Memorial Medical Center

Franciscan St. Francis Health -

MooresvilleMoses Taylor Hospital of Scranton University of California, San

Francisco

Gundersen Health System Northside Hospital Forsyth University of Pittsburgh Medical

Center (UMPC)

Hackensack University Medical

CenterNorthwestern Memorial Hospital Wake Forest Baptist Medical Center

Henry Ford Physician Network

from Henry Ford Health SystemOrlando Regional Medical Center Western Connecticut Health

Network - Danbury Hospital

Hoag Orthopedic Institute Palmetto Health

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Icebreaker

Introduce yourself to the other teams at

your table

2014 New Year’s Resolution OR

What you hope to learn from the Joint

Replacement Learning Community over

the next year?

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Annual Number of Joint Replacements 6

0

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By number of

participating hospitals

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Hospital Type

Community Hospital: 60%

Academic Hospital: 33%

Other: 7%

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Faculty and Staff8

Kayla DeVincentis, CHES

Project Coordinator, IHI

Anila Hussaini, RN, MPH

Director, IHI

Kathy Luther, RN, MPM

Vice President, IHI

Derek Haas, MBA

Senior Project Leader, HBS

Jill Duncan, RN, MS, MPH

Director, IHI

Kevin Little, PhD

Improvement Advisor, IHIRobert Kaplan, PhD

Professor Emeritus, HBS

Sam Wertheimer, MPH

Project Leader, HBS

Kevin Bozic, MD, MBA

Orthopedic Surgeon

Tony DiGioia, MD

Orthopedic Surgeon

Lucy Savitz, PhD, MBA

Intermountain Healthcare

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Faculty and Staff9

Kayla DeVincentis, CHES

Project Coordinator, IHI

Anila Hussaini, RN, MPH

Director, IHI

Kathy Luther, RN, MPM

Vice President, IHI

Derek Haas, MBA

Senior Project Leader, HBS

Jill Duncan, RN, MS, MPH

Director, IHI

Kevin Little, PhD

Improvement Advisor, IHIRobert Kaplan, PhD

Professor Emeritus, HBS

Sam Wertheimer, MPH

Project Leader, HBS

Kevin Bozic, MD, MBA

Orthopedic Surgeon

Tony DiGioia, MD

Orthopedic Surgeon

Lucy Savitz, PhD, MBA

Intermountain Healthcare

IHI’s Work: Five Key Areas10

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Quality, Cost, and Value11

Our Goal:

Encourage, empower, and enable health care delivery systems to provide truly value-based care that ensures the best health care We strive to call out and address disparities in health and health care wherever they exist.

Challenges we hear from customersQuality, Cost, and Value

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“We know we need to offer care

differently in an ACO world but doing it

is proving to be difficult

“We have a path forward for how to engage

with clinicians and patients and building

sustainable systems for the long haul”

“Motivating physicians and front-line staff

who have cost reduction fatigue”

“We have approaches and tools that

appeal to clinical staff because they

identify waste and proven paths to

cost improvement.”

“Financial analysts and clinical staff aren’t

aligned in their approach to cost reduction”

“We have a disciplined approach that leads

to financial viability and good outcomes.”

“Incorporating improvement initiatives while

maintaining the everyday work flow.”

“We have proven and non-disruptive

improvement processes.”

“There are multiple, disjointed

initiatives around quality, cost

and value.”

“We have an integrated strategy that

improves outcomes and drives results.”

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A new partnership across the river . . .13

Accelerating learningAccelerating improvement

Accelerating change

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Program Overview

Participants will learn how to measure costs using Time-Driven Activity-Based Costing (TDABC), and what outcomes to track and measure (clinical and patient reported)

The program will focus on total joint replacements, but the methodologies are transferrable to any condition

Participants will be able to compare their outcomes and care cycle processes to highlight high value practices (exact cost information will be kept confidential)

The program will help organizations identify and pursue opportunities to improve their outcomes and lower their costs

Learn

Share

Improve

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Program Driver Diagram 16

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Overview of the Year20

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Learning Session 1 in Boston 9

Webinar for Physician Advisors 9

Join monthly webinars with IHI 30 27 27 24 29 26 31 28 25 30 20 18

Participate in “office hour”

coaching calls• • • • • • • • • • • •

Monthly outcome data submission 20 20 20 20 20 20 20 20 20 20 20 20

Cost and outcome measurement • • • •

Data synthesis • •


Performance Improvement • • • • • •Re-measure and synthesize • •

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coaching calls• • • • • • • • • • • •



Data synthesis • •Learning Session 2 in Boston 7



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coaching calls• • • • • • • • • • • •






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coaching calls• • • • • • • • • • • •





Meeting Aim26

At the end of the first in-person meeting

participants will begin to apply the TDABC

methodology to hip and knee arthroplasty

procedures and begin implementing selected

outcome measures.

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Objectives for the Day

Demonstrate how to apply Time-Driven Activity-Based

Costing (TDABC) methodology to hip and knee

arthroplasty procedures using a case study

Examine the process for putting outcome measurement

(including patient-reported outcomes) into practice and

work toward a plan to track a standard set of outcomes

Share the summary of measures collected from the pre-

work exercises

Introduce the learning community design

Meet other organizations and faculty; develop contacts that can be helpful throughout the duration of this work

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Agenda for the Day

Topic Time

Welcome and Introductions 8:00 – 8:30 am

A Surgeon's Perspective 8:30 – 9:15 am

Case Study Activity 9:15 – 10:30 am

BREAK 10:30 – 10:50 am

Time-Driven Activity-Based Costing Training 10:50 am – 12:30 pm

LUNCH 12:30 – 1:15 pm

World Café Activity 1:15 – 2:00 pm

BREAK 2:00 – 2:15 pm

Driving Outcomes 2:15 – 3:30 pm

Team Activity: Translating Learning into Action 3:30 – 4:15 pm

Wrap-up and Next Steps 4:15 – 4:30 pm

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Ground Rules

We learn from one another – “All teach, all learn”

Why reinvent the wheel? – Steal shamelessly

This is a transparent learning environment

All ideas/feedback are welcome and encouraged

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Home Team – Away Team31

Home Team: List

Name Role

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Program Materials33

Pre-work Presentations Participant

Folders

One (1) copy of each

team’s pre-work, one (1)

blank copy of the aims

worksheet, three (3)

copies of the Home Team

worksheets, and two (2)

index cards are available

in a folder at your table.

We will refer to these

materials throughout the

program.

All presentations are

available on ihi.org.

Instructions for

downloading materials

from the website can be

found in the participant

folder.

Program Agenda

Faculty Biographies

Boston Children’s Case

Case Worksheet

Case Assignment

Webinar Schedule

Coaching Call Schedule

Suggested Resources

Downloading Materials

Data Sharing Grid

Calendar of Events

Event Evaluation

A Physician Advisor Webinar is scheduled for this evening, Jan 9th 8 – 9 PM ET

Agenda: brief overview from today and focus on their role in this work

Copyright © Harvard Business School, 2013

The Value Based Health Care Delivery

Framework

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35Copyright © Harvard Business School, 2013

The central goal in health care must be value for patients, not access, volume, convenience, quality, or cost containment

Value =Health outcomes

Costs of delivering the outcomes

The Value approach requires that we measure two fundamental parameters:

1. Outcomes: the full set of patient health outcomes over the care cycle

2. Costs: the total costs of resources used to care for a patient’s condition over the care cycle

Value-based health care delivery


Source: Tim Ferris, MD, personal communication

Patient-level outcomes and costs are measured over a complete cycle of care for a clinical condition

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Measuring Outcomes:

(M. Porter, NEJM (December 2010)

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

Long-term consequences of therapy

Tier1

Tier2

Tier3

Health Status Achieved

or Retained

Process of Recovery

Sustainability of Health

Recurrences

Care-induced

Illnesses

• Clinical Status

• Functional Status


Measuring Costs:Time-Driven Activity-Based Costing (TDABC)

• A bottoms-up approach to costing patient care based on the actual

clinical and administrative processes, and resources, used to treat

patients.

• Combines process mapping from industrial engineering with the most

modern approach for accurate and transparent patient-level costing

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HBS cost measurement & management project sites


HBS cost measurement & management project areas

• Chronic kidney disease

• Care transitions/preventing

readmissions

• Diabetes

• Primary care for patients with

behavioral health

• Bariatric surgery

• Child birth and pregnancy

• Heart valve replacements and

repairs

• Head and Neck cancers

• Hysterectomies

• Mastectomies

• Joint replacements

• Neurosurgical procedures

• Observation patients

• Prostate cancer surgeries and

radiation treatments

• Rotator cuff repairs

• Tonsils & adenoids

Chronic and Primary Care Episodic Care

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Questions?