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The “Transition”: Challenges and Opportunities
Roger Ray, MDChief Physician Executive Carolinas HealthCare SystemMay 2015
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The Agenda• Who are we?
• The Transition
• Whole System Context– Maturity Model– Harm Agenda
• Your Work – Challenges– Opportunities
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Carolinas HealthCare System
We’re big… • 39 hospitals• 900+ care locations• 30,000 employees • 3,000 physicians• 15,000 nurses• 11M+ annual patient
encounters• $8B+ annual revenue
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We deliver integrated,quality care on a large scale
• Innovative care organizationsand services
• 18 million transactions/day in our EMR
• More than 65,000 diabetic patients in managed care
• Large virtual critical care(e-ICU) programs
• 500+ behavioral health ED consults conducted virtually per month
• Saved nearly $60 million in health care-related costs over two years 5
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Fundamental: The Transition from Volume to Value
Current StrainSTRAIN
uncoordinated
facility basedvariable
Silo work
volume-based
fee for service
Issue-focused
individual patient focus
VOLUME
VALUE
team accountability
standardization
engaged physicians
cost containment
improved qualitysafe
patient-centric
transparency
care coordinationinnovation
team-based care
information technologyreactive
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Reflection on Transformation
Why are we pursuing quality? Are we willing to change? Do we have a model that increases
access to care and leverages integration? Have we made a commitment to embrace
technology and be excellent in its application?
Are we actively moving to a value-based system ahead of external drivers?
Are we willing to be accountable and transparent?
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Role of Quality Pursuit
• Performance• Unification• Engagement• Accountability • Culture• Differentiation• “Value”
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System Integration
Virtual Care
Specialty Services
Primary Care
BetterOutcomes
Lower Costs
ImprovedPatient
Experience
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Integration Maturity Model Criteria1. Clinical Integration Priority Tool used2. One and three-year Cross continuum/geographies plans 3. Specialty “Principle Coordinator of Care” criteria developed4. Integration with palliative care, home health, etc.5. Service line work influencing primary care, continuing care and/or acute care6. Method to stratify patients is developed and deployed7. Chronic Disease Management Model for key conditions and chronic populations 8. Navigator/Coordinator connected to the medical home9. Action plan for readmission reduction is in place10. Goals articulated in all three dimensions of value11. Cross continuum value dashboards are developed 12. Care coordination models, clinical pathways, transitions developed and executed13. Physician leaders engaged in strategy and tactics through physician colleagues 14. Physicians ensure compliance with cross continuum care pathways/protocols 15. Team-based care models are developed16. Access leverage17. Action plan positively impacting our employee population is developed/executed18. Action plans: high drug costs utilization; unnecessary lab testing; high cost test settings; avoidable ED visits
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Driving ChangeIntegrated System of Care: Work differently and do different work
• Integration across service lines and points of care
• Navigator connected to medical home
• Readmission reduction action plan
• Team-based care models• New training approaches
CHS Maturity Model OrthopaedicsSNF
Children's
Behavioral Health
Emergent Care
Hospice & Palliative Care
Hospitalist Care
NeurosciencesHome Health
Rehabilitative Care
Cardiovascular
Trauma
Cancer
Critical Care
Primary Care
Respiratory Health
0%
20%
40%
60%
80%
100%
2013 2014 2015
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Broad Array of Results
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175HOME HEALTH TRANSFERS
to acute care have been avoided
954READMISSIONS
have been avoided
9,844PATIENT SAFETY EVENTS AVOIDED THROUGH OUR
Hospital Engagement Network
25,614PATIENTS
Received documentedAPPROPRIATE CARE
28,094MORE PATIENTS WERE discharged from emergency departments in fewer than
180 MINUTES THAN IN 2012
$60 million savings in related health care costs from quality programs
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Harm Agenda
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HEN & LEAPT
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Transparency
http://www.carolinashealthcare.org/value-report
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Challenges• ‘Proceduralist’ vs.
Episode Manager
• Upstream capability
• Immaturity of global measurement
• Ecosystem strain
Your Work
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Opportunities • Physician Leadership• Aggressive use of
technology• Embrace move to
reliability• Value measurement• Creation of evidence
Your Work
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