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It’s no secret the U.S. health care system needs to change. The Affordable Care Act (ACA) introduced a focus on new health care payment models, which placed clear economic incentives on providers while also striving for better outcomes. Today, we see an emphasis on preventing hospital readmissions, reducing emergency room visits and avoiding unnecessary health care utilization while enhancing quality and the patient experience. As a result, health care stakeholders are rethinking the way care is delivered, how data is used and how people collaborate and communicate in more preventive, proactive ways. This means moving from episodic, fee-for-service, disease treatment models toward value-based care delivery to improve outcomes, better utilize resources and expand access to care. Improved population health has become the Holy Grail of U.S. health care, with many early experiments and some promising successes. We take a look at Banner Health, a pioneer in transforming their health delivery systems with Robert Groves, MD, Vice President, Health Management, Banner Health.
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Hospital of Tomorrow
October 2014
Disruptive Change: How to Save the Healthcare System
Align, Engage, Integrate, Enable and Partner Across the Health Continuum
Amy AndersenHealthcare Transformation ServicesOctober 2014
Hospital of Tomorrow
Prevention Diagnosis Treatment Recovery Wellness
Population Health
Philips Population Health Management
Focusing on human and cultural elements for better alignment, communication and collaboration.
Align
Driving patient activation and shared decision-making for better outcomes at lower cost.
Engage
Building highly coordinated multi-disciplinary teams for patient-centered care across the health continuum.
Integrate
Align: Transforming to People-Centered Neonatal CarePhilips Wee Care®: Creating developmentally supportive care environments
Altimier LB, Tedeschi L., Developmental care: changing the NICU physically and behaviorally to promote patient outcomes and contain costs, Neonatal Intensive Care Vol .17 No. 2
* LOS dependent on gestational age category
Our approach• Engage staff in redesign of
environmental and clinical practices • Educate multidisciplinary team to
deliver the best evidence-based care• Coach staff to encourage/support
family participation in baby’s care• Implement and monitor core
measures for sustained performance
People-focused outcomes• ↑ parent satisfaction• ↓staff turnover from 15% to 2%• Improved compliance to outcomes-
driven practices– Sound levels reduced from 95 to 55 dB– Light levels reduced from 150 to 50 FC
• ↓LOS from 22 to 32%*
Engage: Patient Participatory Decision-MakingProstaid®: Shared decision-making program for prostate cancer patients
People-focused outcomes• Choice of treatment in the hands of the
patient and his family• Closer collaboration between patient and
physician• Improved patient’s sense of control and
satisfaction with choices
The challenge• Give patients clear, personalized
information about treatments and side effects
• Ensure patient’s pathway choices align with quality of life values
• Reduce patient stress and anxiety
Our approach• Facilitate shared decisions for
patients, family, and physician as part of clinical workflow
• Create a clear, simple-to-use, web-based encryption-secured tool
• Combine patient’s values, preferences and clinical data with evidence-based medical guidance
Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, et al. “Decision aids for people facing health treatment or screening decisions,” Cochrane Database Syst Rev. 2011; (10):CD001431;/www.nashp.org/sites/default/files/shared.decision.making.report.pdf
Integrate: A holistic transformation of the Stroke ContinuumMultidisciplinary, end-to-end care for vulnerable patients
People-focused outcomes• Scaled scarce expert resources in a cost
effective manner• Exceeded core measures performance
exceeding AHA GWTG benchmarks• Enhanced recovery, treatment compliance
and healthy lifestyles with end-to-end patient-tailored support
The challenge• Improve quality of stroke care and
outcomes across care settings• Reduce care fragmentation that drives
estimated $95B projected cost (2015)• Support patients in return to a new state
of wellness and healthy lifestyles
Our approach• Connect pre-hospital providers with
experts for rapid assessment/treatment• Connect patients, family and providers to
share information through mobile and app-based technologies
• Design interactive adaptive healing environments tuned to patient’s needs hospital through rehabilitation
Westerberg, H., Jacobaeus, H., Hirivikoski, T., Cleverberger, P., Östensson, M.-L., Bartfai, A., & Klingberg, T. (2007). Computerized working memory training after stroke – A pilot study. Brain Injury, 21 (1), 21-29.; Lisbeth Claesson, Thomas Lindé, Ingmar Skoo, Christian Blomstrand, Cognitive Impairment after Stroke –Impact on Activities of Daily Living and Costs of Care for Elderly People, Cerebrovasc Dis 2005;19:102–109
Partnering with the Hospitals of Tomorrow
Sweden15 years
USA15 years
Netherlands10 years
Belfast15 years
KUBIN CLINICAustria8 years
Types of partnering and innovation
Care transformation and care redesign Enterprise quality and care management Consumerism and patient engagement Co-develop and pilot new technologies
Collaboration for higher equipment utilization Managed services and business model Shared performance metrics and risk sharing
Hospital of Tomorrow
Jane Lucas, Health Policy Counsel, Office of U.S. Senator John Thune
Coordinated Telehealth & Care Transformation
“It is not the strongest of the species that survive, nor the most intelligent,
but the one most responsive to change”.
Charles Darwin
Brian A. Rosenfeld, MDVP & Chief Medical Officer, Hospital to HomeOctober 2014
Qua
lity
of L
ife
Estimated Cost of Care / Day$10,000$1,000$100$10$1
H2H: Higher Quality of Life at Lower Cost
ACUTE CARE
ED/OBS
Medical/Surgical
Intensive Care Unit
RESIDENTIAL CARE
Skilled Nursing Facility
Assisted Living
HOME CAREIndependent, Healthy Living
Aging in Place
Hyper-Chronic Disease Mgmt
$40 – $100k
$9 – $30k
$2,583
$248
Segmentation based on healthcare
spending
Percentage of total
expenditure
Average expenditure per patient
per year
50.6%
23.7%
22.6%
3.1%
5%
6-20%
21-50%
50-100%
Healthcare Cost Segmentation
HomeEmergent care
HomePerpetual chronic care
Post discharge careAging in place
HospitalICU, Med Surg,
LTACH, SNF
EMR HIE
Digital Health Platform
Telehealth Center
Coordinated Telehealth Across the Care Continuum
15
Virtual Care Center
eICU Programs
16
Wages for Health
CareWorkers
56%
$1.45 Trillion
Other44%
$1.15 Tril-lion
“…Unlike virtually all other sectors of the U.S. economy, health care has experienced no gains over the past 20 years in labor productivity, defined as output per worker.”
Healthcare Productivity: Do More With Less
Intensivist(1)
Critical Care Nurses(2-3)
Computer Intelligence
eICU: 130-150 ICU beds
Kocher, M.D., Nikhil R. Sahni, B.S. NEJM: 365;15, 1370-1373.
eAcute Care Program
• Monitor high acuity patients to prevent avoidable complications – reducing hospital LOS and cost
• Use centralized resources to drive best practices (sepsis, falls)
• Video-visitation: Increase patient/family satisfaction
• Facilitate transitions from hospital to home/SNF
Virtual Sepsis Unit
Hospital in Home: Enabling Technology
• Tele-station in the home feeds patient data real-time
• Temperature, heart rate, blood pressure, oxygen saturation
• Weight Scale
• Point of care testing:– Glucose– WBC
• Wound photos
Home Environment
WellnessAging in placeMultiple chronic illness
Driving behavior changeand enabling Team Care
Phenotype for patients & families
Patient Portal – Greater self care
Outcome = ET × A(P+F)
Patient Engagement: One Size Doesn’t Fit All
Their Family
The Person
Their Health Team
211 21
Intensive Ambulatory Care Program
Lifeline AutoAlert & GoSafe
Senior MobilityMonitor
Fall Prevention and Detection
Focused Rehabilitation
23
“Vision without action is just imagination”
Robert Groves, MD, Vice President, Health Management
Banner Health
Banner Health at a Glance
• 25 Acute care hospitals
• Over 35,000 employees
• Over 450 bed tele-ICU
• 55 bed Simulation Medical Center
• Truven Top 5 large health systems 3/5 yrs
• $5 Billion in revenue
• Over 1,000 employed physicians
25
Banner’s 2020 Vision
26
Acute Hospital
Company
Clinical Quality
Company
Population Health
Management Company
“Our Steps to the Future”
Industry Leadership2016-2020
Innovation2016-2020
Growth2007-2010
Performance2003-2006
Turnaround2000-2002
GROWIT!
CHANGEIT!
LEADIT!
DOIT!
FIXIT!
Working Harder Isn’t Always the Answer…
27
28
1. Identify adverse trends and intervene before they become adverse outcomes
2. Respond quickly to requests for help
3. Monitor and assist with “evidence-based practice” and reliability
4. Measure performance across the system
5. Use data (real time and retrospective) to drive performance improvement
Five Areas of Focus…
29
30
Longitudinal ICU & Hospital Mortality
0.78 0.83 0.870.81
0.960.88
0.82 0.850.76
0.62 0.64 0.60 0.590.67 0.68 0.69
0.62 0.63 0.650.74
0.65
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
(A/P
) IC
U M
ort
2009-Q1 2010-Q1 2011-Q1 2012-Q1 2013-Q1 2014-Q1
Hosp DC Yr-Qtr
2014 Q2 - Banner Health
APACHE IVa ICU Mortality Ratio
0.69 0.650.73 0.69
0.800.74 0.69 0.67
0.570.50 0.51 0.51 0.52 0.55 0.55 0.56 0.53 0.54 0.54
0.620.56
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
(A/P
) H
osp
Mo
rt
2009-Q1 2010-Q1 2011-Q1 2012-Q1 2013-Q1 2014-Q1
Hosp DC Yr-Qtr
2014 Q2 - Banner Health
APACHE IVa Hospital Mortality Ratio
eAcute Pilot Results
“ Application of the eICU care model to the medical surgical patient population reflects an impact on patient outcomes,
throughput and costs…”
Baseline eHospital
Average LOS 3.96 days 3.30 days
Cases / month 307 389
Cost / case $6161 $5166
ICU Admissions from general ward
First 24 hours 0.9% 0.8%
After 24 hours 1.1% 0.6%
Discharge status Death or hospice 2.7% 2.0%
Home 84.1% 86.5%
Falls per 1000 days 3.3 2.1
31
Banner iCare Acute Care
ICU 2013
• >20,000 fewer ICU days than predicted
• >50,000 fewer Hospital days
• >$68,000,000
• >2,000 lives saved (APACHE 0.42)
eHx
• ICU Transfers dropped from 1.1% to 0.6%
• $4.5 M saved
32
33
Remote Skilled Nursing Facility Care
Telehealth Center
Qua
lity
of L
ife
Estimated Cost of Care / Day$10,000$1,000$100$10$1
Home: Higher Quality of Life at Lower Cost
ACUTE CARE
Specialty Clinic
Community Hospital
Intensive Care Unit
RESIDENTIAL CARE
Skilled Nursing Facility
Assisted Living
HOME CAREIndependent, Healthy Living
ComfortableSetting
Chronic Disease Mgmt.
Cost Effective
34
Integrated Population Health Management
Health Management
Delivery System
Care Mgmt/Corp Svcs
Banner Health Network
36
Enabling Technology
Mobile Care Tools
Population Management Intelligent MonitoringContinual Surveillance
2-Way Video with AudioWeb-enabled Remote Consult
Event Management
37
38
39
Data Overview55 members: 3-month follow-up
Months -12/0 -11/1 -10/2 -9/3 -8/4 -7/5 -6/6 -5/7 -4/8 -3/9 -2/10 -1/11
Pre 2443 2941 4601 2488 1965 2704 2547 2278 2200 2675 3009 1627
Post 2395 840 972 729 627 491 0 0 0 0 0 0
Banner iCare™ period
40
Member Needs Assessment Center360 Omni-Channel Health Management
Population Management & Coordinated Care Center
4141
Any Patient, Any Provider, Any Time
42
“If you don’t like change,you will like irrelevance even less.”
Eric K. Sinseki, Former U.S. Army General Chief of Staff
43
Question & Answer Session
Brian A. Rosenfeld, MD
Thank you!
