Transcript Essentia Health Values - Performance Excellence Network

Twin Ports Performance
Excellence Network
(TPPEN)
Essentia Health: Journey
to Accountable Care
Debbie Welle-Powell, MPA
SVP Accountable Care
August 14, 2015
Essentia Health Overview
Essentia Health is a fully integrated healthcare system, with
$2 billion in annual revenues, serving patients in Minnesota,
North Dakota, Wisconsin and Idaho
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Our Mission, Vision and Values
Essentia Health Mission
We are called to make a healthy difference in people’s
lives.
Essentia Health Vision
Essentia Health will be a national leader in providing
high quality, cost effective, integrated health care
services.
Essentia Health Values
Quality · Hospitality · Respect
Stewardship · Justice · Teamwork
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Essentia Health
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Duluth Based Not-for-Profit Four State Health System
$1.6 Billion Annual Revenues
13,000 Employees
800 Physicians
750 Credentialed Professionals
18 Hospitals
68 Clinics
446,000 Unique Patients (covered lives)
NCQA ACO Accreditation (Level 3)
S&P “A” Rated
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Essentia Health: Operating Company
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The Future
(Innovation)
The Evolution
of Essentia
Health
2010-Present
2004-2010
1997
1888
&
1915
St. Mary’s
Hospital
Duluth
Clinic
1 Region
• 3 Hospitals
• 22 Clinics
• Family Practice
Residency
• 321 MDs
• 4,200 Employees
SMDC
• 13 Hospitals
• 18 Clinics
• 50 Long Term Care
and Assisted Living
• Family Practice
Residency
• Multiple EMRs
• 400 MDs
• 13,000 Employees
Essentia Holding Company
3 Regional Hubs
• 18 Hospitals
• 68 Clinics
• Essentia Institute of
Rural Health
• 6 Long Term Care
• 5 Assisted Living
• Family Practice
Residency
• 1 EMR (Epic)
• 800 MDs
• 750 Credentialed
Providers
• 13,000 Employees
• Common Quality
Scorecard
• Care Management
• Telemedicine
• Education Services
Expansion
• Research Expansion
(EIRH)/Data
Warehouse
• Advanced
Technology
• Innovative Payor
Relationships
• Accountable Care
Organization
• Essentia Foundation
• Continued Growth
Essentia Operating Company
Comprehensive Care
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So What’s the Problem
With Health Care?
Annual Growth Rates, Gross Domestic Product (GDP) And National Health Expenditures
(NHE), Calendar Years 1990–2023.
Sisko A M et al. Health Aff doi:10.1377/hlthaff.2014.0560
©2014 by Project HOPE - The People-to-People Health Foundation, Inc.
A Few Cost the Most
National Sample of 21 Million Insured Americans, 2003-2007
% of
Population
1%
9%
20%
70%
% of Total Healthcare
Expense
Mean Annual
Cost per Person
29%
$101,000
39%
$15,000
21%
$3,700
11%
$580
Source: Thomson Reuters Markets can Database
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Real Life Examples
Family Health Insurance (Full Pay Plan)
1980
2000
2015
Est.
2025
Monthly
Premium
$100
$1,000
$2,833
$4,614
Annual
Premium
$1,200
$12,000
$34,000
*$55,379
*Union Plan B (almost no cost sharing)
**5% Inflation/Year
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Affordability?
• Premium @ $24,000/year = $11.53/hour
• Premium @ $34,000/year = $16.34/hour
Who
Can
Afford?
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Primary Strategy for Affordability
• Cost Shifting & Cost Sharing
– Deductibles, Co-pay, etc.
• Tiering of Providers
– Drive toward lower cost provider
– Race to the bottom
• Complain
– Someone else’s problem!
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Taking Health
Care to the
Next
Level…ACO’s
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What is an ACO?
ACOs are provider-based organizations that
take responsibility for meeting the health care
needs of a defined population with the goal of
simultaneously:
 Improving health
 Improving the patient experience
 Reducing per capita costs
ACOs Achieve the Triple Aim
by Focusing on:
Wellness and disease prevention
 Effective chronic disease management
 Hospital care that achieves lasting,
positive outcomes
 Setting and achieving high standards for
quality, safety and customer service
 Leveraging all of the above to lower
costs
Earliest ACO’s
• Kaiser Permanente
• Group Health
• St. Mary’s Hospital 1886
Why Essentia Has Moved
to an ACO Model For Care?
• ACO fits with Essentia Health’s mission to make a
healthy difference in people’s lives. (Focusing on
wellness is the right thing to do.)
• Private insurers and businesses support ACOs as
way to improve care and reduce costs
• Traditional fee-for-service payment model is
unsustainable. Health care systems will collapse
without change.
National Committee on
Quality Assurance
• Essentia is an “Early Adopter” for ACO Accreditation (1/6
in U.S.)
• Our “Blueprint for Quality”
• Private, 501(c)3 Not-for-Profit
• Founded 1990
• Central Figure in Delivering Quality and & Quality
Improvement in Health Care
• Assures purchasers, patients, and consumers of the ACO
 A common set of expectations
 Focuses on the patient and their care
 The ACO rigorously holds itself to nationally
recognized standards
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NCQA: The 7 Standards
Organizational/Structural Standards
1. Established ACO structure and operations
2. Access to the full range of services and specialties needed to deliver
comprehensive care
3. Patient-centered primary care
4. Care management
5. Care coordination and transition planning
6. Clear patient rights and responsibilities policies
7. Performance reporting and quality improvement process
Essentia Health
Accountable Care Initiatives
A C C O U TA B L E C A R E P L AT F O R M
Accountable Care (ACO)
VA L U E - B A S E D C O N T R A C T S
Population Health Management (121,234 total lives)
MSSP
30,814
Lives
MSHO
1,482 Lives
IHP MN
Medicaid,
23,304 lives
UCare
Seniors
5,303 Lives
BCBS ACO
37,918 Lives
Health
Partners
9,949 Lives
Essentia
Employee
Health Plan
12,464 Lives
ORGANIZED SYSTEM OF CARE
Collaboration between clinicians and administrative leaders who have a shared commitment for the
quality, cost and patient experience across the entire care continuum
VA L U E - B A S E D C A R E C A PA B I L I T Y S E T S
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Accountable Care Infrastructure
ORGANIZED SYSTEM OF CARE
Collaboration between clinicians and administrative leaders who have a shared commitment for the
quality, cost and patient experience across the entire care continuum
Clinicians
/ Care
Teams
Skilled
Nursing
Home
Care
Hospice
and
Palliative
Hospitals
Long Term
Care
Behavioral
Health
Community
Health
FQHC
VA L U E - B A S E D C A R E C A PA B I L I T Y S E T S
Quality
Mgmt
Performance
Improvement
Programs
Outcomes
Monitoring &
Reporting
Financial
Reporting
Population
Mgmt &
Risk
Stratification
Advanced
Data
Analytics
Care
Coordination
Chronic Care
Mgmt
Coding and
Documentation
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Our Journey from Volume to Value:
Percent of Business Tied to Value
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Median
Essentia
Today
In Three Years
In Five Years
Median: HFMA National Survey
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Essentia Health: Journey from
Volume to Value
2014
2013
Data Integration
2015
2014
Analysis
2016
2015
Action
2017
2016+
Results Reporting
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Population Stratification Tool
Patient has
no future
Primary Care
Appointment
Patient has
visited the ED 5
times in the last
12 months
Patient
takes 32
medications
Patient has been
admitted to the hospital
6 times in the last 12
months
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Essentia Performance System
lig
nm
A
Fo
cu
s-
D
or
tf
en
D
ire
No Meeting Zone
em
ag
an
ct
io
n-
SW
M
of
LSW
d
ho
et
Sustaining Improvement
using Standard Work
M
en
t
Essentia
Performance
System
Leader Standard Work
Review of Flow Board
Gemba Walks
Huddles
Standard Work Reviews
Performance Board Reviews
ly
ai
Gemba Rounds
k
or
W
Clear Line of Sight
Performance Boards
Visual Management
PDSA & Countermeasure
Monthly PMI
Action Plans on Key Focus Metrics
Cascade of:
Performance Board Reviews
Gemba Rounds
Communication
Leaders have 2 jobs -Run their business -Improve their business
Cultural Transformation- Entire Leadership Team owns the performance management system
Stewardship
Respect
Essentia Values and Culture
Hospitality
Justice
Quality
Teamwork
Vision: By 2018, Essentia Health will be a national leader in providing high quality, cost effective, integrated health care services.
Mission: We are called to make a healthy difference in people’s lives.
Focus, transparency, and accountability
STEPS to Alignment on our Shared Goals
Individual
performance
goals
Department
metrics and goals
Region metrics
and initiatives
Essentia System:
Strategy Map, BSC
metrics and
Strategic Initiatives
Integrating all Three: Performance Board, Strategy Map, Strategic Initiatives, Metrics
The environment we face
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Discussion
Questions & Comments