near-term and long-range strategies to improve quality
TRANSCRIPT
Richard A. NorlingPresident and CEOPremier Inc.
Near-Term and Long-Range Strategies to Improve Quality
Hospital Authority Convention 2008May 5, 2008
Dramatic and Sustained Improvement
CMS HQID Composite Quality Score
CM
S Q
ualit
y Sc
ore
Avg. improvement across all clinical areas
for median CQS (15 quarters)
17.3%
Clinical Area Percent Improvement
AMI (heart attack)
8.0%
CABG (Coronary Bypass)
12.7%
Pneumonia 23.5%
Heart Failure 29.3%
Hip & Knee 12.9%
CMS/Premier HQID Project Participants Composite Quality Score: Trend of Quarterly Median (5th Decile) by Clinical Focus Area
October 1, 2003 - June 30, 2007 (Year 1 and 2 Final Data; Year 3 and 4 Preliminary Data)
89.6
%
85.1
%
70.0
%
64.0
%
85.1
%
90.0
%
85.9
%
73.1
%
68.1
%
86.7
%
91.5
%
89.4
%
78.1
%
73.1
%
88.7
%
92.5
%
90.6
%
80.0
%
76.1
%
90.9
%93.5
%
93.7
%
82.5
%
78.2
%
91.6
%93.4
%
94.9
%
82.7
%
81.6
%
93.4
%
95.1
%
96.2
%
84.8
%
83.0
%
95.2
%
95.7
7%
97.0
1%
86.3
0%
84.3
8%
95.9
2%
96.0
%
96.8
%
88.5
%
86.7
%
96.0
%
96.1
% 98.3
%
89.3
%
88.8
%
96.9
%
96.8
%
98.4
%
90.1
%
90.0
%
97.5
%
96.8
%
98.4
%
91.4
%
89.9
%
97.6
%
97% 98
%
92%
90%
98%
97.0
%
97.7
%
92.4
%
91.6
%
97.9
%
97.6
%
97.8
%
93.5
%
93.2
%
98.0
%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
AMI CABG Pneumonia Heart Failure Hip and Knee
Clinical Focus Area
Com
posi
te Q
ualit
y Sc
ore
4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06 4Q06 1Q07 2Q07
Premier Performance Pays Research
Hospital Costs for Pneumonia Patients
6,000
8,000
10,000
0 to 50% 51 to 99% 100%
Aver
age
Hos
pita
l Cos
ts
Premier’s Performance Pays study demonstrated that when evidence-based care is reliably delivered, quality is higher and costs are lower. The recently updated study using all payors and three years of data
(over 1.1 million patients), confirms this result.
Mortality Rate for CABG Patients (%)
0%
2%
4%
6%
0 to 49% 50 to 74% 75-100%
Mor
tality
Rat
e (%
)
Patient Process Measure Patient Process Measure
Study finds higher reliable care yields lower mortality rates for heart bypass surgery patients
Study finds higher reliable care yields lower hospital costs for patients with pneumonia
Success is generating next generation programs
Hospital Examples of HQID Success
AMI CHF PNEUMONIA HIP- KNEE CABG
SLMC 5 4 3 6 3
SLSS N/A N/A N/A N/A N/A
ASMC 6 6 3 8 6
WAMH 10 5 2 2 N/A
AMCWC 5 4 3 N/A
MHB 5 5 1 6 N/A
AMC-KEN 7 4 2 9 N/A
ALMC 10 8 2 10 N/A
ABMC 5 8 4 9 9
AMCMC 3 2 1 2 N/A
SMMC 6 2 1 1 N/A
N/A
Achieve progress towards the 2007 goal of being in the top 20% for all Medicare (CMS)pay-for-performance measures by achieving above median performance for each one
of these measures by year-end 2005.
Decile Performance -- 1 = Top Performer 10 = Bottom PerformerBased on HQID Year 1 Results (4th Q 2003 – 3rd Q 2004 Data)
Aurora: HQID Bingo Card (before)
Aurora: HQID Bingo Card (after)
Achieve progress towards the 2007 goal of being in the top 20% for all Medicare (CMS) pay-for-performance measures by achieving above median performance for each one of these measures.
* On track for Top Improvement Award 85% in Upper Median58% in Top 20%Based on Oct. 2006 –June 2007 Data
Performance 1 = Top Performer10 = Bottom Performer
CMS/Premier HQID Best Patient Care
Aurora Health System: Improving Cost and Quality
5,000
10,000
15,000
20,000
25,000
30,000
4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q0660%
70%
80%
90%
100%
110%
Hip/Knee Replacement CQS Hip Replacement Total Cost Knee Replacement Total Cost
10,000
12,000
14,000
16,000
18,000
20,000
22,000
24,000
4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06
Tota
l Cos
t
70%
80%
90%
100%
Com
posi
te Q
ualit
y Sc
ore
AMI CQS AMI Total Cost
Memorial Hospital BurlingtonHip and Knee Replacement Patients
Aurora St Luke's Medical CenterQuality improved and Cost decreased
in AMI Patients
West Allis Memorial HospitalHeart Failure Patients
5,000
6,000
7,000
8,000
9,000
10,000
11,000
4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06
Tota
l Cos
t
60%
70%
80%
90%
100%
Com
posi
te Q
ualit
y Sc
ore
Heart Failure CQS Heart Failure Total Cost
Transition from Bottom to Top Performance
CONSISTENT TOP PERFORMER
United Hospital CenterClarksburg, WV
• Top performer in two areas in Year 2
• Top performer in three areas in Year 3
• Tracking to be top performer in four areas in Year 4
Highlight of Success Stories
– Moved from 71% compliance with PCI within 120 minutes…to 100% compliance within 90 minutes
• Mortality reduction by nearly 55%
* UHC is Part of a WV State PCI Demonstration Project
• Sustained 100% performance for the HQID measures
• Improved D2B times* (2007 average = 62 minutes)
13.4%
10.2%
7.0% 7.9%
5.9%
0%
2%
4%
6%
8%
10%
12%
14%
16%
2003 2004 2005 2006 2007
% AMI Mortality AMI Mortality Trend
Acute Myocardial Infarction (AMI)
Improvements in Quality and Outcomes
UNITED HOSPITAL CENTERTrend of Quarterly Composite Quality Score (CQS) and Total Cost
for Hip and Knee Patients
5,000
6,000
7,000
8,000
9,000
10,000
11,000
12,000
13,000
4Q03 1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q0660%
70%
80%
90%
100%
110%
Hip/Knee Replacement CQS Hip Replacement Total Cost Knee Replacement Total Cost
Quality improved and Cost decreasedin Hip and Knee Replacement Patients
Quality improved and Mortality Rate decreased in Heart Failure Patients
UNITED HOSPITAL CENTERTrend of Quarterly Composite Quality Score (CQS) and Mortality Rate
for Heart Failure Patients
0%
1%
2%
3%
4%
5%
6%
7%
8%
20034 20041 20042 20043 20044 20051 20052 20053 20054 20061 20062 200630%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
110%
Heart Failure CQS Heart Failure Mortality Rate
Improvement and Savings
Avg. cost improvement per patient across all clinical areas
$1,063
If all hospitals in the nation were to achieve this improvement, the estimated cost savings would be greater than $4.5 billion annually with estimated 70,000 lives saved per year
Avg. improvement in mortality across four clinical areas
1.87%Clinical Area ImprovementAMI $1,599
CABG $1,579
Pneumonia $811
Heart Failure $1,181
Hip Replacement $744
Knee Replacement $463
Clinical Area Improvement
AMI 2.27%
CABG 0.95%
Pneumonia 2.39%
Heart Failure 1.86%
A look at the future of healthcare delivery
Desired Results
Process Improvement/AutomationCulture
Population/Community
Health
MicroSystems
BusinessUnit
SystemsOf Care
Long-Term Progression of Vision
Payment System
Prediction: what will happen?
Prediction
Monitoring: what’s happening now?
Monitoring
Analysis: why did it happen?
Analysis
Improving care means predicting and then preventing adverse events
Improving Outcomes & Safety
Com
plex
ity
Reporting: what happened?
Reporting
