strategies and challenges facing today’s hospitals state of reform conference january 7, 2016

Strategies and Challenges Facing Today’s Hospitals

State of Reform ConferenceJanuary 7, 2016

Margarita Gardea

added this as official title slide for presentation; updated all slides (1-12) to latest PPT template

COPE Health Solutions (COPE) was founded in 1995, incorporated in 2002. In 2015, it is transforming into a for-profit social entrepreneurship and spinning off a new foundation.

Our value proposition is unique in the field of health care consulting. Matched only by a top drawer team and commitment to population health management, we have proven to be a highly capable partner for providers and payers seeking to succeed in the new value-based payment environment while developing the diverse talent needed to fill future health care roles.

COPE Health Solutions offers an extensive line of health care consulting and workforce development services. We specialize in:

• Strategic planning, strategic management and clinical redesign for health systems, health plans and providers of all types

• Financial analytics and pro forma modeling to align financial incentives and ensure financial viability

• PMO for large implementations and new corporate launches related to population health management and managed care models

• Training and development of the future health care talent pool, including numerous certificate programs offered in collaboration with UCLA School of Public Health

COPE currently has over 60 employees servicing clients in four states, S. Korea, Japan and Canada, with a growing national and global presence.

Organizational Overview

Copyright © 2015 COPE Health Solutions. All rights reserved.

Margarita Gardea

This slide is directly from the presentation provided by Melissa from All Hands, so all i would recommend woud be to remove the sections in red text and make these talking points instead so the slide doesn't look so busy

Thought Leadership, Visionary Transformation


MissionTo help our clients achieve visionary, market-relevant health care solutions

VisionOur clients are leaders in adding value for consumers

through innovations in population health management, talent development and alignment of financial incentives

Growing National Reach

Clients*

5-6

2-31-2

10+

3-4

2014

2007

2011

2002

2015

2015

2014

2007

2008

*Year represents date of first engagement in region.


Care Transformation

Hospitals, Health

Systems, Physicians,

Clinics, SNFs,

Disability Agencies,

Health Plans

Demand for tailored, high-performing networksPatient centered, coordinated care Radical shifts to community, retail and home based services over timeReduction in use of expensive acute care servicesCase management and Transitions-of-care is a critical ingredient and aspect of business modelPayment for outcomesChanges to core business models


Community resource as safety net provider (ED, Urgent Care, Acute care)

Source of integrated care deliveryExperience with EHR and IT integrationAccess to specialty care and ancillary care

servicesAccess to primary careSource for project management expertiseMajor employer in the community

What is the Role of Hospital Delivery Systems?


Government Programs becoming a larger part of “book of business” (Medicare, Medicaid, PEBB, etc.)

Consolidation of hospital delivery systemsValue-based reimbursement and quality metricsWorkforce development, recruitment and

retention

Challenges Confronting Hospital Delivery Systems


Putting Delivery System Reform Incentive Payment (DSRIP) Program in Context (Medicaid)


Current State

DSRIP ($3 Billion

over 5 years)

Future State

DSRIP can help you achieve your strategic goals with additional funds

DSRIP PROPOSALS DUE 1/15/16

The Medicaid waiver is working towards improving the Triple Aim:

Better care for individualsBetter population healthLess cost

The DSRIP menus have evolved from State to State to include more projects and a variety of providers

Each provider will have a different approach to DSRIP

General Philosophies


Creating Integrated Delivery Networks (IDNs)


DSRIP helps move providers towards creating IDNs through collaboration and capacity-

building

Choosing and working with collaborative partners outside your hospital:

• Who is your population? Who are your members?• Where else do your patients/members go?• Who can help you manage populations?• What competencies do you need help with?• What networks do you want to build?

Designing Your IDN/IDS


Washington DSRIP Project Categories


Health system capacity building (workforce, tele-medicine, FFV payment models)

Care delivery re-design (bi-directional integrated delivery systems, access to care coordination,

outreach supports)

Population health management (behavioral health, chronic disease prevention, prenatal

services)

Goals: Reduce avoidable intensive services and settings, improve population health, accelerate

transition to VBP, reduce Medicaid costs

It is crucial to link the DSRIP projects you choose to your strategic plan

Strategic planning

13

Strategic Plan

ACA-driven

transformation

1. How will you link DSRIP to your strategic goals?

2. What transformation initiatives are you planning to implement regardless of DSRIP? How can DSRIP bolster these initiatives?

3. What current competencies can you build on?

4. How will you need to transform in the post-ACA environment?

Considerations when choosing projects

14

4.What is your ambulatory strategy?

5.How can DSRIP help you coordinate care and bridge to long-term care, home care and community-based care providers (socio-economic and culturally relevant demands)?

– DSRIP not only provides funding to implement needed change, but the ability to create sustainable programs that benefit the organization and community

– Organizations anticipate seeing long term financial gain from investment in DSRIP participation

Considerations, cont.

15

Copyright © 2014 COPE Health Solutions. All rights reserved

Contact Information

Allen Miller• [email protected]• (213) 259-0245

Howard Springer• [email protected]• (206) 310-5275

16

State of Reform Panel: Strategies and Challenges Facing Today’s Hospitals

January 7, 2016

Mark C. Adams, MDChief Medical OfficerCHI Franciscan Health

/

Who We AreHospitals

• St. Joseph Medical Center, Tacoma• St. Francis Hospital, Federal Way• St. Clare Hospital, Lakewood• St. Elizabeth Hospital, Enumclaw• St. Anthony Hospital, Gig Harbor• Highline Medical Center, Burien• Harrison Medical Center,

Bremerton & Silverdale• Regional Hospital, Burien

/ 19

Who We Are Medical Groups

• Two large medical groups– Franciscan Medical Group

• Clinics in Pierce, King, and Kitsap counties– Harrison HealthPartners

• Clinics throughout Kitsap, Mason, Jefferson and Clallam counties

• Hospice and Palliative Care– In-home and inpatient care– One of largest programs in the country– Includes 20-bed Franciscan Hospice House

• Only such facility in South Sound

New Employee Orientation

/ 20

• 11,847 employees • 2,140 medical staff members• Hospital facts:

– 336,061 emergency visits– 689,766 outpatient visits– 43,620 surgeries– 8,439 babies delivered

• FMG and HHP visits: 1,312,341

New Employee Orientation

Who We AreCHI Franciscan Health

New Employee Orientation/ 21

Challenges

• Understanding and preparing for population health management in a fee for service volume based environment

• Investing in an uncertain future while margins are shrinking

• Balancing consumerism and continuum of care

• Standardization and reducing variation


Strategies

• Separate volume based strategy from value based strategy

• Rationalize services

• Leverage technology

• Incentivize value based metrics


Clinically Integrated Network

• Align incentives with providers

• Provider driven

• Provider selection

• Data analytics

• Maintain financial discipline

UW MEDICINE │ PATIENTS ARE FIRST

STRATEGIES AND CHALLENGES FACING TODAY’S HOSPITALS

DANA KYLES, MS, RNADMINISTRATOR

HARBORVIEW MEDICAL CENTER

2016 WA STATE OF REFORM HEALTH POLICY CONFERENCE

JANUARY 7, 2016

HARBORVIEW MEDICAL CENTER

• Owned by King County & managed by the University of Washington• Licensed as a 413 bed acute care hospital - operates at 90%

occupancy• Over 18,000 inpatients per year• Over 15,500 surgical procedures per year• 4,700 FTEs all are UW employees• All physicians are UW Physicians• Strives to operate on a break-even or 1% margin, provided $168

million in charity care (2014)• National leader in quality & patient safety. Ranks 2nd nationally on

the Quality & Safety Scorecard for academic medical centers• Completes approximately $25M per year in performance

improvement initiatives to remain financially viable and reduce the costs of care, while delivering quality care to the most vulnerable in our community

UW Medicin

e

Harborview Medical

Center and

associated clinics

University of Washington

Medical Center and associated

clinics

Northwest Hospital &

Medical Center

and associated

clinics

Valley Medical

Center and

associated clinics

UW Neighborhood Clinics

UW Physicians

UW School of Medicine

Airlift Northwest

UW MEDICINE: MISSION TO IMPROVE THE HEALTH OF THE PUBLIC

OPPORTUNITIES

• Improving the health of the public as payment systems undergo changeo Bundling of acute and post‐acute payment is among

the most significant changes in healthcare reformo In a bundled payment system, development of a model

system of shared financial and outcome risk is critical.o Must guarantee access to beds, and include mutually

agreed upon outcome and LOS targets. o Patients must be returned to the system if they need

further careo PAC provider must receive fair payment.

• Post Acute Care has become particularly challenging in that:o Growing number of patients require PAC often in

a variety of settingso Increase in the number of patients who no longer

meet inpatient hospital criteria, but cannot be discharged to an appropriate PAC setting.

o Health reform has expanded the number of patients covered for acute care, but additional complexity for post acute care options under different coverage options (managed care, State and private insurers.)

OPPORTUNITIES

28

STRATEGIES - ONE EXAMPLE

• UW Medicine Regional Burn Center o WWAMI region – ¼ USA land masso 22 acute care beds o 18 intensive care unit bedso Burn/Plastic Surgery Outpatient Clinic -

5,020 visits 2013o 1 of 64 verified burn centers in North

Americao Admits 750-1,000 patients annually (1/3

children)

STRATEGIES

• Increasing short-stay hospital admissions for patients with non life-threatening burns (requiring ≤ 2 hospital days)

• Historically, admitted to the hospital for wound care, pain management, physical and occupational therapy, and teaching

• To decrease unnecessary admission, started 24/7 Fast Track Program for patients who have the following:o Small superficial burn (<5%) that needs minor

debridement and wound care teaching o Can be discharged home with Clinic follow up visito Uncomplicated social situation

STRATEGIES

• Better healthcare for patients (quality, safety, experience) o Limited resourceso Reduce readmissionso Continuum of care

• Better health for populations o Telemedicineo Washington NOT a member of the Nursing

Licensure Compact, under which any RN/ARNP with a license from a Compact state may practice in any other Compact state.

STRATEGIES

• Reduced costso Utilization of existing expertise and resources

outside of the emergency departmento providing 24/7 resource without increasing

positions within nursing or therapy (occupational or physical therapists)

• Continuing Care Hospital combines all hospital‐level PAC into a virtual continuum of care that would facilitate patient transition and treatment within one post‐acute venue.

CONCLUSION

• Keys to success include corporate leadership, physician buy‐in, integrated information and case‐management systems, quality and outcome metrics, and financial systems that align incentives across all entities.

• Most critical for success is the development of systems that pay for value, not volume, by rewarding both near‐term and longer‐term outcomes.

• Health care reform embraces many of these elements by offering new tools and incentives for innovation and best practice across the acute and PAC continuum of care.

strategies and challenges facing today’s hospitals state of reform conference january 7, 2016

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