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Strategically Pursuing the Triple Aim at St. Charles Health System Trissa Torres, Senior Vice President, IHI

AHA Webinar

September 11, 2014

Definition

System designs that simultaneously improve three dimensions: – Improving the health of the populations; – Improving the patient experience of care (including quality and

satisfaction); and – Reducing the per capita cost of health care.

Global Triple Aim Participants

Triple Aim Populations

• Defined Populations: A defined population that makes business sense (e.g. who pays, who provides) around the Triple Aim

• Community-Wide Populations: Working in a geographic area to accomplish the Triple Aim for the community

Triple Aim

Results

Defined Populations

Community-Wide

Populations

Determinants of Health and Their Contribution to Premature Death

Social circumstances

15%

Environmental exposure

5%

Health care10%

Behavioral patterns

40%

Genetic predisposition

30%

Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78-93.

Proportional Contribution to Premature Death

Potential Triple Aim Population Outcome Measures (6/2011)

Dimension Measure Population

Health 1. Health Outcomes:

Mortality: Years of potential life lost; Life expectancy; Standardized mortality rates

Health/Functional Status: single question (e.g. from CDC HRQOL-4) or multi-domain (e.g. SF-12)

Healthy Life Expectancy (HLE): combines life expectancy and health status into a single measure, reflecting remaining years of life in good health

2. Disease Burden: Incidence (yearly rate of onset, avg. age of onset) and/or prevalence of major chronic conditions

3. Risk Status: composite health risk appraisal (HRA) score

Experience of Care

1. Standard questions from patient surveys, for example: Global questions from US CAHPS or How’s Your Health surveys Experience questions from NHS World Class Commissioning or

CareQuality Commission Likelihood to recommend

2. Set of measures based on key dimensions (e.g., US IOM Quality Chasm aims: Safe, Effective, Timely, Efficient, Equitable and Patient-centered)

Per Capita Cost 1. Total cost per member of the population per month

2. Hospital and ED utilization rate

Setup for Population Management

1. Choose a relevant Population for improved health, care and lowered cost

2. Identify and develop the Leadership and Governance for a Triple Aim effort

3. Articulate a Purpose that will hold your stakeholders together

4. Develop a Portfolio (group) of projects that will yield Triple Aim results

Population Change Packages • Assess and segment the

population

• Activate the population

• Care for the population

• Address macrosystem factors that will support the population

Delivery of Services at

Scale

Community, Family and Individual Resources

Managing Services for a Population

Feedback Loops

Needs Assessment for

Segment Service Design

Coordination Goals

Integrator

Population Segmentation

Population Outcomes

Feedback Loops

Learning System for Population Management

1. System level measures 2. Explicit theory or rationale for system changes 3. Segmentation of the population 4. Learn by testing: PDSA cycles, sequential testing of

changes 5. Use informative cases: “Act for the individual learn for

the population” 6. Learning during scale-up and spread with a production

plan to go to scale 7. People to manage and oversee the learning system

with periodic review

Activities of a Population Management Learning System

Creating Readiness

Establish Triple Aim as a core part of your business strategy Articulate how the Triple Aim makes business sense Secure the commitment of top leadership Secure other key stakeholders Develop and deploy improvement capability to manage the portfolio of projects and learning system

What does it mean to be Strategic Partners?

Our missions and strategies align We are learning side by side Guide evolution of strategy and plan Access to learning and expertise from around the world Support for building improvement capability across the organization Work together to drive for results and expand impact

Jim Diegel, FACHE, CEO & President Robin Henderson, PsyD, Chief Behavioral Health Officer & VP Strategic Integration

The IHI Journey: Drivers, Aims and a Plan for Population Management

• 2008 - Embracing the Triple Aim • 2010 – Reorganization around IDS/TA • 2012 – Participation in TAIC • 2013 – TAIC + The Conversation Project • 2013 – New Vision/Mission/Values

St Charles IHI Journey

• 2013 – Open School Certificate for all leadership

• 2013 – Strategic Partnership with IHI, Aims, Primary Drivers, Improvement Advisors

• 2014 - Creation of Strategic Improvement Department

• 2014 – Joining IHI Leadership Alliance and founding partner of the 100 Million Lives project

• The Board developed four Strategic Aims: • Each Aim has several identified Primary Drivers • Each Aim has a set of global metrics to measure

progress • With the exception of the first Aim, there are

physician/administration dyads responsible for each Aim

Strategic Aims

STRATEGIC AIM: Independent Market Leader (Jim Diegel)

Secure Independent Market Leader Status Financial Strength / Capital Capacity

Manage Populations

Financial/Clinical Integration

Cost Management / Cost Structure • Financial performance meets Moody’s A2 targets

by year end 2014

• Cost per adjusted patient day decreased by 2% by year end 2014

• Achieve a 2% reduction in per capita medical expenditure trend from July 2013-July 2015

• 100 providers participating in at-risk contracts by year end 2014

• 2 new patient advisory groups activated by year end 2014

Partnership with Patients

PRIMARY DRIVERS

METRICS

STRATEGIC AIM

STRATEGIC AIM: Better Health/Better Value (Jeff Absalon, MD/Karen Shepard)

Manage Populations around the Triple Aim Integrated Data Support

Patient Centered Medical Home

Financial/Clinical Integration

Partnership with Community

Manage Populations

• Achieve a 2% reduction in per capita medical expenditure trend from July 2013-July 2015

• Improve Top box patient satisfaction scores by 2% by year end 2014

• Decrease inpatient utilization of populations by 1% by year end 2014

• Decrease ED visits of populations from 49.4/1000 member months to 44.6/1000 year end 2014

• Increase clinical depression screenings from XX% to XX% by year end 2014*

* 2014 target will be set by Oregon Health Authority in August 2014

PRIMARY DRIVERS

METRICS

STRATEGIC AIM

STRATEGIC AIM: Better Care/Better Value (Michel Boileau, MD/Pam Steinke, RN, MSN)

Improve Quality, Experience, and Value throughout system

Removal of Waste and Cost

Clinical Informatics

Workforce Management

• Improve risk adjusted mortality index measures by 10% by year end 2014

• Improve patient safety index measures by 20% by year end 2014

• Improve risk adjusted complication index measures by 10% by year end 2014

• Improve Top box patient satisfaction scores by 2% by year end 2015

• Cost per adjusted patient day decreased by 2% by year end 2014

Patient Experience

Process Improvement

PRIMARY DRIVERS

METRICS

STRATEGIC AIM

STRATEGIC AIM: Learning and Culture (John Nunes, MD/Nancy Pennell, PhD)

Build a Culture of Self-Awareness and

Continuous Improvement Caring: Reconnect soul and

role in the workplace

Science of improvement: Build capacity and capability

in the workplace

• 100% of managers and above hired after June 2013 complete IHI Open School within 9 months of hire

• 50 improvement projects started between January and December 31, 2014

• 90% of 228 caregivers who began the Soul & Science of Caring (SSoC) program in 2014-Q2 complete it by November 30, 2015.

• SSoC participant retention will be 20% better than overall SCHS caregiver trends.

PRIMARY DRIVERS

METRICS

STRATEGIC AIM

• Primary Drivers align with the Vision and Mission of the hospital

• The Vision is supported by the Mission • Better Health • Better Care • Better Value

• Each primary driver aligns with part of the Mission • The strategic program and projects are detailed for

each primary driver • The projects also have metrics identified in detail on

their dashboards (not included in this presentation)

Vision/Mission Alignment

VISION

BETTER HEALTH, BETTER CARE, BETTER VALUE

PRIMARY DRIVERS:

CARING: SCIENCE OF IMPROVEMENT

REMOVAL OF WASTE AND COST PROCESS IMPROVEMENT CLINICAL INFORMATICS

PARTNERSHIP WITH PATIENTS PATIENT EXPERIENCE PATIENT-CENTERED

MEDICAL HOME

PRIMARY DRIVERS:

INTEGRATED DATA SUPPORT

PARTNERSHIP WITH COMMUNITY

PATIENT-CENTERED MEDICAL HOME

PRIMARY DRIVERS:

FINANCIAL STRENGTH AND CAPITAL CAPACITY

MANAGE POPULATIONS

FINANCIAL/CLINICAL INTEGRATION

PRIMARY DRIVERS: INTEGRATED DATA SUPPORT • Population data management

PARTNERSHIP WITH COMMUNITY • Community health needs • Transform philanthropy

PATIENT-CENTERED MEDICAL HOME • Medicaid management program

BETTER HEALTH

INTEGRATED DATA SUPPORT • Population data management

PARTNERSHIP WITH COMMUNITY • Community health needs • Transform philanthropy

PATIENT-CENTERED MEDICAL HOME • Medicaid Management Program

BETTER HEALTH – Medicaid management program

Better Health Lower Cost Collaborative • Patient access • Patient engagement • Physician

Engagement Behavioral Health Integration in Primary Care

PRIMARY DRIVERS: CARING: SCIENCE OF IMPROVEMENT • Learning and culture

CLINICAL INFORMATICS • Viable clinical data management strategies

FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS • Hospital Strategic Growth PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council

REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service

BETTER CARE

CARING; SCIENCE OF IMPROVEMENT • Learning and culture CLINICAL INFORMATICS • Viable clinical data management strategies

FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS • Hospital strategic growth PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council

REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service

BETTER CARE – Learning and culture

Science of Improvement in Action • Open School • Improvement

Advisors • On-site SIA to

train leaders

CARING: SCIENCE OF IMPROVEMENT • Learning and culture CLINICAL INFORMATICS • Viable clinical data management strategies

FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS • Hospital strategic growth PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council

REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service

BETTER CARE – Hospital strategic growth

Patient Flow project (target start date October 2014)

CARING: SCIENCE OF IMPROVEMENT • Learning and culture CLINICAL INFORMATICS • Viable clinical data management strategies FINANCIAL STRENGTH AND CAPITAL CAPACITY REMOVAL OF WASTE AND COSTS

• Hospital strategic growth

PARTNERSHIP WITH PATIENTS, PATIENT EXPERIENCE • Develop an engaged patient advisory council REMOVAL OF WASTE AND COST, PROCESS IMPROVEMENT • Perioperative center of service

BETTER CARE – Patient Advisory Councils

Patient/Family Advisory Councils

PRIMARY DRIVERS: FINANCIAL STRENGTH AND CAPITAL CAPACITY • Outpatient and strategic growth, SCMG • Harney District EMR • Health Plan Build Out

MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO and

evaluation of management populations FINANCIAL/CLINICAL INTEGRATION • Redesign payment methodologies and incentives for

ambulatory care

BETTER VALUE

FINANCIAL STRENGTH AND CAPITAL CAPACITY

• Outpatient and strategic growth, SCMG • Harney District EMR • Health plan build out

MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO and

evaluation of management populations FINANCIAL/CLINICAL INTEGRATION

• Redesign payment methodologies and incentives for ambulatory care

BETTER VALUE – High risk high cost strategies

Better Health Lower Cost TAIC: • Identification of High

Risk/High Cost (HR/HC) population

• Management of adult Medicaid HR/HC population

Management of Pediatric HR/HC New projects based on data

FINANCIAL STRENGTH AND CAPITAL CAPACITY

• Outpatient and strategic growth, SCMG • Harney District EMR • Health plan build out

MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO

and evaluation of management populations

FINANCIAL/CLINICAL INTEGRATION • Redesign payment methodologies and incentives for

ambulatory care

BETTER VALUE – Viable payment and risk models

Better Health Lower Cost TAIC • CCO Global Budget /

Risk Contract Discrete Population TAIC (2013-14) • Caregiver population

FINANCIAL STRENGTH AND CAPITAL CAPACITY

• Outpatient and strategic growth, SCMG • Harney District EMR • Health plan build out

MANAGE POPULATIONS • High risk high cost strategies • Viable payment and risk models for CCO and

evaluation of management populations

FINANCIAL/CLINICAL INTEGRATION • Redesign payment methodologies and

incentives for ambulatory care

BETTER VALUE – Redesign payment methodologies

Physician Engagement aligned to Triple Aim goals

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