Improving Value: Better Care at Lower Cost
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1 Improving Value: Better Care at Lower Cost MARK D. SMITH MD MBA THE KINGS FUND NOVEMBER 2015
2 Outline 1. Defining terms 2. IOM ( NAM ) Report and its aftermath 3. Radical Redesign 4. The woeful state of our service industry 5. The greatest untapped resource
3 But first, a disclaimer
4 Value = Quality Cost
5 What is quality to a patient/customer? 1. Clinical quality (often assumed) 2. Service Quality Communication Empathy Convenience Personlization Responsiveness
6 Efficiency ef fi cient əˈfishənt/ adjective (especially of a system or machine) achieving maximum productivity with minimum wasted effort or expense.
7 Peter Drucker There is nothing so useless as doing efficiently that which should not be done at all.
8
9 Broad overview What s changed since Quality Chasm? Complexity and excess costs New tools and levers Continuous learning capacity
10 The vision Moving from the linear
11 The vision From missed opportunities, waste, and harm
12 The vision And best care at lower cost
13 Quality Persistent missed opportunities, waste, and harm Patient harm One-fifth to one-third of hospital patients harmed during their stay, largely preventable. Recommended care Only about half of recommended preventive, acute, and chronic care actually delivered. Outcome shortfalls If care quality matched highest statewide performance, there would have been 75,000 fewer deaths nationally.
14 Category Unnecessary Services Cost Sources of unnecessary health spending Inefficiently Delivered Services Excess Administrative Costs Prices That Are Too High Missed Prevention Opportunities Fraud TABLE S-1 Estimated Sources of Excess Costs in Health Care (2009) Estimate of Excess Costs $210 billion $130 billion $190 billion $105 billion $55 billion $75 billion
15 Computing New tools and levers Capacity changes since 2000 Better connectivity to information and among participants Stronger processing capacity for new knowledge Systems/process improvement strategies spreading with increasing success Patient-clinician culture change strategies in play Policy levers for incentives, transparency, accountability, engagement
16 The Paradox of Innovation in Health Care The past half-century has seen unprecedented knowledge generation and technical innovation in biomedical science; there is much more to come but our systems for choosing, training, deploying, and paying the health care workforce and organizing their work have not kept up with the biomedical science.
17 SOAP Notes, anyone? Any system of care that depends on the personal knowledge and analytic capabilities of physicians cannot be trusted. - Lawrence L. Weed, MD & Lincoln Weed
18 The leading edge(s) Center for Medicare and Medicaid Innovation Center (CMMI)
19
20 The leading edge(s) Center for Medicare and Medicaid Innovation Center (CMMI) Patient-Centered Outcomes Research Institute (PCORI)
21
22 The leading edge(s) Center for Medicare and Medicaid Innovation Center (CMMI) Patient-Centered Outcomes Research Institute (PCORI) Health Care Payment Learning and Action Network (LAN)
23
24 The leading edge(s) Center for Medicare and Medicaid Services Innovation Center (CMMI) Patient-Centered Outcomes Research Institute (PCORI) Health Care Payment Learning and Action Network (LAN) Private Sector innovation
25
26 New Rules for Radical Redesign in Health Care IHI Leadership Alliance Change the balance of power Standardize what makes sense Customize to the individual Promote wellbeing Create joy in work Make it easy Move knowledge, not people Collaborate and cooperate Assume abundance Return the money
27
28 Eliminating Low-value care
29
30 Primary Care: Physicians vs. Capacity
31 Physician shortage
32
33 How bad are we?
34 Banking
35 Travel arrangements
36 Research
37 Medical Consultation
38 The greatest untapped resource for high-value care: Patients (with enabling technology)
39 Strep throat
40 Anticoagulation
41 Hypertension
42 Dialysis
43 A time for experimentation In theory there is no difference between theory and practice. In practice there is. - Yogi Berra (maybe)
44 Wonk World Manager World Real World
45 Transition turbulence: One foot in the canoe and one on the dock
46 Outline 1. Defining terms 2. IOM ( NAM ) Report and its aftermath 3. Radical Redesign 4. The woeful state of our service industry 5. The greatest untapped resource
47 Thank you!
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