Clinical Program Cost Leadership Improvement

Transcription

1 Clinical Program Cost Leadership Improvement December 2017 Presbyterian recently developed a rapid-cycle process for integrating sustainable cost and quality improvements within clinical programs. Population Health teams partner with clinical program leaders to develop and implement strategies to reduce costs that are linked to clinical variances. The Essentials Population Health conducts an analysis of clinical cost data to identify clinical variation and highlight opportunities for streamlined spending. Targeted clinical variances can be reduced in a relatively short period; an action plan is associated with an 8-week timeline. As a value-based initiative, the goal of this process is to reduce healthcare costs while maintaining or improving quality. Impact The Clinical Program Cost Leadership Improvement process is designed to identify opportunities to reduce clinical variation, decrease average cost per case, optimize utilization, eliminate waste, improve quality, and provide value-based care. Lowering the total cost of care for our patients and making healthcare coverage more affordable for our members aligns with Presbyterian s strategic goal of Cost Leadership, which is part of the Triple Aim. What We Know About Cost Leadership Improvement Achieving excellence in quality and cost is a continuous process that requires iterative planning, executing, and monitoring of cost leadership strategies. Care delivery systems use a variety of strategies to cut costs while improving care quality in their service lines. Whatever the model, the goal is the same to use evidence-based medicine to create metrics, protocols, and care pathways that reduce unwanted variations in care and improve patients experiences and outcomes. That work, in turn, lowers costs by reducing lengths of stay, complication rates, and readmission rates. The end result is value, which opens the door to participating in new payment models, such as accountable care organizations, global pricing, and payment bundling (e.g., the CMS Comprehensive Care for Joint Replacement model). Some services lend themselves more easily to value management because they have comprehensive quality metrics that providers have experience using, and because they represent a large portion of health care spending. These services include cardiovascular surgery, interventional cardiology, orthopedics, stroke, Points of Contact: Pete Vlaovic Executive Director, Population Health pvlaovic@phs.org Anita Smith, PMP Director, Population Health, PMO asmith@phs.org 2017 Presbyterian Healthcare Services 1

2 and some cancers. Focusing cost leadership within service lines has proven successful in some hospitals. When it comes to reducing costs, not every service line or clinical program is the same. Size, clinical complexity, reimbursement models, and access to information influence each program s ability to drive improvement. For example, Orthopedics may focus on the cost of supplies and implants as their first opportunity for improvement. In contrast, Heart and Vascular may look at procedures to change practice from open surgery to minimally invasive techniques. Each decision is based on clinical indications and outcomes and is further informed by cost. Analyzing costs associated with episodes of care as well as improved costing methodology have enabled the service lines in some hospitals to better understand the true cost of care. Data-analytics can show cost by unit, episode, and provider, allowing clinical leaders to engage physicians in meaningful conversations that can help them understand cost drivers, identify operational and clinical variation, and create a culture of accountability and continuous improvement. How Presbyterian s Clinical Program Cost Leadership Improvement Works Clinical Program Cost Leadership Improvement is a value-based initiative supported by Presbyterian s Population Health department. This clinician-led operating model examines clinical variation and strives to standardize clinical practices around best practice, which not only improves the quality outcomes and experiences but also reduces costs. An improvement project commences when medical cost analysts provide program leaders with reliable cost and variance data from which they can set variance targets and devise an action plan. Project Management assists by scheduling the action plan according to an 8-week timeline and documenting its results. Value Based Initiative Team The Population Health Value Based Initiative (VBI) team initiates the improvement process by identifying opportunities and compiling data. A standard data package, developed in collaboration with Data and Analytics as well as clinical program leaders, includes cost per case, linked to specific outcomes such as length of stay, readmission rates, mortality rates, and/or infection rates. The analysis shows cost variation linked to risk adjusted outcomes and articulated at various levels, including department, charge or item, and/or physician. External benchmarking is shown for any high cost and/or high utilization items (supplies, labs, drugs, etc.). Supplemental data relevant to a procedure may be exhibited, too. The VBI team presents this standard data package to both clinical and administrative stakeholders for the program (including finance, quality, clinical). Once the clinical program s stakeholders are engaged, the clock begins ticking to accomplish an 8-week improvement cycle. In addition, the team trains the stakeholders regarding cost leadership and the improvement process, and guides the development of achievable action plans. Project Management Team A Population Health Project Manager (PM) is assigned to each action plan. The PM establishes scope and milestones within the timeframe, helps to remove barriers, and provides any other services that can support the progress of the action plan. The PM can also identify challenges, constraints, and risks. The PM facilitates activities throughout the improvement cycle period to ensure documentation, training, and process change are achieved Presbyterian Healthcare Services 2

3 Clinical Program Team The clinical program s activities will vary; program leaders will know what strategies for making change would work best within their program. Leaders will have the opportunity to validate the data package. Moreover, the clinical leaders will know what data makes sense for their program s scope services. They are able to accept or reject data. Governance The outcomes of the clinical program s activities are monitored by the Cost Leadership Governance Committee, chaired by the Chief Medical Officer, PHS, and the Vice President of Operations, PDS. Other members include the Executive Medical Director of PMG, the Vice President of Operations, RDS, the Vice President of Data and Analytics, the Executive Director of Population Health, the Project Manager, and clinical program representatives. This Committee reports cost leadership outcomes to Physician Advisory Council (PAC), Presbyterian Clinical Leadership Team (PCLT), and Presbyterian Integrated Leadership Team (PILT), as appropriate. Process and Responsibilities The following diagram summarizes the stages in the 8-week improvement process: 2017 Presbyterian Healthcare Services 3

4 Additional Roles and Responsibilities CORE TEAM Clinical Program Medical Director Clinical Program Administrator Director of Practice Operations Quality Manager Finance Manager EXTENDED TEAM Analysts Clinical Subject Matter Experts, supply chain, ancillaries, etc. POPULATION HEALTH TEAM Executive Director Subject Matter Expert Project Manager GOVERNANCE Cost Leadership Governance Committee Measures of Success (Responsibilities may be assigned differently from this outline.) Serves as Clinical Champion Communicates with physicians to get buy-in for practice change Serves as Operational Champion Reinforces importance of the work Ensures timelines are met Serves as Operational Owner/Data Super User Drives project Also serves as Data SME; responsible for monitoring, feedback, and course correction Ensures appropriate quality metrics are included as a counterbalance Prioritizes cost savings steps and quantifies action plan Serves as backup Data Super User Gather cost and variance data Serve as Advisers, depending on the findings from Core Team Develops standard data package Trains the Core Team regarding data and process Manages the initiative through the implementation of the action plan Oversees initiatives designed to improve clinical care by reducing inappropriate variation Promotes the application of evidence-based, analytics-driven, sustainable, continuous improvement processes Provides clinical and operational guidance for strategic direction Ensures accountability and removes barriers to progress This cost leadership improvement initiative connects to three objectives within Population Health: Objective Measure Aligns with Aim Achieve targeted Medical Cost Initiatives and targeted cost savings on schedule [To be determined by the program] Cost Leadership Reduce the total cost of care [To be determined by the program] Cost Leadership Reduce medically unnecessary services and encourage appropriate utilization [To be determined by the program] Cost Leadership Better Health These measures are reported to the Cost Leadership Governance Committee Presbyterian Healthcare Services 4

5 Future Work Clinical Program Cost Leadership Improvement cycles are slated throughout Opportunities for cost savings associated with specific procedures will be targeted, including: Heart and Vascular (PCI, CABG, Valve, CHF, and AMI) Surgery (Spine, Hernia) Adult Medical Specialty (Rheumatoid Rx, Pain & Spine) Urgent and Emergent Services (Imaging, other ancillaries) After several iterations of this improvement process within each clinical program, program leaders will become more adept at making data-driven changes, more physicians will be engaged in value-based care decisions, and the delivery system will have established an enterprise-wide model for sustainably lowering costs while maintaining or improving quality. Glossary Cost Leadership Value-based Initiative A primary objective of The Triple Aim (a widely accepted model advocated by the Institute of Healthcare Improvement), Cost Leadership includes Presbyterian s efforts to lower the cost of healthcare delivery by redesigning care models, maximizing process efficiency, and eliminating waste. Through the use of data and analytics, this kind of program identifies cost and utilization reduction opportunities to both lower the total cost of care and improve the quality of care. These initiatives focus on trends, delivery system services, and improvement in population health metrics. Additional References Clinical Care Model Total Joint Replacement 2017 Presbyterian Healthcare Services 5