October 2016 Innovative Approaches on our Journey Toward Improving Care, Value, and the Health of Populations Trissa Torres, MD, MSPH, FACPM Chief Operations and North America Programs Officer
Changing the World
About IHI Our Mission To improve health and health care worldwide. Our Vision Everyone has the best care and health possible. Who We Are IHI is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide.
World Map of Triple Aim Teams Since 2008 Whittington, John, Kevin Nolan, Ninon Lewis, and Trissa Torres. "Pursuing the Triple Aim: The First 7 Years." Milbank Quarterly 93.2 (2015): 263-300.
Where My Experience Comes From http://www.commonwealthfund.org/publications/case-studies/2010/jul/genesys-healthworks.aspx http://www.commonwealthfund.org/publications/case-studies/2010/jul/genesee-health-plan.aspx
Lonely World
Payment Reform: Affordable Care Act (ACA) President Obama signs the Affordable Care Act. (3/23/2010) Bring Down Health Care Premiums (1/1/11) Encouraging Integrated Health Systems &Launch of ACO Pioneer Program (1/1/12) Improving Preventative Health Coverage & Launch of SSP ACO model (1/1/13) Prohibiting Discrimination Due to Pre-Existing Conditions or Gender (1/1/14) 2010 2011 2012 2013 2014 HHS to tie 90% of all traditional Medicare payments to quality or value by 2018 Prohibit Denying Coverage of Children Based on Pre-Existing Conditions (9/23/2010) Provide Free Preventative Care (9/23/2010) Increase Access to Services at Home and in the Community (10/1/1/11) Understanding and Fighting Health Disparities (3/1/12) Open Enrollment in the Health Insurance Marketplace Begins (10/1/13) Establishing the Health Insurance Marketplace (2014) Source: U.S. Department of Health and Human Services
Being a Leader During Tumultuous Times
Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, health, and cost. Health Affairs. 2008 May/June;27(3):759-769 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.
Determinants of Health and Their Contribution to Premature Death Proportional Contribution to Premature Death Genetic predisposition 30% Social circumstances 15% Environmental exposure 5% Health care 10% Behavioral patterns 40% 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.
Population Health David Kindig and Greg Stoddart. What Is Population Health? American Journal of Public Health March 2003: Vol. 93, No. 3, pp. 380-383.
More Stats Maryland United States Uninsured (%) 7% 9% Could not see a doctor because of cost (%) 10.1% 14.3% Adults without a usual place of medical care (%) 14.6% 17.3% Cancer incidence (per 100,000 people) 451 439 Adult smokers (%) 14.6% 17.4% Adults reporting illicit drug dependence/abuse in past year 2.7% 2.6% Kaiser Family Foundation- http://kff.org/statedata/
Changing Healthcare Context Fee for Service Pay for Performance Shared Savings Shared Risk Global Payment Focus on Individuals Individuals and Populations Individuals, Populations and Communities Care Care and Cost The Triple Aim Do to Do for Do WITH
Approach to Triple Aim for Populations Choose a relevant Population for improved health, care and lowered cost Conduct a needs and Assets Assessment Design or Redesign Services to meet the needs of the population Develop a Portfolio (group) of projects that will yield Triple Aim results Create a Learning System and Measures that will show improvement for the population Build a Team of individuals who can manage this work Use Improvement Methods to drive results Develop a brisk and realistic plan for Execution and Scale Whittington, John, Kevin Nolan, Ninon Lewis, and Trissa Torres. "Pursuing the Triple Aim: The First 7 Years." Milbank Quarterly 93.2 (2015): 263-300.
What Matters I miss my family. It s scary when I can t breathe. Sometimes I m just too tired to go to the doctor.
What Matters If only someone could check on her. I know what she needs, but not how to help her. I don t have the time or the resources.
What might Care Redesign look like? EMS implements shared protocol to treat instead of transport if appropriate Physician s office staff ask church members to visit Care manager checks on her regularly Her son gets her a tablet and sets up Facetime
Leverage Improvement Science to Drive Change Build a Ramp Model A P S D Changes That Result in Improvement Hunches Theories Ideas A P S D Additional reference material: www.ihi.org/resources/pages/audioandvideo/ MikeEvansVideoQIHealthCare.aspx
Pathways Community Hub Partnering with Community Services Source: The Pathways Community HUB Model
Percent of LBW Births Pathways Community Hub 10 Low Birth Weight Rates in Ohio and Richland County: 2005-2008 9.5 9 8.5 Richland Ohio 8 7.5 7 2005 2006 2007 2008 Source: The Pathways Community HUB Model
Coordinated Resource Delivery Partnering with the Postal Service Source: http://www.commonwealthfund.org/interactives-anddata/infographics/2015/sep/call-and-check
Cure Violence Baltimore Safe Streets Treats violence as an epidemic Greatest risk factor for violence is exposure to violence New role - Violence Interrupters Evaluation of Baltimore s Safe Streets Program. Johns Hopkins Bloomberg School of Public Health, 11 Jan 2012.
Partner to Change Policy: Homeless Moms Source: http://www.homelessprenatal.org/services
Not So Lonely World Lead for the long term while selectively addressing short term pressures Push the edges of our thinking Systematically drive improvement (in what matters to us, our patients and our communities) Partner, Partner, Partner we don t have to do this alone
Let s Be Change Agents Together!