ML13 Designing Innovative Care Models to Drive Down Cost and Improve Outcomes Terry Platchek, MD Brian Brady, MD December 2017
Learning Lab Objectives Identify key curriculum tenets of teaching healthcare delivery redesign Learn from our example about common roadblocks to implementing a value-based health care curriculum Take away pragmatic, implementable approaches to use design thinking in your own career These presenters have nothing to disclose
Disclosures Stanford s Clinical Excellence Research Center receives grant funding from The Peterson Center on Healthcare, a nonprofit organization established by the Peter G. Peterson Foundation. Infographics from the Peterson Foundation are used in this presentation.
Healthcare Spending Outpacing GDP Projected Tax Revenue (%GDP)
Annual Percent Change The Healthcare Spending Tapeworm What s the Problem? 8 7 6 5 4 3 2 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 Per Capita Health Spending GDP per capita Data from: Kaiser Family Foundation analysis of Medicare spending data from Boards of Trustees; private health insurance spending data from the CMS National Health Expenditure data; GDP data from BEA (historical) and CBO (projected), and CPI data from the BLS (historical) and CBO (projected). 2017 A. Milstein/Stanford Univ 2
Our Burning Platform
Our Jedi Master
CERC Healthcare Design Fellowship Founded in 2011 36 graduated design fellows Develop high value care delivery models Plan for pilot testing Better health, less spending
CERC Curriculum
Bootcamp (8/1-9/9) CERC orientation Team building 5 weeks of Speakers (~3 per day) Curricular Tracks Societal Demand Healthcare Economics and Policy Efficiency Frontier Tools for Innovation Design Resources Industry Knowledge Care Model Specifics Design Thinking course Deliverables Debrief top 3 take aways after each speaker Start literature review with particular attention to costs Top 5-10 opportunities to lower cost learned in bootcamp Literature Review (8/14-9/26) Review most up to date clinical care Understand major costs of care to determine inflection points in the cost curve Identify price for performance frontier sites Deliverables Lit Review drafts Final presentation Brief Clinical summary 80% focus on cost of care analysis including cost reducing interventions 20% focus on Quality and Experience Identify value frontier organizations Top 5-10 opportunities to lower cost CERC Design Fellowship Year Observation (9/20-10/25) Scheduling clinical sites (starting in August) Additional sites identified and scheduled based on literature review Instruction in triple aim observation approach Deliverables Key site visit take away s Needs finding using disguster approach Operations map Cost burden map Obs. report presentation Input Synthesis & Model Needs (10/23-10/31) Categorize Inputs to model needs Separate higher order from lower order needs Assign relative weights and rank Deliverables Distill top 5-10 needs Patients Clinicians Society Model Input synthesis defining opportunities which will drive concept refinement Concepts (11/1-11/15) Brainstorming phase Generate large number of concepts addressing the triple aim Select top concepts Early Dec Financial Modeling Framework sessions Rapid prototyping Process diagrams Feedback from users, payers, stakeholders Deliverables Prioritized list of concepts Top concepts with effect on triple aim Care model Iteration & Cost Modeling (11/30-3/23) Arrange concept elements into care model Prototype model components and iterate Cost modeling Deliverables One page care model summary diagram Into to Cost Modeling Session Second Cost Modeling Session 2 nd prototype 3 rd prototype Cost Modeling Discussion 4 th prototype with cost estimates 5 th prototype Final presentation with cost modeling IVP (4/2-6/30) Identify leads Qualify prospects Prepare and Present Negotiate agreement if applicable Deliverables Mock IVPs Stoke interest Identify Credible Sites Model paper (3/1-6/20) Identify target journal Plan authorship Abstract and Methods Outline Figures Deliverables 1 st draft 2 nd draft Completed Model Paper Implement ation Guides (4/2-6/13)
Training Tomorrow s Value Leaders
Learning Lab Plan Condense 11-month fellowship into three hours! Teams of 8-10 develop care redesign models Present on Cost Drivers/Opportunities Present Models
Outline for Learning Lab Bootcamp > Videos from CERC Literature Review -> Cost Drivers Teams Present on Cost Drivers/Opportunities Literature Review -> Innovative Solutions 30-min break Teams Present Redesign Models
The Prescription Medication Problem
From: The High Cost of Prescription Drugs in the United StatesOrigins and Prospects for Reform JAMA. 2016;316(8):858-871. doi:10.1001/jama.2016.11237 Figure Legend: Per Capita Spending on Prescription PharmaceuticalsData are derived from the Organisation for Economic Cooperation and Development (OECD), reflect expenditures in 2013 (or the nearest year), and include all countries for which values were reported. Data used with permission from OECD, Health at a Glance 2015: OECD Indicators, 2015. Date of download: 11/24/2017 Copyright 2016 American Medical Association. All rights reserved.
How can we use prescription medications more effectively to lower total per capital health spending?
Part 1 Cost Drivers and Opportunities
Bootcamp View 4 video clips Individually debrief top 2-3 takeaway points following each video Team debrief following all videos to extract top 4-5 takeaway points
Bootcamp Video 1
Bootcamp Video 2
Bootcamp Video 3
Bootcamp Video 4
Team Debrief Bootcamp Videos Cost Drivers and Opportunities
Literature Review What are the cost drivers in the pharmaceutical realm? Where are the opportunities to improve how we prescribe or take medications? How do we pay for medications in US? How are formularies designed? How do other countries pay for medications?
Deliverable #1 Cost Drivers and Opportunities
Part 2 Building the Model
Literature Review All team members read abstract Individuals read full articles assigned to them
Literature Review How can we prescribe medicines better? How can we improve medication adherence? Can medications be priced according to value? Can we use fewer medications? Can we use medications in a more effective way?
Deliverable #2 Care Re-Design Models
Thank You