Improving the health of individuals, families and communities JJ Parsons Presbyterian Healthcare Services Vice President, Business Development & Contracting [email protected](505) 923-8512 Total Quality Management in Health Care Marketing How the Market’s Demand for Quality is Changing!
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Improving the health of individuals, families and communities JJ Parsons Presbyterian Healthcare Services Vice President, Business Development & Contracting.
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Improving the health of individuals, families and communities
JJ ParsonsPresbyterian Healthcare ServicesVice President, Business Development & [email protected](505) 923-8512
Total Quality Management in Health Care MarketingHow the Market’s Demand for Quality is Changing!
Improving the health of individuals, families and communities
Americans are more likely to want a new direction in health care even compared to the situation in Iraq!
Health care
Iraq
Immigration
Foreign policy in places other than Iraq
Family values issues
Global Warming
Trade
39%35%29%22%20%13%10%
Source: Public Opinion Strategies (2007)
Improving the health of individuals, families and communities
Healthcare Needs a Quality Focus
• “The current healthcare system is economically unsustainable and negatively impacting our nation's ability to compete globally.” Craig Barrett, Intel Chairman, 2006.
• The Institute Of Medicine estimates that44,000-98,000 deaths occur annually in American Hospitals due to medical errors.
Improving the health of individuals, families and communities
Market Implications:
1.National and local healthcare reform and legislation
2.Market transparency of quality outcomes
3.Changes in Reimbursement
4. Increase focus by regulators
5. Increased competition by healthcare travel companies
6.Healthcare corporations focused on balanced scorecards
Improving the health of individuals, families and communities
Don’t Try this at Home
“Why are they always pushing quality on us?”
Improving the health of individuals, families and communities
1. National & Local Healthcare Reform & Legislation
• Massachusetts – 2006 - First state to require health insurance
• New Mexico– Governor Richardson seeking healthcare
coverage expansion but outlook in Legislature is uncertain
Improving the health of individuals, families and communities
Insurance: National Scene
•Rising healthcare costs•Evolving consumer role & interests•Importance of technology•Increasing government
involvement•Increasing focus on quality &
customers •Consolidation
Improving the health of individuals, families and communities
Improving the health of individuals, families and communities
Insurance: New Mexico Market - Overall• Increasing role of government
including legislative bill and restrictions on profit levels of health plans
• Higher percentage of individuals covered under government programs; lower reimbursement for these programs increase rate for Commercial market
Improving the health of individuals, families and communities
Physicians/100,000 Population: New Mexico
3858
3186
1954.601832.28
197.4
173.8
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2001 2006
Year
Nu
mb
er o
f A
ctiv
e P
atie
nt
Car
e P
hys
icia
ns
160.0
165.0
170.0
175.0
180.0
185.0
190.0
195.0
200.0
NM
Po
pu
lati
on
(in
0's
)
Number of Active Patient Care Physicians NM Population (in 0's) Physicians per 100,000 Population
Source: US Census Bureau & Center for Health Workforce Studies
Improving the health of individuals, families and communities
2. Market transparency of quality outcomes Who are the audiences for health
performance information?
Consumers…use this information at various points of interaction with the health system, from the time they choose a health plan to the point of selecting a health care provider for a specific service.
Employers/Purchasers…want information to use in selecting from among various health plans, including the cost and outcomes of providers and quality standards.
Improving the health of individuals, families and communities
Transparency (continued)
Health Plans…want to evaluate the price and quality of all physicians, hospitals, and other providers. May also want to benchmark their performance on service and quality measures to their competitors.
Providers…Hospitals, physicians, and other health care providers would benefit from more transparent price and quality information as a feedback loop for improved performance efficient or effective referrals.
Policymakers…Federal/state officials for oversight and monitoring of provider and health plan performance.
Improving the health of individuals, families and communities
Improving the health of individuals, families and communities
Quality in Healthcare: Performance Scores (continued)
Improving the health of individuals, families and communities
Response: Demand for Increased Transparency
• Cost (IRS Form 990)– Collection practices– Community benefit– Tax-exempt status
• Quality– IHI: “5 Million Lives Campaign”– Leapfrog: 27 Safe Practices– Never Events– Regulatory
Improving the health of individuals, families and communities
3. Changes in Reimbursement: CMS Halts Payments for Never Events
• CMS – “The right care, for every patient, every time.”
• October, 2007: 1st step toward preventing Medicare from paying hospitals for costs of treating a patient who acquires specific conditions during hospitalization.
• “Never Event” Examples:–Objects left in surgery–Catheter-associate urinary tract infections–Decubitus ulcers
Improving the health of individuals, families and communities
4. Increased focus by regulators: Transparency of Patient Satisfaction Data
As stated by CMS and AHRQ:• “HCAHPS is a tool to be used for public reporting
of major areas of hospital performance to support consumer choice”
• “HCAHPS is not a stand-alone quality improvement tool”
HCAHPS presents the symptoms—additional measurement is needed to make a diagnosis and improve.
Hospital Consumer Assessment of Healthcare Providers and Systems
Improving the health of individuals, families and communities
Transparency of Patient Satisfaction Data• Consumers will have access to the data
– Consumers will relate more easily to HCAHPS than to clinical data
– Some will use HCAHPS data to choose hospitals– Will have volume, revenue, and reputation
implications• HCAHPS will be in the public eye
– Media coverage– Promotion by hospitals themselves
• Reported for consumers on Hospital Compare Web site (www.hospitalcompare.hhs.gov)
• Typical public report data are shown as frequencies– Hospital performance frequencies– National and state average performance
Improving the health of individuals, families and communities
Transparency of Patient Satisfaction DataPublic reporting will include the following six
domains (March 2008):• Communication with Doctors• Communication with Nurses• Responsiveness of Hospital Staff• Pain Control• Communication about Medicines• Discharge InformationThe following four questions will also be
reported:• Cleanliness of Hospital Environment• Quietness of Hospital Environment• Overall Rating of Hospital• Recommend Hospital
Improving the health of individuals, families and communities
Don’t Speak in “Quality-ese”
“It’s a vice-president thing, Berger.You wouldn’t understand.”
Improving the health of individuals, families and communities
5. Increased competition by healthcare travel companiesMedical Tourism Plans Blossoming Around the country
• Why?– Reduced costs
• Ex: Open Heart Surgery in US: $100,000 Wockhardt, India: $7,500
- Way in which patient Treated• Care outside medical services includes: gourmet
meals; laundry services; quality of room; hotel suite like room
• Access to physician call phones
- Opportunity to see new part of the world: “vacation” - Access to procedures not yet approved by FDA Source: ForbesLife
Improving the health of individuals, families and communities
2007 Theme: Every Patient, Every Member, Every Time
2007 Vital Few Create process and information infrastructure changes to:Objectives: – Improve outcomes of the Patient Care Process (access, throughput, satisfaction, safety) – Reduce cost per member and cost per unit of service
Improving the health of individuals, families and communities
Presbyterian serves to improve
the health of individuals,families and communities.
We value clinical and service excellencethrough:-- People helping people -- Stewardship -- Integrity -- Honest, caring relationships
-- Totality of health: body, mind and spirit.
Sense of Mission
Sense of Mission
To benefit patients and members,Presbyterian is dedicated to national excellence by theachievement of 3 Things:
C.A.R.E.S.
To earn from eachcommunity served:
Dear Pres byterian:You were born and ra is ed here because we neededa p lace for hea ling and car ing. A s we grew and changed, you have grown wi th us. Y ou s erv e each ind ividual and fami lywith compassion and sensi tivi ty . By your exam ple, you teach us to take better care of ourse lves. We are wil ling partner s wi th you in making our communi ties better p laces to l ive . You have met the cha llenge of m aking your ser vices ac cess ib le, affor dable, and accountable to the c omm unity. It’s no wonder you are r ecogn ized nationally fo r heal thcare excel lenc e. We are proud to cal l you our own.
Comm unities Throughout the S outhwest
1 . Malcolm Baldrige Quality Award - c ontinuously improv eprocesses to produce nationally excellen t c lin ic al, servic eand business res ul ts .
2 .Top 10% in Patient Safet y - create the safest poss ib le envi ronment for those who place thei r tr ust in us.
3 . “AA” Rating - control expenses while growing our business to sus ta in positiv e financia l
perform ance and to fund excellence.
Or iginal Board Ap proval 12 /9 5 3rd Revision Adopted 10/22/02
To benefit patients and members, Presbyterian
is dedicated to national excellence by the achievement of 3 Things:
1.Malcolm Baldrige Quality Award - continuously improve processes to produce nationally excellent clinical, service and business results.
2.Top 10% in Patient Safety - create the safest possible environment for those who place their trust in us.
3.“AA” Rating - control expenses while growing our business to sustain positive financial performance and to fund excellence.
To benefit patients and members, Presbyterian
is dedicated to national excellence by the achievement of 3 Things:
1.Malcolm Baldrige Quality Award - continuously improve processes to produce nationally excellent clinical, service and business results.
2.Top 10% in Patient Safety - create the safest possible environment for those who place their trust in us.
3.“AA” Rating - control expenses while growing our business to sustain positive financial performance and to fund excellence.
Improving the health of individuals, families and communities
PHS Baldrige Journey Timeline
2006
Plan from self-assessment
Zia application completion
QNM Roadrunner Recipient
49 QNM Examiners
Achieve MBNQA Consensus Stage
NMQA Zia Award Recipient
40 QNM Examiners
One MBNQA Examiner
Training
Define customers and requirements
Key core process identification
Organizational Profile
Self Assessment
Four areas of focus
2002 2003 2004 2005
MBNQA Site Visit
25 QNM Examiners
One MBNQA Examiner
MBNQA Site Visit
Two MBNQA examiners: One senior
26 QNM Examiners
2007
Focused on Key Learnings
49 QNM Examiners
1 MBNQA Examiner
Improving the health of individuals, families and communities