Intermountain’s Journey Kim Henrichsen, RN, MSN Vice President, Clinical Opera2ons and CNO
Jan 17, 2017
Intermountain’s Journey Kim Henrichsen, RN, MSN
Vice President, Clinical Opera2ons and CNO
GETTING TO KNOW INTERMOUNTAIN Who are we?
Since 1975 • 22 hospitals • 2,784 licensed beds
Since 1983 • Health plans • 700,000+ members
Since 1994 • 1,200 employed physicians • 558 advanced pracOce clinicians • 30 Instacare Clinics
Since 1997 • 10 key service lines
Highly Integrated Health System Hospitals
SelectHealth
Medical Group
Clinical Programs
Our Charge: To become a “Model Healthcare System”
OUR M I S S ION Helping people live the healthiest lives possible
OUR V I S ION Be a model health system by providing extraordinary
care and superior service at an affordable cost
GETTING TO KNOW INTERMOUNTAIN How are we doing?
The Intermountain Way Engage paGents & align incenGves
Evidence-‐based best pracGces
SystemaGc approach-‐ measure & improve
OpOmal Outcomes
High Quality Clinical Care Utah Rank
Utah Amount
U.S. Median
Utah Differ.
Healthcare expenditures per capita* 1 $5,031 $6,815 -‐26%
Medicare admits 75 yrs+ / 1,000 beneficiaries 2 42.0 68.0 -‐38%
Medicare 30-‐day hospital readmission rate 3 28.0 45.0 -‐38%
Mortality amenable to healthcare / 100,000 4 62.0 82.0 -‐24%
Home health paOents with hosp. admission 1 14.0 17.0 -‐18%
Source: Commonwealth Fund State Scorecard, April 2014; *Wall Street Journal, April 8, 2013
• There is usually wide variaOon in
clinical pracGce • ObjecOve data measurement will
demonstrate opportunity for improvement
• Performance improves with systemaGc adopGon of best pracOces
• Intermountain’s main physician engagement strategy: OpGmal paGent outcomes
Clinical Program Principles
Our Experience Value Based Purchasing
Intermountain Discharge MedicaOons in 2000
99%95%
91%94%
90%
30%
40%
50%
60%
70%
80%
90%
100%
ASA HmG BB p MI ACE for CHF Coumadin
% Eligible Patients Treated at Discharge with Appropriate Medications
2000 National Statistics
Impact of Intermountain Discharge Med Program on Heart Failure Readmissions/Mortality
ACE inhibitor prescripGon at hospital discharge increased from 65% in 1997 to 95% in 1999-‐2001 and for these IHC heart failure paGents:
• One-‐year readmissions were reduced from 46.5 % to 38.5% • 551 readmissions are prevented per year • $2,480,000 are saved based on avoided readmissions • One-‐year mortality rate reduced from 22.7% to 17.8% • 331 lives are saved per year
CMS Pay for Performance Programs
VBP, Readmission ReducGon, HAC Intermountain Healthcare
Hospital Acquired CondiOons
Value Based Purchasing
Readmission ReducOon Program
FY 2015 9 of 22 (penalty) 1 of 22 (penalty) 3 of 22 (penalty)
FY 2016 9 of 22 (penalty) 2 of 22 (penalty) 5 of 22 (penalty)
Awards & RecogniOon Benefits
Cred
ibility
Strategic Fit Low Low
High
High
Public Quality ReporGng
• Intermountain Healthcare hospitals score very well on some surveys and poorly on others with similar metrics.
• There is variability exisGng even between our faciliGes
• Intermountain was an early leader in core measures, we fell in ranking, not in performance as public reporGng increased
Summary
Closing Thoughts • CMS Pay for Performance metrics are
aimed at improving care for paGents • CMS should conGnue to replace process
measures with outcome measures • OrganizaGons should conGnue to focus
on areas where literature supports improved paGent outcomes
• ConsideraGon should be given to reducing complexity for those delivering the care (and burden of measurement)
Right Thing
Right Time
Every Time