3/31/2017 1 The Future of Heart Failure Care Delivery Innovating to Reduce Potentially Preventable Readmissions Angie Schadler, DNP, MHCDS, ARNP University of Iowa Health Care AAHFN HF Readmission Symposium: Navigating Transitions in Care April 8 th , 2017 Disclosures • No financial disclosures • Completed Master’s of Health Care Delivery Science Degree through Dartmouth 1/2016 Health Care Policy: What do we know? • We need to reduce cost and provide high value health care – High risk patients – Care coordination – Readmission reduction – Quality improvement – Process improvement – Multidisciplinary team management – Bundled payments
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The Future of Heart Failure Care Delivery
Innovating to Reduce Potentially Preventable Readmissions
Angie Schadler, DNP, MHCDS, ARNPUniversity of Iowa Health Care
AAHFN HF Readmission Symposium: Navigating Transitions in Care
April 8th, 2017
Disclosures
• No financial disclosures
• Completed Master’s of Health Care Delivery Science Degree through Dartmouth 1/2016
Health Care Policy: What do we know?
• We need to reduce cost and provide high value health care– High risk patients
– Care coordination
– Readmission reduction
– Quality improvement
– Process improvement
– Multidisciplinary team management
– Bundled payments
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US Health Care
Outcomes of the U.S. health care system
An estimated $750 billion, or as much as 30% of all U.S health care expenditures
Arundel, The American Journal of Medicine, 2016; Bahtia, The American Journal of Medicine, Volume 128, Issue 7, 2015, 715–721; Sanam, The American Journal of Medicine, 2016.
Mortality and Readmission
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Roth et al. Journal of the American College of Cardiology, Volume 67, Issue 9, 2016, 1062–1069
GDMT Prior to ICD Implant Variation
What do we do?
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Where Are Avoidable Costs?
• GMDT• Variability
– Process Assessment– Process Improvement– Standardization of care– Reduce silos
• Quality– Data analytics– Real time reporting– Quality improvement– Integrate care within and outside organizations
• Highest-cost patients– Hot-spotting– Care management/home care/community
• Effective – evidenced based• Patient centered – focused on
needs and rights of patient• Timely – avoidance of delays
and barriers to patient care flow
• Efficient – elimination of waste• Equitable – fair access to
comparable health care services for all
You cannot manage what you do not measure!
Creating Value thru Innovation
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StandardizationStandard work is a written description of the safest, highest quality and most efficient way to perform a task.
Benefits of standardization:• Clearly defines specific steps• Captures best, safest practices• Reduces variation• Increases consistency• Applies to all settings• Easy to recognize deviation of the norm• Allows for cross-coverage
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Waste
By standardizing care processes and utilizing/applying analytics, variation is noted and non-value added activities are removed from the process
• Increases capacity to perform primary functions
• Saves time by eliminating non-value added activities
• Decreases cost of providing care
Physician focus on outcomes rather than productivity
Daily Time Requirement Address Patients’ Needsto
Controlled
Uncontrolled
Camden Coalition
• Dr. Jeff Brenner, Camden, New Jersey• Camden, New Jersey
– 60% of residents on public assistance– 1/3 live below the poverty line– 2nd most dangerous city in the United States
• Hot-Spotting– Most of the time 80% of costs come from 20% of patients– Data analytics– Chronic Care Management– “The problem in health care, of Band-Aids applied to solve a failure in
complex systems, is that they usually stay stuck-on and become part of the system; and thus runs the fundamental question: “Do you keep adding Band-Aids on top of a wound, or do you really fix healthcare?” Jeff Brenner, MD
• www.camdenhealth.com
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Shouldice Hernia Repair
• Canadian based
• Hospital just for hernia repairs
• Costs including travel 1/3 of normal costs
• Outcomes
– Lower surgical complications
– Improved functional capacity
– Decreased risk of hernia recurrence
Does LEAN Work in Healthcare?
• Group Health of Puget Sound reduced E.R visits by 29% using their medical home redesign at the same time reducing hospital readmissions by 11%
• Akron children’s Hospital reduced cost by $8 M while reducing appointment access wait times by 74,600 days using LEAN
• ThedaCare’s redesigned inpatient Collaborative Care unit has achieved 0 medication reconciliation errors for 4 years running and the cost of inpatient care dropped by 25% www.createhealthcarevalue.com
• Henry Ford reduced infections rates, falls, and medication errors in 2010 resulting in a $4.4 M improvement
• Mercy North Iowa has achieved zero blood specimen tube labeling error for over a year
• Seattle Children’s Hospital avoided $200M in capital expense by freeing capacity with continuous process improvement
• Patient from beginning to end of disease process
• Self-Management
• Delivery system design
• Decision Support
• Clinical information systems
• Health System
• Community
Cawley J. The Permanente Journal. Summer 2011; 15(3); 37-42
Maine Heart Failure System of Care
• Maine’s system– Improvements– Enhanced communication and integration– Improved outcomes
• Home health• Readmission rates• Medications
– Efficiency • Improved access• Standardization of patient education and clinician education• Decrease number of meetings• Decrease duplication of services
Cawley J. The Permanente Journal. Summer 2011; 15(3); 37-42
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Amber E. Johnson et al. American Journal of Medical