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WelcomeJoint Replacement Learning Community
January 9, 2014
The Charles Hotel, Cambridge, MA
1st In-Person Meeting
Welcome to Boston
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8:00 – 8:30 AM
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Thank you
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Who is in the room? 4
Adventist Medical Center Hospital Alvorada, Brazil Providence Alaska Medical Center
Advocate Health Care Hvidovre Hospital, University of
CopenhagenProvidence Sacred Heart Medical
Center
Central Dupage Hospital of
Cadence Health Jewish General Hospital, Montreal Regional Hospital of Scranton
Connecticut Joint Replacement
InstituteJohns Hopkins Bayview Medical
Center
Sierra Medical Center
Delnor Hospital of Cadence
Health Kadlec Regional Medical Center Straub Clinic and Hospital
Evergreen Health Montefiore Medical Center UMass Memorial Medical Center
Franciscan St. Francis Health -
MooresvilleMoses Taylor Hospital of Scranton University of California, San
Francisco
Gundersen Health System Northside Hospital Forsyth University of Pittsburgh Medical
Center (UMPC)
Hackensack University Medical
CenterNorthwestern Memorial Hospital Wake Forest Baptist Medical Center
Henry Ford Physician Network
from Henry Ford Health SystemOrlando Regional Medical Center Western Connecticut Health
Network - Danbury Hospital
Hoag Orthopedic Institute Palmetto Health
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Icebreaker
Introduce yourself to the other teams at
your table
2014 New Year’s Resolution OR
What you hope to learn from the Joint
Replacement Learning Community over
the next year?
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Annual Number of Joint Replacements 6
0
1
2
3
4
5
6
7
8
9
10
By number of
participating hospitals
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Hospital Type
Community Hospital: 60%
Academic Hospital: 33%
Other: 7%
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Faculty and Staff8
Kayla DeVincentis, CHES
Project Coordinator, IHI
Anila Hussaini, RN, MPH
Director, IHI
Kathy Luther, RN, MPM
Vice President, IHI
Derek Haas, MBA
Senior Project Leader, HBS
Jill Duncan, RN, MS, MPH
Director, IHI
Kevin Little, PhD
Improvement Advisor, IHIRobert Kaplan, PhD
Professor Emeritus, HBS
Sam Wertheimer, MPH
Project Leader, HBS
Kevin Bozic, MD, MBA
Orthopedic Surgeon
Tony DiGioia, MD
Orthopedic Surgeon
Lucy Savitz, PhD, MBA
Intermountain Healthcare
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Faculty and Staff9
Kayla DeVincentis, CHES
Project Coordinator, IHI
Anila Hussaini, RN, MPH
Director, IHI
Kathy Luther, RN, MPM
Vice President, IHI
Derek Haas, MBA
Senior Project Leader, HBS
Jill Duncan, RN, MS, MPH
Director, IHI
Kevin Little, PhD
Improvement Advisor, IHIRobert Kaplan, PhD
Professor Emeritus, HBS
Sam Wertheimer, MPH
Project Leader, HBS
Kevin Bozic, MD, MBA
Orthopedic Surgeon
Tony DiGioia, MD
Orthopedic Surgeon
Lucy Savitz, PhD, MBA
Intermountain Healthcare
IHI’s Work: Five Key Areas10
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Quality, Cost, and Value11
Our Goal:
Encourage, empower, and enable health care delivery systems to provide truly value-based care that ensures the best health care We strive to call out and address disparities in health and health care wherever they exist.
Challenges we hear from customersQuality, Cost, and Value
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“We know we need to offer care
differently in an ACO world but doing it
is proving to be difficult
“We have a path forward for how to engage
with clinicians and patients and building
sustainable systems for the long haul”
“Motivating physicians and front-line staff
who have cost reduction fatigue”
“We have approaches and tools that
appeal to clinical staff because they
identify waste and proven paths to
cost improvement.”
“Financial analysts and clinical staff aren’t
aligned in their approach to cost reduction”
“We have a disciplined approach that leads
to financial viability and good outcomes.”
“Incorporating improvement initiatives while
maintaining the everyday work flow.”
“We have proven and non-disruptive
improvement processes.”
“There are multiple, disjointed
initiatives around quality, cost
and value.”
“We have an integrated strategy that
improves outcomes and drives results.”
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A new partnership across the river . . .13
Accelerating learningAccelerating improvement
Accelerating change
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Program Overview
Participants will learn how to measure costs using Time-Driven Activity-Based Costing (TDABC), and what outcomes to track and measure (clinical and patient reported)
The program will focus on total joint replacements, but the methodologies are transferrable to any condition
Participants will be able to compare their outcomes and care cycle processes to highlight high value practices (exact cost information will be kept confidential)
The program will help organizations identify and pursue opportunities to improve their outcomes and lower their costs
Learn
Share
Improve
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Program Driver Diagram 16
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Program Driver Diagram 17
Program Driver Diagram 18
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Program Driver Diagram 19
Overview of the Year20
Jan
Feb
Ma
r
Ap
r
Ma
y
Jun
Jul
Au
g
Se
pt
Oct
No
v
De
c
Learning Session 1 in Boston 9
Webinar for Physician Advisors 9
Join monthly webinars with IHI 30 27 27 24 29 26 31 28 25 30 20 18
Participate in “office hour”
coaching calls• • • • • • • • • • • •
Monthly outcome data submission 20 20 20 20 20 20 20 20 20 20 20 20
Cost and outcome measurement • • • •
Data synthesis • •
Learning Session 2 in Boston 7
Performance Improvement • • • • • •Re-measure and synthesize • •
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Overview of the Year21
Jan
Feb
Ma
r
Ap
r
Ma
y
Jun
Jul
Au
g
Se
pt
Oct
No
v
De
c
Learning Session 1 in Boston 9
Webinar for Physician Advisors 9
Join monthly webinars with IHI 30 27 27 24 29 26 31 28 25 30 20 18
Participate in “office hour”
coaching calls• • • • • • • • • • • •
Monthly outcome data submission 20 20 20 20 20 20 20 20 20 20 20 20
Cost and outcome measurement • • • •
Data synthesis • •Learning Session 2 in Boston 7
Performance Improvement • • • • • •Re-measure and synthesize • •
Overview of the Year22
Jan
Feb
Ma
r
Ap
r
Ma
y
Jun
Jul
Au
g
Se
pt
Oct
No
v
De
c
Learning Session 1 in Boston 9
Webinar for Physician Advisors 9
Join monthly webinars with IHI 30 27 27 24 29 26 31 28 25 30 20 18
Participate in “office hour”
coaching calls• • • • • • • • • • • •
Monthly outcome data submission 20 20 20 20 20 20 20 20 20 20 20 20
Cost and outcome measurement • • • •
Data synthesis • •
Learning Session 2 in Boston 7
Performance Improvement • • • • • •Re-measure and synthesize • •
1/8/2014
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Overview of the Year23
Jan
Feb
Ma
r
Ap
r
Ma
y
Jun
Jul
Au
g
Se
pt
Oct
No
v
De
c
Learning Session 1 in Boston 9
Webinar for Physician Advisors 9
Join monthly webinars with IHI 30 27 27 24 29 26 31 28 25 30 20 18
Participate in “office hour”
coaching calls• • • • • • • • • • • •
Monthly outcome data submission 20 20 20 20 20 20 20 20 20 20 20 20
Cost and outcome measurement • • • •
Data synthesis • •Learning Session 2 in Boston 7
Performance Improvement • • • • • •Re-measure and synthesize • •
Overview of the Year24
Jan
Feb
Ma
r
Ap
r
Ma
y
Jun
Jul
Au
g
Se
pt
Oct
No
v
De
c
Learning Session 1 in Boston 9
Webinar for Physician Advisors 9
Join monthly webinars with IHI 30 27 27 24 29 26 31 28 25 30 20 18
Participate in “office hour”
coaching calls• • • • • • • • • • • •
Monthly outcome data submission 20 20 20 20 20 20 20 20 20 20 20 20
Cost and outcome measurement • • • •
Data synthesis • •
Learning Session 2 in Boston 7
Performance Improvement • • • • • •Re-measure and synthesize • •
1/8/2014
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Overview of the Year25
Jan
Feb
Ma
r
Ap
r
Ma
y
Jun
Jul
Au
g
Se
pt
Oct
No
v
De
c
Learning Session 1 in Boston 9
Webinar for Physician Advisors 9
Join monthly webinars with IHI 30 27 27 24 29 26 31 28 25 30 20 18
Participate in “office hour”
coaching calls• • • • • • • • • • • •
Monthly outcome data submission 20 20 20 20 20 20 20 20 20 20 20 20
Cost and outcome measurement • • • •
Data synthesis • •Learning Session 2 in Boston 7
Performance Improvement • • • • • •Re-measure and synthesize • •
Meeting Aim26
At the end of the first in-person meeting
participants will begin to apply the TDABC
methodology to hip and knee arthroplasty
procedures and begin implementing selected
outcome measures.
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Objectives for the Day
Demonstrate how to apply Time-Driven Activity-Based
Costing (TDABC) methodology to hip and knee
arthroplasty procedures using a case study
Examine the process for putting outcome measurement
(including patient-reported outcomes) into practice and
work toward a plan to track a standard set of outcomes
Share the summary of measures collected from the pre-
work exercises
Introduce the learning community design
Meet other organizations and faculty; develop contacts that can be helpful throughout the duration of this work
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Agenda for the Day
Topic Time
Welcome and Introductions 8:00 – 8:30 am
A Surgeon's Perspective 8:30 – 9:15 am
Case Study Activity 9:15 – 10:30 am
BREAK 10:30 – 10:50 am
Time-Driven Activity-Based Costing Training 10:50 am – 12:30 pm
LUNCH 12:30 – 1:15 pm
World Café Activity 1:15 – 2:00 pm
BREAK 2:00 – 2:15 pm
Driving Outcomes 2:15 – 3:30 pm
Team Activity: Translating Learning into Action 3:30 – 4:15 pm
Wrap-up and Next Steps 4:15 – 4:30 pm
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Ground Rules
We learn from one another – “All teach, all learn”
Why reinvent the wheel? – Steal shamelessly
This is a transparent learning environment
All ideas/feedback are welcome and encouraged
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Home Team – Away Team31
Home Team: List
Name Role
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Program Materials33
Pre-work Presentations Participant
Folders
One (1) copy of each
team’s pre-work, one (1)
blank copy of the aims
worksheet, three (3)
copies of the Home Team
worksheets, and two (2)
index cards are available
in a folder at your table.
We will refer to these
materials throughout the
program.
All presentations are
available on ihi.org.
Instructions for
downloading materials
from the website can be
found in the participant
folder.
Program Agenda
Faculty Biographies
Boston Children’s Case
Case Worksheet
Case Assignment
Webinar Schedule
Coaching Call Schedule
Suggested Resources
Downloading Materials
Data Sharing Grid
Calendar of Events
Event Evaluation
A Physician Advisor Webinar is scheduled for this evening, Jan 9th 8 – 9 PM ET
Agenda: brief overview from today and focus on their role in this work
Copyright © Harvard Business School, 2013
The Value Based Health Care Delivery
Framework
January 9, 2014
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35Copyright © Harvard Business School, 2013
The central goal in health care must be value for patients, not access, volume, convenience, quality, or cost containment
Value =Health outcomes
Costs of delivering the outcomes
The Value approach requires that we measure two fundamental parameters:
1. Outcomes: the full set of patient health outcomes over the care cycle
2. Costs: the total costs of resources used to care for a patient’s condition over the care cycle
Value-based health care delivery
36Copyright © Harvard Business School, 2013
Source: Tim Ferris, MD, personal communication
Patient-level outcomes and costs are measured over a complete cycle of care for a clinical condition
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37Copyright © Harvard Business School, 2013
Measuring Outcomes:
(M. Porter, NEJM (December 2010)
Survival
Degree of health/recovery
Time to recovery and return to normal
activities
Sustainability of health /recovery and nature
of recurrences
Disutility of the care or treatment process
Long-term consequences of therapy
Tier1
Tier2
Tier3
Health Status Achieved
or Retained
Process of Recovery
Sustainability of Health
Recurrences
Care-induced
Illnesses
• Clinical Status
• Functional Status
38Copyright © Harvard Business School, 2013
Measuring Costs:Time-Driven Activity-Based Costing (TDABC)
• A bottoms-up approach to costing patient care based on the actual
clinical and administrative processes, and resources, used to treat
patients.
• Combines process mapping from industrial engineering with the most
modern approach for accurate and transparent patient-level costing
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39Copyright © Harvard Business School, 2013
HBS cost measurement & management project sites
40Copyright © Harvard Business School, 2013
HBS cost measurement & management project areas
• Chronic kidney disease
• Care transitions/preventing
readmissions
• Diabetes
• Primary care for patients with
behavioral health
• Bariatric surgery
• Child birth and pregnancy
• Heart valve replacements and
repairs
• Head and Neck cancers
• Hysterectomies
• Mastectomies
• Joint replacements
• Neurosurgical procedures
• Observation patients
• Prostate cancer surgeries and
radiation treatments
• Rotator cuff repairs
• Tonsils & adenoids
Chronic and Primary Care Episodic Care
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Questions?