The “Transition”: Challenges and Opportunities

Roger Ray, MDChief Physician Executive Carolinas HealthCare SystemMay 2015

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The Agenda• Who are we?

• The Transition

• Whole System Context– Maturity Model– Harm Agenda

• Your Work – Challenges– Opportunities

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Carolinas HealthCare System

We’re big… • 39 hospitals• 900+ care locations• 30,000 employees • 3,000 physicians• 15,000 nurses• 11M+ annual patient

encounters• $8B+ annual revenue

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We deliver integrated,quality care on a large scale

• Innovative care organizationsand services

• 18 million transactions/day in our EMR

• More than 65,000 diabetic patients in managed care

• Large virtual critical care(e-ICU) programs

• 500+ behavioral health ED consults conducted virtually per month

• Saved nearly $60 million in health care-related costs over two years 5

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Fundamental: The Transition from Volume to Value

Current StrainSTRAIN

uncoordinated

facility basedvariable

Silo work

volume-based

fee for service

Issue-focused

individual patient focus

VOLUME

VALUE

team accountability

standardization

engaged physicians

cost containment

improved qualitysafe

patient-centric

transparency

care coordinationinnovation

team-based care

information technologyreactive

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Reflection on Transformation

Why are we pursuing quality? Are we willing to change? Do we have a model that increases

access to care and leverages integration? Have we made a commitment to embrace

technology and be excellent in its application?

Are we actively moving to a value-based system ahead of external drivers?

Are we willing to be accountable and transparent?

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Role of Quality Pursuit

• Performance• Unification• Engagement• Accountability • Culture• Differentiation• “Value”

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System Integration

Virtual Care

Specialty Services

Primary Care

BetterOutcomes

Lower Costs

ImprovedPatient

Experience

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Integration Maturity Model Criteria1. Clinical Integration Priority Tool used2. One and three-year Cross continuum/geographies plans 3. Specialty “Principle Coordinator of Care” criteria developed4. Integration with palliative care, home health, etc.5. Service line work influencing primary care, continuing care and/or acute care6. Method to stratify patients is developed and deployed7. Chronic Disease Management Model for key conditions and chronic populations 8. Navigator/Coordinator connected to the medical home9. Action plan for readmission reduction is in place10. Goals articulated in all three dimensions of value11. Cross continuum value dashboards are developed 12. Care coordination models, clinical pathways, transitions developed and executed13. Physician leaders engaged in strategy and tactics through physician colleagues 14. Physicians ensure compliance with cross continuum care pathways/protocols 15. Team-based care models are developed16. Access leverage17. Action plan positively impacting our employee population is developed/executed18. Action plans: high drug costs utilization; unnecessary lab testing; high cost test settings; avoidable ED visits

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Driving ChangeIntegrated System of Care: Work differently and do different work

• Integration across service lines and points of care

• Navigator connected to medical home

• Readmission reduction action plan

• Team-based care models• New training approaches

CHS Maturity Model OrthopaedicsSNF

Children's

Behavioral Health

Emergent Care

Hospice & Palliative Care

Hospitalist Care

NeurosciencesHome Health

Rehabilitative Care

Cardiovascular

Trauma

Cancer

Critical Care

Primary Care

Respiratory Health

0%

20%

40%

60%

80%

100%

2013 2014 2015

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Broad Array of Results

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175HOME HEALTH TRANSFERS

to acute care have been avoided

954READMISSIONS

have been avoided

9,844PATIENT SAFETY EVENTS AVOIDED THROUGH OUR

Hospital Engagement Network

25,614PATIENTS

Received documentedAPPROPRIATE CARE

28,094MORE PATIENTS WERE discharged from emergency departments in fewer than

180 MINUTES THAN IN 2012

$60 million savings in related health care costs from quality programs

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Harm Agenda

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HEN & LEAPT

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Transparency

http://www.carolinashealthcare.org/value-report

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Challenges• ‘Proceduralist’ vs.

Episode Manager

• Upstream capability

• Immaturity of global measurement

• Ecosystem strain

Your Work

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Opportunities • Physician Leadership• Aggressive use of

technology• Embrace move to

reliability• Value measurement• Creation of evidence

Your Work

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