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Transforming the Future of UI Health Care

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“Because  things  are  the  way  they  are,                                                  things  will  not  stay  the  way  they  are.”  

—Bertolt  Brecht    

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Where were we in this transformation process?

What challenges are we facing?

How are we to tackle these challenges?      

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Our Three Missions

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One Vision, One Future: Value of Integration

●  Integration has numerous benefits: ●  Provides for highly aligned and streamlined management

●  Shared enterprise team for strategic planning, communications, information technology services, human resources, finance and other services

●  Well-established collaborative decision-making ●  Eliminates territoriality

●  Facilitates major initiatives and partnerships ●  Enables stronger presence across the region ●  Supports a sustainable financial model

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Patient Care: Examples of Service in Action

●  30,344 Admissions ●  196,323 Days of Care ●  997,243 Clinic Visits ●  61,000 Emergency Visits

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UIHC Patient Care Outreach to Iowa, 2012-2013 Lyon Osceola Dickinso

n Emmet Winnebag

o Worth Mitchell Howard Winnesh

iek Allamak

ee

Sioux O’Brien Clay Palo Alto

Hancock

Cerro Gordo Floyd Chickasa

w Fayette Clayton

Plymouth

Cherokee

Buena Vista

Pocahontas

Humboldt

Wright Butler Bremer

Woodbury

Sac Calhoun Webster

Hamilton

Hardin Grundy Black Hawk

Buchanan

Delaware

Dubuque

Monona Crawford

Carroll Greene

Dallas

Story Marshall Tama Benton Linn Jones

Harrison Shelby Audubon

Guthrie

Boone

Polk Jasper Poweshiek

Kossuth

Franklin

Ida

Jackson

Clinton

Iowa Johnson Cedar

Scott

Pottawattamie

Cass Adair Madison

Warren

Marion Mahaska Keokuk Washington

Muscatine

Louisa

Mills Montgomery

Union Clarke Lucas Monroe

Wapello

Jefferson Des

Moines

Henry Adams

Fremont Page Taylor Ringgold Decatur Wayne Appanoose

Davis Van Buren Lee

Lyon Osceola Dickinson

Emmet Winnebago

Worth Mitchell Howard Winneshiek

Allamakee

Sioux O’Brien Clay Palo Alto

Hancock

Cerro Gordo Floyd Chickasa

w Fayette Clayton

Plymouth

Cherokee

Buena Vista

Pocahontas

Humboldt

Wright Butler Bremer

Woodbury

Sac Calhoun Webster

Hamilton

Hardin Grundy Black Hawk

Buchanan

Delaware

Dubuque

Monona Crawford

Carroll Greene

Dallas

Story Marshall Tama Benton Linn Jones

Harrison Shelby Audubon

Guthrie

Boone

Polk Jasper Poweshiek

Kossuth

Franklin

Ida

Jackson

Clinton

Iowa Johnson Cedar

Scott

Pottawattamie

Cass Adair Madison

Warren

Marion Mahaska Keokuk Washington

Muscatine

Louisa

Mills Montgomery

Union Clarke Lucas Monroe

Wapello

Jefferson Des

Moines

Henry Adams

Fremont Page Taylor Ringgold Decatur Wayne Appanoose

Davis Van Buren Lee

60 COMMUNITIES 190 CLINICS

41,750 PATIENT VISITS

Sioux City

Council Bluffs

Carroll

Creston

Shenandoah

Ames

Keosauqua

Fairfield

Keokuk

Ft. Madison

West Burlington

Marengo

Muscatine

Davenport

Clinton

Des Moines

Anamosa

Pella

Waterloo

Spencer

Columbus Junction

Vinton

Johnson

Coralville

North Liberty Iowa City

Solon

Hills

Oakdale

Wapello

PEDIATRIC SPECIALTY CONSULTATION CLINICS. ……………………………8,851 ADULT SPECIALTY CONSULTATION CLINICS ……....……………………….32,899

Sioux Falls, SD

Dubuque

Oelwein

Mt. Pleasant

Winfield

Mason City

Centerville

Washington

Clive Grinnell

Storm Lake

Fort Dodge

Decorah

Amana

5

9 6 2

2

3

4

3

5

74

5

32

2

12

4

3

5 2

2

3

2 4

2 17

Sigourney

Kalona 4 Welman

Decatur

Manchester

Burlington 2

5

UI Health Care

Cedar Rapids

Ottumwa

West Liberty 2

3

3

Clarinda

Johnston 4

3 2Mitchellville

Newton

9

3

Williamsburg Bettendorf

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Research Funding

●  $225 million in research funding

●  168 RO1 Grants ●  445 active patents

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●  1,000 Faculty

●  583 Medical Students

●  51 PA Students

●  119 PT Students

●  370 Graduate Students

●  5,000 Undergraduates

Education

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Iowa River Landing From  pediatrics  and  women’s  

health  to  cardiology  and  rou<ne  exams,  world  class  health  care  is  

now  available  at  a  new,  convenient  loca<on  in  Coralville.  

Opened 2012

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What challenges are we facing?

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Understanding our Future

●  The Transformation of Academic Medicine: This Time is Really Different

●  Our Roadmap: Leading the Challenge for Change

●  Renewal of Purpose: Taking Charge of the Future

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Transformation of Academic Medicine ●  This Time Is Really Different

1.   The  Worst  Recession  

 

Indexed  job  loss  for  prior  four  recessions  

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Transformation of Academic Medicine ●  This Time Is Really Different

1.  The  Worst  Recession  2.   The  Sequester  

 

•  Clinical  spending:    Cut  $109.3  billion  per  year  for  the  next  eight  years—resulEng  in  an  annual  2%  reducEon  in  Medicare  hospital  and  physician  payments  alone  

•  Research  funding:  NIH  to  cut  5%  or  $1.55  billion  of  its  fiscal  year  2013  budget    

–  The  result  was  that  approximately  700  fewer  compeEEve  research  project  grants  were  awarded  in  FY  2013  

•  NSF  support:  This  is  subject  to  a  $2.1  billion  reducEon  in  funding  over  five  years  

•  Military  research  and  development  (R&D):  Under  the  best  scenario,  the  Pentagon  faces  a  reducEon  of  up  to  20%  of  its  procurement  and  R&D  budget—more  than  $33  billion—through  2017    

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Transformation of Academic Medicine ●  This Time Is Really Different

1.  The  Worst  Recession  2.  The  Sequester  3.   Affordable  Care  Act  

Five  key  provisions:  -­‐  Coverage  expansion  -­‐  Insurance  market  reform  -­‐  Payment  and  delivery  reform  -­‐  Quality  and  safety  improvement  -­‐  Cost  control  

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Transformation of Academic Medicine ●  This Time Is Really Different

1.  The  Worst  Recession  2.  The  Sequester  3.  Affordable  Care  Act  4.   Major  decrease  in  public-­‐

sector  health  spending  

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How are we to tackle these challenges?

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Research: The Key Differentiator

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Transforming Our Research Mission

●  Challenge is opportunity ●  We must aggressively pursue NIH funding—despite

sequestration, there is still $30+ billion available! ●  BRAIN Initiative ●  BD2K Initiative

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Examples of Groundbreaking Research

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UI Pappajohn Biomedical Discovery Building

On schedule to open June 2014

A world-class setting in which scientists from across the University will collaborate to explore high-risk/high-yield scientific questions in the life sciences with the goal of advancing treatments for a wide array of human diseases.

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Plan for Research Investment

●  UI Health Care recognizes that the research mission is critical

●  Support for research through comprehensive development plan ●  Recruitment of outstanding researchers

●  Infrastructure needs

●  Investment requirements

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Building on a Strong Educational Foundation

●  New curriculum ●  FUTURE in Biomedicine ●  CCOM Rural Iowa Scholars Program ●  Distinction tracks ●  Master in Medical Education Degree ●  Residency and fellowship training programs

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Transforming Our Education Model

●  Emerging focus on interprofessional education ●  Changing healthcare environment focused on multi-

disciplinary teamwork ●  Optimize each and every team member

●  Enable each to play his/her patient care role to the maximum extent allowed by license

●  Train each learner to function in the new world of health care

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Interprofessional Skills and Team Based Healthcare

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Leading with Interprofessional Education

The Sydney Interprofessional Declaration

• We the participants of the All Together Better Health 5 International

Conference believe that a common global understanding of

Interprofessional Collaborative Practice and Care, brought about through

interprofessional education and learning, is of fundamental importance to

health care providers and users for the provision of high quality health care

and better health outcomes.

• The Sydney Interprofessional Declaration is premised on The World Health

Organization’s definition of Health, that health is a state of complete

physical, mental and social well-being and not merely the absence of

disease or infirmity.

• It underpins the call for action from the WHO Framework for Action

on Interprofessional Education and Collaborative Practice.

• Through the following articles the Sydney Interprofessional Declaration will

advance and strengthen the cause of Interprofessional Collaborative

Practice across the globe. It was approved by and is issued on behalf of

delegates present at the final plenary session of the All Together Better

Health 5 Conference held in Sydney, Australia, 6th-9th April 2010.

Article 1 All users of health and human services shall be entitled to fully integrated, interprofessional collaborative health

and human services.

Article 2

All health and human services work to create and strengthen a culture that promotes the delivery of contextual

opportunities for interprofessional learning and collaborative team training. Interprofessional education and

training for collaborative practice should be a core element of continuing professional development.

Article 3 Health worker education and training prior to practice shall contain significant core elements/learning domains of

interprofessional education. These core elements/learning domains shall contain practical experiences, for

example simulation. These core elements/learning domains for interprofessional education will be formally

assessed.

Article 4 Between ATBH5 and ATBH6 the global interprofessional community will undertake to develop a globally agreed

upon set of definitions and descriptions that capture interprofessional education, learning, practice and care.

Article 5 The global interprofessional community will work with the World Health Organization to implement the

Framework for Action on Interprofessional Education and Collaborative Practice.

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Transforming our Clinical Enterprise

●  Continue to generate high levels of patient care activity

● Work together to create the high value health care delivery organization of the future

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Shaping the New Value Proposition

●  Improving population health ● Offering better care and outcomes ●  Decreasing costs

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Patients at the Center

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Patients at the Center

●  Patients are now firmly at the center and driving their own value equation ●  Making informed decisions about their care ●  Demanding holistic, integrated, personalized care ●  Controlling the dollars – being intelligent consumers

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An Example from Our NICU

Survival  of  Inborn  VLBW  Infants    22  -­‐  27  weeks  EGA    

0%10%20%30%40%50%60%70%80%90%

100%

22 wks 23 wks 24 wks 25 wks 26 wks 27 wks

Iowa 06 - 12VON 2012

0

1

2

3

4

5

6

7

8

9

10

2008 2009 2010 2011 2012

% o

f all

VL

BW

Severe ROP

Iowa VON

Reduction in Severe ROP in VLBW Infants

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UI Health Care: Responding to the Challenge

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Critical Success Factors

1.  Creating beneficial relationships 2.  Developing ACOs 3.  Participating in new insurance products 4.  Implementing a $100 million initiative

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University of Iowa Health Alliance  

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1. Creating Beneficial Relationships ●  University of Iowa Health Alliance

●  Expansion – now five major members

●  Now includes 60% of Iowa’s hospitals ●  Other Collaborations

●  Pediatric Associates

●  Future focus: ●  Clinical integration

●  Single-signature contracting ●  Population risk management

●  Deploying e-health connectivity

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2. Developing our ACOs

●  UI Health Care is involved in three (3) Accountable Care Organizations: ●  Medicare Shared Savings Plan (established 2012)

●  with Mercy-Cedar Rapids

●  Wellmark ACO (established 2013) ●  with Mercy-Cedar Rapids

●  Medicaid ACO (established 2014) ●  with University of Iowa Health Alliance

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3. Moving into New Insurance Products

●  From IowaCare to Iowa Health and Wellness Plan

● Enrollment in the Iowa Health and Wellness Plan now exceeds the IowaCare total ●  69,744 in the Iowa Wellness Plan (0%-100% of FPL) ●  17,783 in the Marketplace Choice Plan (101%-138% of FPL) ●  87,527 total

Enrollment in IowaCare at the end of June 2013 was 71,002.

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CoOportunity Health

●  CoOportunity Health has successfully enrolled over 70,000 members

●  CoOportunity health is one of only two Co-Ops (out of 23) with more than 50,000 members

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4. $100 Million Initiative

●  Achieve $100 million in savings and/or new revenues over the next three years

Why? ●  UI Health Care continually looks for opportunities to increase

revenues and decrease costs. ●  The opening of the new UI Children’s Hospital in 2016 will

add an estimated $30M in new operating costs. ●  Taking steps now to prepare for this change will help to make

this transition seamless

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The New UI Children’s Hospital

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Five Priorities

●  Develop Primary Care & Outreach Strategies ●  Improve Coordination of Care ●  Improve Access ●  Ensure Full & Complete Documentation & Coding ●  Right-size Programs (GME, Clinical and Research/Education)

Mark  Hingtgen  &  Sabi  Singh  are  tracking  progress  on  the                    $100M  ini<a<ve  &  its  projects  

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IowaFirst: Our Campaign for Breakthrough Medicine

●  Surpassed our $500 Million goal

●  “We Are Phil” faculty/staff giving program launched October 2013

●  IowaFirst wrapped into “For Iowa. Forever More: The Campaign for the University of Iowa”

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“Effort  and  courage  are  not  enough  without  purpose  and  direc<on.”    

—John  F.  Kennedy  

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Questions and Answers