Achieving Value Through Awareness, Appropriateness and Affordability - - PowerPoint PPT Presentation

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Achieving Value Through Awareness, Appropriateness and Affordability - - PowerPoint PPT Presentation

Apr 16, 2023 271 likes •914 views

Achieving Value Through Awareness, Appropriateness and Affordability Chris Moriates, MD Assistant Dean for Healthcare Value Associate Chair Safety, Quality, and Value Associate Professor of Internal Medicine @ChrisMoriates Dell Medical School

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Chris Moriates, MD Assistant Dean for Healthcare Value Associate Chair Safety, Quality, and Value Associate Professor of Internal Medicine Dell Medical School at The University of Texas at Austin

Achieving Value Through Awareness, Appropriateness and Affordability

@ChrisMoriates

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Christopher Moriates, MD

Executive Director, Costs of Care Assistant Dean for Healthcare Value and Associate Chair for Quality, Safety & Value Dell Medical School at the University of Texas

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Disclosures

Royalties from McGraw-Hill for “Understanding Value-Based Healthcare” Grant support from ABIM Foundation, Macy Foundation, Episcopal Health Foundation, and ACGME Executive Director, Costs of Care (non-profit)

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“You folks need to be prepared for a career that will be massively different from mine. You will be under relentless pressure to deliver the highest quality, safest, most satisfying care … at the lowest possible cost.”

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“What exactly were you trying to do?”

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We can do better

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Value

Outcomes that matter to patients Total Costs of Care

=

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Measuring What Matters

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Barnett ML et al. N Engl J Med 2017;377:4-6.

Changes in Average Length of Stay and Spending among Medicare Beneficiaries, by Setting, 2004–2011.

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Barnett ML, Grabowski DC, Mehrotra A. New England Journal of Medicine. 2017;377(1):4-6.

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Value

Outcomes that matter to patients Total Costs of Care

=

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Understanding Costs in Health Care

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Image from: Wired Magazine, 2012

Costs have traditionally been hidden from clinicians and the public…

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Awareness Goal: Equity

Health Care Value

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Awareness Appropriateness Goal: Equity

Health Care Value

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Cutting Out Waste

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From: Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501-1509.

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UCSF Division of Hospital Medicine High Value Care Committee

Committee described in: Moriates, et al. J of Hosp Med, 2014

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Findings In pre-post comparisons, implementation of the analytic tool was associated with a significant decrease in costs (7%-11% for total joint replacement and 11% for laboratory testing) and improvement in quality.

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Value Transformation at NYU

Institution-wide program with significant investment in creating joint clinical and

  • perational leadership, data and cost

accounting capabilities, a centralized project support staff, and a shared savings program. Began in April 2014

Chatfield SC, Volpicelli FM, Adler NM, et al. BMJ Qual Saf. 2019;28(6):449-458.

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Value Transformation at NYU

Focused primarily on clinician-led projects (with a project manager co-lead) to decrease costs across six main domains: 1.

  • perational efficiency,

2. resource utilization, 3. supply chain management, 4. revenue cycle, 5.

  • utliers (highest cost patients),

6. corporate services (administrative and

  • verhead costs)

74 projects in first 3 years!

Chatfield SC, Volpicelli FM, Adler NM, et al. BMJ Qual Saf. 2019;28(6):449-458.

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Total institutional net savings = $53.9 million over 3.75 years. [This net savings estimate accounted for the cost of the program, which the authors report as $5.375 million over the study period.]

Chatfield SC, Volpicelli FM, Adler NM, et al. BMJ Qual Saf. 2019;28(6):449-458.

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Gupta R, Moriates C,Harrison JD, et al. BMJ Qual Saf. 26 Oct 2016 doi:10.1136/bmjqs-2016-005612

Find out more: www.highvaluecareculturesurvey.com (www.hvccs.com)

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Total institutional net savings =

$53.9 million over 3.75 years.

Chatfield SC, Volpicelli FM, Adler NM, et al. BMJ Qual Saf. 2019;28(6):449-458.

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Cutting waste in hospitals is NOT going to “trickle down” to patients

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5 10 15 20 25 30 35 1999 2001 2003 2005 2007 2009 2011 2013 2015 Whole Country (% total) Households (% total)

Moving from Total Costs to Affordability

Slide by: Neel Shah MD MPP, Costs of Care

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AND…. What do we do when the care a patient needs is both NECESSARY and EXPENSIVE?

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Awareness Appropriateness Affordability Goal: Equity

Health Care Value

? ? ?

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Foundation: Trust Awareness Appropriateness Affordability Goal: Equity

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Public trust is a vital asset for clinicians and medical centers, crucial to keep patients seeking needed care, adhering to treatment, and achieving positive health outcomes.

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Over the past 60 years, public trust of physicians in the US (assessed as an aggregated group) has declined from 74% (1966) to 34%... alongside declining trust in institutions.

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www.moonshot.costsofcare.org

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Tools you can use to learn and teach high-value care

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vbhc.de dellm lmed. d.ute texas.edu du

Discovering Value-Based Health Care Interactive Learning Modules from Dell Med

Collection Modules Introduction to Health-Care Value 1-3 Value Based Health Care Delivery 4-5 Improving Value at the Bedside 6-7 Improving Value in Systems 8-10

45 mins- 1hr per module

Free Access Free CME Credit

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>200,000 Page views >18,000 Unique users

63% 62% 63% 36% 36% 30% 1% 2% 4% 0% 20% 40% 60% 80% 100%

After completing the modules, I can provide examples of low and high value care. After completing the modules, I can define value in health care. The content of the modules was aligned with the module outcomes (educational objectives).

Strongly agree Somewhat agree Neutral Somewhat disagree Strongly disagree

Discovering Value-Based Health Care Interactive Learning Modules from Dell Med

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www.vbhc.dellmed.utexas.edu

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September 2020

Recruiting interprofessional teams (3-5 members, with at least 1 trainee and 2 professions represented) now!

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We can do better

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(Some) Conclusions

Medical centers and clinicians should strive to ensure that no patient has to choose between their life and their life-savings, rebuild trust with patients through authentic and measurable efforts, and help them achieve the best possible health

  • utcomes at a price they can live with.

www.moonshot.costsofcare.org

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Chris Moriates, MD Cmoriates@austin.utexas.edu

@ChrisMoriates

www.moonshot.costsofcare.org #CoCMoonshot