IHI Expedition Expedition: Preparing Care Teams for Bundled Payments - PowerPoint PPT Presentation

March 24, 2015 Begins at 1:00 PM ET IHI Expedition Expedition: Preparing Care Teams for Bundled Payments Session 1: Volume to Value Trisha Frick, MS, RN Lucy Savitz, PhD, MBA Nick Bassett, MBA Molly Bogan, MA

Today’s Host 2 Akiera Gilbert is a Project Assistant at the Institute for Healthcare Improvement. She is primarily responsible for the Passport membership, and is involved in the facilitation of Expeditions. Her work also delves into the Conversation Ready Project within Patient and Family- Centered Care, as well as the Primary Care Collaborative. Akiera is a second-year student at Northeastern University, and is on her first co-op at IHI. She is pursuing a Bachelor of Science in Human Services (concentrating in Public Health) and a minor in Social Entrepreneurship.

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8 By joining Passport, your entire staff gets access to a wide range of web-based tools to help prioritize, deploy, and accelerate your improvement initiatives without leaving your desks. Passport membership will: • Bring IHI's world-class expertise to your doorstep (virtually) and support multiple teams closest to the point of care as they make rapid improvements in the areas of greatest concern to hospitals today. • Help your staff meet its continuing education requirements for physicians, nurses, and pharmacists. • Give your middle managers the skills they need to guide your organization's efforts to improve patient care and achieve its strategic goals. • Save you time, set your teams up for success, and facilitate more effective use of your resources. For more information or to enroll, email Passport@ihi.org

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What is an Expedition? ex • pe • di • tion (noun) 1. an excursion, journey, or voyage made for some specific purpose 2. the group of persons engaged in such an activity 3. promptness or speed in accomplishing something

11 Expedition Director Molly Bogan, MA, co-leads IHI’s Quality, Cost and Value portfolio of work. Molly began her career in health working in clinics and outreach programs in Washington State. She went on to join the US Peace Corps, assisting local government with health services planning in Paraguay. Molly also managed a USAID Global Health fellowship program and an NIH-funded child health improvement research program at Harvard School of Public Health in Boston, MA. Molly holds a Master of Arts in International Development and Global Health Affairs from the University of Denver. Prior to joining IHI, Molly was the Director of Finance and Administration for an international health non-profit organization.

12 Chat What is your goal for participating in this Expedition? Please send your message to All Participants 12

Today’s Agenda 13  Ground Rules & Introductions  Pre- Survey Debrief  Moving from Volume to Value  IHI’s Model for Improvement  Action Period Assignment

14 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!

15 Expedition Objectives At the conclusion of this Expedition, participants will be able to:  Describe the benefits of transitioning to a value- based purchasing model  Understand and apply an activity-based cost accounting methodology to at least one care process  Demonstrate examples of how to engage stakeholders in building a bundle  Describe how to customize care team redesign to deliver optimum care under value-based purchasing

16 Schedule of Calls Session 1 – Moving from Volume to Value Date: Tuesday, March 24, 1:00 - 2:30 PM Eastern Time Session 2 – Building a Care Bundle Date: Tuesday, April 7, 1:00 - 2:00 PM Eastern Time Session 3 – Collecting Data Using Activity-based Costing Date: Tuesday, April 21, 1:00 - 2:00 PM Eastern Time Session 4 – Engaging Stakeholders in Bundle Design Date: Tuesday, May 5, 1:00 - 2:00 PM Eastern Time Session 5 – Care Team Redesign Date: Tuesday, May 19, 1:00 - 2:00 PM Eastern Time Session 5 – Putting it All Together: Case Study Date: Tuesday, June 2, 1:00 - 2:00 PM Eastern Time

17 Pre-Work Assignment & Survey Results • Complete the IHI Open School Course QI 102: The Model For Improvement: Your Engine for Change • Complete the Preparing Care Teams for Bundled Payments Pre-Survey ( thanks to all who already completed!)

18 Faculty Nick Bassett, MBA Trisha Frick, MS, RN Lucy Savitz, PhD, MBA Healthcare Assistant Director of Director of Research and Transformation Managed Care Education Manager Johns Hopkins Intermountain Healthcare Intermountain HealthCare LLC Salt Lake City, Utah Healthcare Glen Burnie, Maryland Salt Lake City, Utah

19 Introduction to Bundled Payments Public and private payers are moving toward global payment arrangements with health care providers Agreements tie set payments to successful deployment of specific bundles of care Require teams from across the system – from contracting and finance teams to physicians and front- line care teams – to engage in coordinating care

20 Volume to Value Focus on the cultural changes required to coordinate care under the new payment structures Relationship between better patient care and potential savings – keep the patient at the center Quality indicators must not decline as costs are reduced New skill sets and mindsets required – are your teams ready?

21 Setting the Stage “Bundled payment is generally touted as a promising example of payment innovation — but the true benefit of bundling payments derives from reengineering care delivery , not from combining separately paid line items into a single tab. Bundled payment provides the impetus, but the work of care redesign must follow if the promise of bundled payment is to be realized .” - Tom Williams and Jill Yegian, Modern Healthcare blog

IHI Expedition: Preparing Care Teams for Bundled Payments March 24, 2015 Webinar Lucy A. Savitz, Ph.D., MBA Director of Research and Education Intermountain Institute for Health Care Delivery Research

The Burning Platform

Driving Change • An eagerness to accelerate reforms in healthcare financing ahead of evidence that the new models will succeed. • Bundled payments and other ACA payment reforms have strong Federal support and a growing private-sector following.

The Promise • Bundled payment will lead to higher- quality, more coordinated care and lower costs. • Episode-based bundled payment may serve to align financial incentives across the spectrum of care.

Creating a Learning Commons • Evaluation results of in-progress, episodic bundle payment initiatives will not be available for several years. • Making the case for shared learning as we go.

Medicare’s Bundled Payment Initiative: Most Hospitals Are Focused on A Few High-Volume Conditions Tsai TC et al., Health Affairs , March 2015, 371-380 • Aim is to bundle a single payment for an episode of acute care (while hospitalized) with related post- acute care in an appropriate setting. • Participating hospitals are: – Mostly large – Non-profit – Teaching hospitals in the Northeast – Cover conditions with high clinical volumes

Reported Findings Claims-based analysis Focused on only a few clinical conditions • No significant differences in spending between participating & non-participating hospitals • Post-acute care explains the largest variation in overall spending – Presents an opportunity to align incentives across providers

HHS Announcement