Healthcare Call to Action Healthcare Call to Action 20072007

Tom Evans, M.D.Tom Evans, M.D.

A New Era…A New Era…

A new era of transparency and A new era of transparency and accountability…accountability…

Development of evidence-based medicineDevelopment of evidence-based medicineDefine and standardize clinical performance Define and standardize clinical performance metricsmetricsConvergence around new measuresConvergence around new measuresAwareness of effectivenessAwareness of effectiveness

Industry shifts in practiceIndustry shifts in practiceChanges in reimbursement Changes in reimbursement Value Driven Health CareValue Driven Health Care

Value-Driven Health SystemValue-Driven Health System

Connecting the SystemConnecting the System– Standards to connect all health information systemsStandards to connect all health information systems

Measure and Publish QualityMeasure and Publish Quality– Every case, every procedureEvery case, every procedure

Measure and Publish PriceMeasure and Publish Price– Standardize identical services and episodes of careStandardize identical services and episodes of care

Create Positive IncentivesCreate Positive Incentives– Reward those who offer and those who purchase high Reward those who offer and those who purchase high

quality, competitively priced healthcarequality, competitively priced healthcare

Iowa HealthcareIowa Healthcare CollaborativeCollaborative

– 2003 Task Force of providers, payers, 2003 Task Force of providers, payers, purchasers and consumerspurchasers and consumers

““How will this era of transparency and How will this era of transparency and accountability effect Iowa Healthcare with it’s accountability effect Iowa Healthcare with it’s unique challenges?”unique challenges?”

From joint IHA/IMS Task Force … From joint IHA/IMS Task Force … ……to provider-led statewide quality to provider-led statewide quality

improvement initiativeimprovement initiative

Iowa Healthcare CollaborativeIowa Healthcare Collaborative

Align & Equip Health Care Providers on Quality and Value

Responsible Public ReportingResponsible Public Reporting

Engage the CommunityEngage the Community for Clinical for Clinical ImprovementImprovement

Raise the Standard of Care in IowaRaise the Standard of Care in Iowa

IHC Organizational StructureIHC Organizational Structure

IHC Board

IHC Advisory Council

Data Committee

Clinical Initiative Work Groups

EducationCommittee

IHC 2007 Work Plan

Iowa Healthcare CollaborativeIowa Healthcare Collaborative2007 Work Plan2007 Work Plan

EducationEducation

Public ReportingPublic Reporting

Patient SafetyPatient Safety

Clinical InitiativesClinical Initiatives

IHC 2007 Work PlanEducation

ConferencesPatient Safety SummitPhysician’s ForumLEAN in Health Care ConferenceAnnual IHC Conference

Website- www.ihconline.orgToolkits

Anticoagulation, Medication Reconciliation, Health Literacy, Healthcare-associated Infection, Lean in Health Care, Safe Culture Physician Practice Toolkit

IHC 2007 Work PlanIHC 2007 Work PlanPublic ReportingPublic Reporting

Driven by Driven by “Responsible Public Reporting”“Responsible Public Reporting”

IHC SourcesIHC SourcesBoth clinical and administrative dataBoth clinical and administrative dataPublicly available and voluntary reported information sourcesPublicly available and voluntary reported information sources

Data suitable for comparative purposes Data suitable for comparative purposes CMS Hospital CompareCMS Hospital CompareAHRQ Administrative data setAHRQ Administrative data set

Subjective data, not suitable for comparative purposesSubjective data, not suitable for comparative purposesNQF 30 Safe Practices informationNQF 30 Safe Practices informationHealthcare Associated Infection (HAI) measuresHealthcare Associated Infection (HAI) measuresSpread Measures Spread Measures

Public ReportingPublic Reporting

The Iowa ReportThe Iowa Report

– 2005 Report2005 ReportCMS Measures- Hospitals CMS Measures- Hospitals AHRQ Data- Statewide aggregateAHRQ Data- Statewide aggregateSurvey on NQF Safe PracticesSurvey on NQF Safe Practices

– 2006 Iowa Report2006 Iowa ReportCMS Measures- Hospital specificCMS Measures- Hospital specificAHRQ Data- Hospital specific and some statewide aggregateAHRQ Data- Hospital specific and some statewide aggregateHealthcare Associated Infection (HAI) measure section Healthcare Associated Infection (HAI) measure section

Public ReportingPublic ReportingThe 2007 Iowa ReportThe 2007 Iowa Report– Impact storiesImpact stories

– 5 Million Lives Campaign5 Million Lives Campaign– Healthcare-associated InfectionHealthcare-associated Infection– Rapid Response ProcessesRapid Response Processes– Lean in HealthcareLean in Healthcare– Medication ReconciliationMedication Reconciliation

– CMS measuresCMS measures– Expanded AHRQ measures, both hospital specific Expanded AHRQ measures, both hospital specific

and statewide aggregateand statewide aggregate– Expanded HAI Reporting- six new measuresExpanded HAI Reporting- six new measures– Spread of 5M InitiativesSpread of 5M Initiatives

IHC 2007 Work PlanIHC 2007 Work PlanPatient SafetyPatient Safety

Promote NQF 30 Safe PracticesPromote NQF 30 Safe Practices

Medication SafetyMedication Safety– Anticoagulation Anticoagulation – Medication ReconciliationMedication Reconciliation– High Alert MedicationsHigh Alert Medications

Safe CultureSafe Culture

Health LiteracyHealth Literacy

Explore PSO designation Explore PSO designation

IHC 2007 Work PlanIHC 2007 Work PlanClinical InitiativesClinical Initiatives

Lean in Health CareLean in Health Care

IHI 5 Million Lives CampaignIHI 5 Million Lives Campaign

Healthcare-Associated InfectionHealthcare-Associated Infection

Lean in HealthcareLean in Healthcare

Annual Lean Conference Annual Lean Conference – Promote and endorsePromote and endorse– Share Iowa experiencesShare Iowa experiences

““Active” User GroupActive” User Group

Lean CollaborativeLean Collaborative– 21 hospitals…21 hospitals…

5 Million Lives Campaign5 Million Lives Campaign

Strategy:Strategy:– All 12 initiatives, all 117 Iowa hospitalsAll 12 initiatives, all 117 Iowa hospitals– Clustered and aligned with existing IHC workClustered and aligned with existing IHC work– Project Coordinator, goalsProject Coordinator, goals– Convene, share, track progressConvene, share, track progress

Breakthrough series modelBreakthrough series model– Learning sessions (9/11/07, 3/3/08, 9/9/08)Learning sessions (9/11/07, 3/3/08, 9/9/08)– Action periods between with calls and Action periods between with calls and

contactscontacts

Campaign InitiativesCampaign Initiatives

Acute Myocardial Acute Myocardial InfarctionInfarction

Adverse Drug EventsAdverse Drug Events

Surgical Site Infection Surgical Site Infection

Ventilator Assoc. Ventilator Assoc. PnuemoniaPnuemonia

Central Line InfectionCentral Line Infection

Rapid Response Rapid Response TeamsTeams

Congestive Heart Congestive Heart FailureFailure

High Hazard High Hazard MedicationsMedications

Surgical Care Surgical Care Improvement ProjectImprovement Project

Pressure UlcersPressure Ulcers

Methicillin Resistant Methicillin Resistant Staph AureusStaph Aureus

Boards on BoardBoards on Board

Healthcare Associated InfectionHealthcare Associated Infection

Alignment with NQF Safe Practices and the Alignment with NQF Safe Practices and the 5M Campaign5M Campaign

Engagement of ICP CommunityEngagement of ICP Community

Statewide Influenza HCW Vac. GoalStatewide Influenza HCW Vac. Goal

Introduced voluntary reporting of six Introduced voluntary reporting of six statewide measuresstatewide measures

Influenza Vaccination of Healthcare Workers Influenza Vaccination of Healthcare Workers

Central Line Infection- ICUCentral Line Infection- ICU

Surgical site infection rates for Hip, Colon, CABG Surgical site infection rates for Hip, Colon, CABG and Hysterectomyand Hysterectomy

Our Response… Our Response…

Providers Need to Lead

Brightest, most powerful component of the health care equation… Excuses:– “I don’t have time.”– “This isn’t my problem.” – “When the hospital gives me a cut of the action…”– “I don’t have a prescribing pen…no real influence…”

Training and Mindset:– See one, do one, teach one. – We’re trained to not innovate

LeadershipLeadership

To lead, we need to develop… To lead, we need to develop… – A spirit of innovation A spirit of innovation – A sense of ownership A sense of ownership – A focus on ‘nimbleness’A focus on ‘nimbleness’– A commitment to collaboration A commitment to collaboration

Redefining Professionalism

The New Era of Transparency and Accountability based on a Value-Driven Healthcare System…– Evidence-based process measures & metrics– Define and standardize clinical performance metrics– Data used to improve quality and value– Reliable information publicly available on quality and

cost– Rapid spread of best practice– Engagement of patients as partners

Cornerstones for the future…

Align & Equip Health Care Providers on Quality and Value

Responsible Public Reporting

Engage the Community for Clinical Improvement

Raise the Standard of Care