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Symposium on Delivery Science:Evolution & Application
A focus on:• The boundaries of Delivery Science• Tools and expertise for success in patient care in the reformed health system• The role of supply chain in new models of innovation• Meeting the dual demands for clinical and economic integration
A panel from academia, practice, and the supplier community including:• Amol Navathe, M.D., Ph.D., Co-Editor, Health Care: The Journal of Delivery Science and Innovation• Keith Lindor, M.D., Executive Vice Provost and Dean, College of Health Solutions, ASU• Terry Loftus, M.D., MBA, Medical Director of Surgical Services and Clinical Resources, Banner
Health• Michael Nagel, MBA, President and CEO, Vomaris Innovations• Natalia Wilson, M.D., MPH, Co-Director Health Sector Supply Chain Research Consortium, ASU
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The Science of Healthcare Delivery:Moving Beyond Theory
Terry Loftus, MD, MBA, FACSMedical Director
Surgical Services & Clinical ResourcesBanner Health, Phoenix, Arizona
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Agenda
• Challenges– Volume to Value– Transition from High Cost to Low Cost Centers– The Great Migration
• Approaches– Contracting– Utilization– Physician Support– Clinical Practice– Patient Safety
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CHALLENGES
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Volume to Value
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Qua
lity
of L
ifeComfortable setting
Chronic Disease Management
Cost Effective
Independent, Healthy Living
$1 $10 $100
Home Care
Assisted Living
Skilled Nursing Facility
Residential Care
ICU
Community Hospital
Specialty Clinic
Acute Care
Cost of Care / Day
Source: IBM ‘Connected Health’ Solution, 2011
$10,000$1000
High Cost to Low Cost Centers
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The Great Migration
2010 2011 2012 2013 20140.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0% 61.4% 60.8%
51.9% 48.9% 46.7%
Inpatient Surgery CasesAcute Care Facilities
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VALUE ANALYSIS PROGRAMContracting
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VAP: EVAR/ELGs
Vendor A Vendor B Vendor C Vendor D
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Value Analysis Teams
• EVAR/ELGs*• Synthetic Mesh*• Biological Mesh*
– Hernia & Breast Reconstruction• Spinal Implants• Ortho-biologics• Heart Valves• Urinary Incontinence
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Value Analysis Savings
1 2 3
$556,990 $556,990 $556,990
$203,392 $203,392
$106,617
2013 Value Analysis
EVAR Synthetic Mesh Biological Mesh
$867K Total Savings
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ORAL RINSE IN THE ICUUtilization
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CHG Oral Care Case Study
• Critical Care Discipline Team identified a variance in supply usage (Q2 vs Q4)
• Worked with Supply Chain to reviewed literature to identify best practice (Q4)
• Team standardized practice across system and reduced costs
• System savings $129K (cut in half)
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REPROCESSINGUtilization
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Reprocessing
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec $-
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
Reprocessing SavingsPerioperative + Surgery Centers
20122013
45.4% increase from 2012 to 2013 -> $ 2M Savings
(All -> $4.9M Savings)
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ALL HANDS ON DECKUtilization
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Aligning Strategies
Preventing new non-value added spend just as critical as reducing current non-value added spend
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Daily CHG Patient Hygiene Case Study
• Care Management and Supply Chain teamed with Infection Prevention– Care Mgt narrowed scope of patient population– Supply Chain lower cost alternative identified and
contracted
• Potential $1M+ spend down to $300K
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ENERGY DEVICEADHESION BARRIER
Physician Support
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Ortho CCG Recommendation
$255,570 Savings
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OB/Gyn CCG: Adhesion Barriers
--OB Clinical Practice* changed to eliminate adhesion barriers
--Supply cost was reduced by nearly $1 million annually
*Edwards RK, et al. Obstet Gynecol. 2014; 123: 919,923-928.
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BOWEL SURGERYTOTAL KNEE ARTHROPLASTY
Clinical Practice
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• Bowel Surgery– Key Process Steps:
• Early & frequent activity: ambulating 3 or more times on POD #1• Early alimentation: a minimum of 200cc of liquids on POD #1
• Total Knee Arthroplasty– Key Process Steps:
• Early activity: mobilizing patient out of the bed, either to a chair, standing at the bedside or ambulating any distance on POD #0
• Avoidance of continuous urinary catheter: no use of a continuous urinary catheter during their hospital stay
Clinical Practice Metrics
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Accelerating Adoption & Sustaining the Gains
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OutcomesBowel Surgery Outcomes* Reduction
Complications -27.8%
Gastrointestinal -30.2%
Ileus -29.8%
Pulmonary -34.4%
30-day Readmission -17.5%
TKA Outcomes** Reduction
Complications -10.5%
Cost ($1000) mean -9.7%
30-day Readmission -18.8%
LOS -7.6%
* Loftus T, Stelton S, Efaw BW, Bloomstone J. A system wide care pathway for enhanced recovery after bowel surgery focusing on alimentation and ambulation reduces complications and readmissions. J. Healthcare Quality. 2014 Feb 20 (Epub ahead of print).** Loftus T, Agee C, Jaffe R, Tao J, Jacofsky D. A simplified pathway for total knee arthroplasty improves outcomes J. Knee Surg. 2013 Nov 14 (Epub ahead of print).
$3M Savings
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SAFE SURGERY PROGRAM
Patient Safety
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Patient Safety & SRE
• Safe Surgery Program– Implemented in 22 acute and 8 ASC OR’s– Results
• Increase in days between SRE:121%
• Reduction in SRE:52%
• Est. 10 year cost avoidance:$5,565,523
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Questions