provider engagement featured member case … engagement featured member case study: measure twice,...
TRANSCRIPT
PROVIDER ENGAGEMENT
Featured Member Case Study:
Measure Twice, Cut Once Organizational Alignment the Key to Cost Savings
Pratt Vemulapalli
Clinical Director
Lavanavarjit Ragavan
Performance Improvement Manager
Jason Smith
Associate Director
Jennifer Lam
Senior Project Manager
©2015 The Advisory Board Company • advisory.com
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Montefiore
Medical Center
Five-facility health
system in
Bronx, NY
Surgical Profitability
Compass
member since 2013
©2014 The Advisory Board Company • advisory.com
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Road Map
Measuring Results and Scaling the Process
From Doubters to Disciples
Our Strategic Evolution
©2015 The Advisory Board Company • advisory.com
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Transforming a Clunky and Time-Intensive Process
Tedious
Data collection was manual
and required multiple hours
of report generation
Deficiencies in Data Collection Process
One-Sided
Unable to tie certain metrics
together and assess impact
(e.g. linking purchasing data
to operational performance)
Seeking: A higher level tool to identify tactics for
standardization and which initiatives to prioritize
Not Credible
Physicians pushed back on
data and did not change
behaviors accordingly
©2015 The Advisory Board Company • advisory.com
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But was it a false god?
Surgical Profitability Compass – Our Savior
The Challenges of Implementing a New Technology
Value Proposition Perception of Viability
• Explosion of available data
• Operations + Finance + Supplies
• Internal variation
• External comparisons
• General distrust of data
• Not the first time
• Information overload
• Organizational readiness
Intense need for alignment of
executives, surgeons, OR and materials
Skepticism Disruptive Change
©2015 The Advisory Board Company • advisory.com
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The Seven Stages of Surgical Profitability Compass
Early Days
Shifting Reality of Surgeon Engagement
Future
Uninformed Instrumental
Transition
• Denial
• Anger
• Bargaining
• Grief
• Acceptance
• Hope
• Action
From doubters to disciples.
©2015 The Advisory Board Company • advisory.com
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We’ve been through the journey, so here is some advice.
A Word from our “Sponsor”
Data Expectations
• Data is never perfect
• Data is directional
• Data must be actionable
Key Elements for Success
Persistence
• Keep asking questions
• Create competition
• Keep pushing out data
Seeking Input
• Ask your surgeons
• Ask executives
• Ask your DA
Key Strategy
• Open up Procedure Cost Manager live in data-drive conversations to allow for
real-time adjustment of data, e.g. removing outliers, changing comparison sets.
• This opens up the door for a conversation around opportunity, not data.
©2015 The Advisory Board Company • advisory.com
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Identify groups of surgeons as comparison sets and discuss common
drivers of variance by group, not by individual.
Source: Procedure Cost Manager, surgical Profitability Compass 2015
Indisputable Comparisons
©2015 The Advisory Board Company • advisory.com
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Use a participative model of sharing item-level analysis.
Assessing Variance in Utilization
Source: Procedure Cost Manager, surgical Profitability Compass 2015
©2014 The Advisory Board Company • advisory.com
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Road Map
Measuring Results and Scaling the Process
From Doubters to Disciples
Our Strategic Evolution
©2015 The Advisory Board Company • advisory.com
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Aligning Goals with Incentives and Culture
Resident / Service Line
Chair Led Initiatives
Value Analysis
Cost Awareness
Triple Aim Initiative
Incentive
Culture
©2015 The Advisory Board Company • advisory.com
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“I will become the lowest cost surgeon”
Cost Awareness
#1. Cost Awareness
A Lesson in Leadership Surgeon chair sets example, takes her cost per
case from highest to lowest in the system
Dr. Pratt’s Cost Per Case From Highest to Lowest
©2015 The Advisory Board Company • advisory.com
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Aligning cost reduction, quality, & satisfaction.
IHI Triple Aim Initiative
Image from IHI Triple Aim web page
#2. Triple Aim Initiative
Key Elements:
• Surgeons financially incented via
Per Capita Cost Dimension
• Bi-annual payouts based on KPIs
• Cost reduction aligned with quality
and patient satisfaction
• Started in Orthopedics, CT, ORL
Population Health
Experience of Care Per Capita Cost
Triple Aim
©2015 The Advisory Board Company • advisory.com
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Giving residents ownership of cost savings.
Resident/Service Line Chair-led Initiatives
#3. Resident / Service Line Chair Led Initiatives
Resident finds cost
savings opportunity
Resident shares
findings with surgeons
Service line sees
significant savings
Learning Opportunity for Residents Yields Significant Savings
©2015 The Advisory Board Company • advisory.com
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Leading targeted value analysis effort.
Value Analysis
#4. Value Analysis
Savings targets set by perioperative
leadership
Individual performance tied to savings
via utilization and price negotiation
Using benchmarking to maximize
savings by switching vendors on high
volume items
©2014 The Advisory Board Company • advisory.com
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2
3
1
Road Map
Measuring Results and Scaling the Process
From Doubters to Disciples
Our Strategic Evolution
©2015 The Advisory Board Company • advisory.com
17
$10,790
$17,173
$32,000
$48,853
$56,022
$270,869
$300,000
$309,244
$315,000
$454,000
$754,563
Mesh Standardization
Ligasure Substitution Ph1
Lifecell Negotiated Pricing
Eithicon to Covidien Ligation Loop Substitution
Liegasure Substitution Ph2
Lap Chole Cost/Case Reduction
Orthobiologic Standardization
Covidien Venous Solutions Negotiated Pricing
Alcon Negotiated Pricing
Ligasure Substitution Ph3
Hemostatic Sub & Negotiated Pricing
Lap Chole Supply Cost per Case
$1,448 $991
Jun13-May14 Jun14-May15
Year over Year Cost Reduction
$2.6M in Realized Savings Over 14 Months
Return on Investment of 14:1
Savings from Cost Per Case Reduction June 2014-August 2015
20.2M
©2015 The Advisory Board Company • advisory.com
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Expanding to All
Service Lines
Scaling the Process
• Demonstrate the process of
opportunity identification
• Set targets for service line
• Provide training for residents
• Measure performance
Preparation
• Top procedures by
variance opportunity
• Top procedures by
highest volume
• Initial assessment vetted
by department chair
Scheduling
• Leverage existing service line
department meetings
• Create separate meeting if
opportunity is limited to small
number of surgeons
Pilot Service
Lines
Incorporate
Best Practices
Engage
Leadership
Engage
Materials
Demonstrate
Success
Execution
©2015 The Advisory Board Company • advisory.com
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Questions and Discussion