value-based health care delivery: core concepts · health care problem remains a global issue....

This presentation draws heavily on Professor Porter’s research in health care delivery including Redefining Health Care (with Elizabeth Teisberg), What is Value in Health Care, NEJM, and The Strategy That Will Fix Health Care, HBR (with Thomas Lee).A fuller bibliography is attached. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means — electronic, mechanical, photocopying, recording, or otherwise — without the permission of MichaelE. Porter. For further background and references on value-based health care, see the website of the Institute for Strategy and Competitiveness.

Value-Based Health Care Delivery: Core Concepts

Professor Michael E. PorterHarvard Business School

Partners HealthCare Residents and Fellows CourseBoston, MA

Wednesday, January 15, 2020

Copyright 2020 © Professor Michael E. Porter

Disclosure

2

Michael Porter

I have a relevant financial relationship with the following companies:

Company RoleAllscripts AdvisorAZTherapies Advisor, InvestorAmerican College of Surgeons Speaker, HonorariumAscent Biomedical Ventures InvestorBiopharma Credit Investments InvestorAdvanced Aesthetic Tech. InvestorMerck & Co. InvestorMerrimack Pharmaceuticals Former Board Member, InvestorMolina Healthcare Advisor, InvestorRoyalty Pharma InvestorThermo Fisher Scientific Former Board Member, Investor


Health Care Problem Remains a Global IssueHealth Care Spending vs GDP and Income

Wages: Average annual wages per full-time and full-year equivalent employee in the total economySource: EIU GDP (USD), Average Wages (USD) and Healthcare expenditure (USD) from 1990-2018; ECIPE Article 2011

Average Wage Gross Domestic Product (GDP) Health Care Spending

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USIndex(1990=100) HC expenditure 2018:17.2% of GDP

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HC expenditure 2018:9.8% of GDP

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Copyright 2020 © Professor Michael E. Porter4

Incremental “Solutions” Have Had Limited Impact

Restructuring health care delivery is needed, not incremental improvements

• Evidence-based medicine• Accountability for process metrics• Safety/eliminating errors• Prior authorization• Patients as paying customers• Electronic medical records• “Lean” process improvements

• Care coordinators• Retail clinics / urgent care• Programs to address high cost areas• Mergers and consolidation• Personalized medicine• Population health• Analytics and big data


Solving the Health Care Problem

5

Value =Health outcomes that matter to patients

Costs of delivering these outcomes

• The fundamental goal and purpose of health care is to deliver high and rising value for patients

• Delivering high value health care is the definition of success

• Value is the only goal that can unite the interests of all system participants

• Improving value is the only real solution to reducing the burden of health care on citizens and governments

• The questions are how to design a health care delivery system that substantially improves patient value, and to shift competition to competing on value


1. Re-organize care around patient conditions (or groups of related conditions) into integrated practice units (IPUs), covering the full cycle of care

− For primary and preventive care, IPUs should serve distinct patient segments

2. Measure outcomes and costs for every patient, in the line of care

3. Move to value-based reimbursement models, and ultimately bundled payments for conditions

4. Integrate and coordinate care across multi-site care delivery systems

5. Expand or affiliate across geography to reinforce excellence

6. Build an enabling information technology platform 6

Creating a Value-Based Health Care Delivery SystemThe Strategic Agenda


Organize around the patient’s condition, or family of related conditions, over the full care

cycle into an Integrated Practice Unit (IPU)

Affiliated Imaging Unit

West GermanHeadache Center

NeurologistsPsychologists

Physical Therapists“Day Hospital”

Essen Univ.

HospitalInpatient

Unit

PrimaryCare

Physicians

Affiliated “NetworkNeurologists”

Source: Porter, Michael E., Clemens Guth, and Elisa Dannemiller, The West German Headache Center: Integrated Migraine Care, Harvard Business School Case 9-707-559, September 13, 2007

Organize by department, specialty, and discrete service

Re-organize Care Around Patient Medical ConditionsHeadache Care in Germany

Care by Individuals

ImaginingCenters

OutpatientPhysical

Therapists

OutpatientNeurologists

OutpatientPsychologists

Primary Care

Physicians

Inpatient Treatmentand Detox

Units

Care by a Team 7


Integrating Across the Care CycleRole of Surgeons Beyond the Operating Room

Medical Management

Preoperative Care

Surgical Intervention Postoperative

Care Rehabilitation Surveillance

• Partner with medical specialists to manage complex cases and the ongoing evaluation of need for surgery

• Develop non-surgical options with other providers (e.g. physical therapists)

• Collaborate with primary care &anesthesiologist to prepare the patient for successful surgery

• Be accessible to patient and primary care team for pre-operative care questions

• Optimize the surgical process and results

• Co-develop best practices with PACU team

• Lead integrated multidisciplinarypost-operative teams to optimize the hospital stay

• Shift post-acute care to the appropriate setting (e.g. home, rehab)

• Extended clinic hours and after-hours hotline

• Educate home health providers and PTs on best practices

• Ongoing monitoring of patients for recurrence

• Measure longer term outcomes

Prevention & Detection

• Work with primary care to slow/manage disease progression

• Advise primary care on accurate diagnoses and timely referrals

DownstreamUpstream


The Playbook for Integrated Practice Units (IPUs)9

1. Organized around a medical condition, or groups of closely related conditions.

2. Care is delivered by a dedicated,multidisciplinary team devoting a significant portion of their time to the condition− Involved dedicated staff and affiliated staff with

strong working relationships3. ͏Co-located in dedicated facilities.

4. Takes responsibility for the full cycle of care

5. A hub and spoke structure with that allocates care to the right site

6. Addressing common complications and comorbidities, as well as patient education, engagement, adherence, follow-up, and prevention are integrated into the care process

7. The IPU has a clear clinical leader, a common scheduling and intake process, and a unified financial structure (single P + L)

8. A physician team captain, clinical care manager or both oversees each patient’s care

9. The IPU routinely measures outcomes, costs, care processes, and patient experience using a common platform

10. The team accepts joint accountability foroutcomes and costs

11. The team regularly meets formally and informally to discuss individual patient care plans, process improvements, and how to improve results.


• Patient segment: older adults with lower-income, living in under-servedurban communities

• Co-located in dedicated facilities

• Explicit processes to engage patients, address social and economic determinants of health, and provide free rides/home-visits, in-house pharmacy and selected events for community residents

• Selected in-house services in the most relevant specialties for this patient segment such as behavioral health and podiatry and close relationships with outside specialists

• Meet daily and weekly to discuss each patient’s care plans, and process improvement

• Measurement and accountability for outcomes, cost, and patient experience

• Single full-risk value-based payment covering overall care– Including specialty and post-acute care– Medicare Advantage

Value-Based Primary CareOak Street Health


IPU Volume Enhances Value

Better Outcomes, Adjusted for Risk

Rapidly AccumulatingExperience

Rising Process Efficiency

Better Information/Clinical Data

More Tailored Facilities

Rising Capacity for

Sub-Specialization

More Fully Dedicated Teams

Faster Innovation

Greater Patient Volume with the

Medical Condition

Improving Reputation

Costs of IT, Measure-ment, and ProcessImprovement Spread

over More Patients

Wider Capabilities in the Care Cycle, Including Patient Engagement

Mechanisms

The Virtuous Circle of Value

Greater Leverage in Purchasing, Securing

Value-Based Payments

Better Utilization of Capacity

11


Patient Experience/

Engagement/ Adherence

E.g., PSA, Gleason score, surgical margin

Protocols/Guidelines

Patient Initial Conditions,Risk Factors

Processes Indicators

Structure

E.g., Staff certification, facilities standards

Measure Outcomes for Every PatientThe Quality Measurement Landscape

Outcomes

12


Patient Experience/

Engagement/ Adherence

E.g., PSA, Gleason score, surgical margin

Protocols/Guidelines

Patient Initial Conditions,Risk Factors

Processes Indicators

Structure

E.g., Staff certification, facilities standards

Measure Outcomes for Every PatientThe Quality Measurement Landscape

Outcomes

Without outcomes measurement, the value of

measuring other quality dimensions is greatly

diminished

13


Principles of Outcome Measurement• Outcomes should be measured by condition or primary care

segment– Not for specialties, procedures, or interventions

• Outcomes cover the full cycle of care • Outcomes are always multi-dimensional and include what matters

most to patients (and families), not just to clinicians – Patient reported outcomes are important in every condition

• Outcome measurement includes initial conditions/risk factors to control for patient differences

• Outcomes should be standardized for each condition, to maximize comparison, learning, and improvement

• Outcomes should be measured in the line of care

• Value-based measurement differs from the historical focus on measuring provider behavior and overall patient success

14


Survival

Degree of health/recovery

Time to recovery and return to normal activities

Sustainability of health/recovery and nature of recurrences

Disutility of the care or treatment process (e.g., diagnostic errors and ineffective care, treatment-related discomfort, complications, or adverse effects, treatment

errors and their consequences in terms of additional treatment)

Long-term consequences of therapy (e.g., care-induced illnesses)

Tier1

Tier2

Tier3

Health Status Achieved

or Retained

Process of Recovery

Sustainability of Health

Source: NEJM Dec 2010

• Achieved clinical status• Achieved functional status

• Care-related pain/discomfort• Complications• Re-intervention/readmissions

• Long-term clinical status• Long-term functional status

• Time to diagnosis and treatment • Time to return home• Time to return to normal activities

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The Outcome Measures Hierarchy


Source: ICHOM

16

9.2%

17.4%

95%

43.3%

75.5%

94%

Incontinence after one year

Severe erectile dysfunction after one year

5 year disease specific survival

Average hospital Best hospital

Measuring Multiple Outcomes Prostate Cancer Care in Germany

Source: ICHOM

Source: ICHOM

Chart1

Incontinence after one yearIncontinence after one year

Severe erectile dysfunction after one yearSevere erectile dysfunction after one year

5 year disease specific survival5 year disease specific survival

Best hospital

Average hospital

0.092

0.433

0.174

0.755

0.95

0.94

Sheet1

Best hospitalAverage hospital

Incontinence after one year9.2%43.3%

Severe erectile dysfunction after one year17.4%75.5%

5 year disease specific survival95%94%

To update the chart, enter data into this table. The data is automatically saved in the chart.


Source: ICHOM

17

9.2%

17.4%

95%

43.3%

75.5%

94%

Incontinence after one year

Severe erectile dysfunction after one year

5 year disease specific survival

Average hospital Best hospital

Measuring Multiple Outcomes Prostate Cancer Care in Germany

Source: ICHOM

Source: ICHOM

Chart1

Incontinence after one yearIncontinence after one year

Severe erectile dysfunction after one yearSevere erectile dysfunction after one year

5 year disease specific survival5 year disease specific survival

Best hospital

Average hospital

0.092

0.433

0.174

0.755

0.95

0.94

Sheet1

Best hospitalAverage hospital

Incontinence after one year9.2%43.3%

Severe erectile dysfunction after one year17.4%75.5%

5 year disease specific survival95%94%

To update the chart, enter data into this table. The data is automatically saved in the chart.


40

50

60

70

80

90

100

0 200 400 600 800 1000

Source: Scientific Registry of Transplant Recipients, http://www.srtr.org

Adult Kidney Transplant Outcomes1987 - 1989

18

Percent 1-year Graft

Survival

Number of Transplants 1987 – 1989 (Three Year Period)

Number of centers: 219Number of transplants: 19,5881 Year Graft Survival: 79.6%

16 Greater than expected graft survival (7%)20 Worse than expected graft survival (10%)


40

50

60

70

80

90

100

0 200 400 600 800 1000

94.7%

Number of programs included: 209Number of transplants: 38,3701 Year Graft Survival:

4 Greater than expected graft survival (1.9%)5 Worse than expected graft survival (2.4%)

Percent 1-year Graft

Survival

Number of Transplants 2011 – 2013 (Three Year Period)

Adult Kidney Transplant Outcomes2011 - 2013

19


30. Overall Adult Health31. Pediatric Health32. Hand and Wrist33. Neonates34. Congenital Heart Disease35. Depression and Anxiety in

Children and Young People36. Psychotic Disorders 37. Personality Disorders38. Substance Misuse39. Autism Spectrum Disorder

* Published Thus Far in Peer-Reviewed

Journals (19)

1. Localized Prostate Cancer *2. Lower Back Pain *3. Coronary Artery Disease *4. Cataracts *5. Parkinson’s Disease *6. Cleft Lip and Palate *7. Stroke *8. Hip and Knee Osteoarthritis *9. Macular Degeneration *10.Lung Cancer *11.Depression and Anxiety *12.Advanced Prostate Cancer *

Completed Standard Sets(2013-14)

13. Breast Cancer *14. Dementia15. Frail Elderly16. Heart Failure17. Pregnancy and Childbirth

18. Colorectal Cancer *19. Overactive Bladder20. Craniofacial Microsomia21. Inflammatory Bowel

Disease *

Completed Standard Sets(2015-16)

22. Chronic Kidney Disease *23. Congenital Upper Limb

Malformations

24. Pediatric Facial Palsy *25. Inflammatory Arthritis *26. Hypertension *27. Oral Health28. Diabetes29. Atrial Fibrillation

Completed Standard Sets (2017-19)

Committed/In Process

Standardizing Outcome SetsICHOM

Copyright 2020 © Professor Michael E. Porter21Source: Kaplan, Robert and Michael E. Porter, “The Big Idea: How to Solve the Cost Crisis in Health Care”, Harvard Business Review, September 1. 2011

Measure Cost for Every Patient Principles

• Cost is the actual expense of patient care, not the sum of charges billed or collected

• Properly measuring the cost of care requires different cost accounting methods than prevailing approaches in health care, such as departmental, charge-based, or RVU-based costing

• Cost should be measured for each patient by condition, over the full cycle of care

• Cost is created by the use of the resources involved in a patient’s care (people, facilities, supplies, and support services)

– Cost depends on time and actual costs of resource use, not arbitrary allocations

• Understanding costs requires mapping the care process


Mapping Resource UtilizationMD Anderson Cancer Center – New Patient Visit

Registration and VerificationReceptionist, Patient Access

Specialist, Interpreter

IntakeNurse,

Receptionist

Clinician VisitMD, mid-level provider, medical

assistant, patient service coordinator, RN

Plan of Care DiscussionRN/LVN, MD, mid-

level provider, patient service coordinator

Plan of Care Scheduling

Patient Service Coordinator

Decision Point

Time (minutes)

Source: HBS, MD Anderson Cancer Center


Major Cost Reduction Opportunities in Health Care• Utilize physicians and skilled staff at the top of their licenses (people ~65% of costs)• Reduce process variation that increases complexity and raises cost• Eliminate low- or non-value added services or tests• Reduce cycle times across the care cycle, which expands capacity• Invest in additional services (e.g. extra visits, telemedicine), or higher costs inputs that will

lower overall care cycle cost• Reduce service duplication and volume fragmentation across sites• Rationalize redundant administrative and scheduling units• Move uncomplicated services out of highly-resourced facilities• Increase cost awareness in clinical teams, (e.g. costs of inputs (sutures vs. staples))• Improve the efficiency and automation of claims management and billing processes• The number one way to reduce costs is through better outcomes• Many cost improvements also improve outcomes

• Our work with numerous providers reveals typical cost reduction opportunities of 30+%23


Move to Value-Based Payment Models

Capitation/Population Based Payments

Bundled Payment

Pay for care for a life

Pay for care for conditions(acute, chronic) or for primary care patient segments

• Both approaches create positive incentives for reducing costs and separate payment from performing particular services

• Capitation at the hospital or system level can coexist with bundle payment at the condition level

Fee for Service

Global Budgets

Volume Value

Budget for a defined period of time that covers all presenting service needs

24


• Accountable for costs and outcomes patient by patient, and condition by condition

• A single risk-adjusted payment for the overall care for a life

Emerging Value-Based Payment ModelsCapitation (Population-Based) Bundled Payment

• Responsible for all needed care in the covered population

• Accountable for population level quality metrics

• At risk for the difference between the sum of payments for the population and overall spending

− Providers take on disease incidence risk, not just execution/outlier risk

• Accountable for overall cost and population level quality measures

• A single risk adjusted payment for the overall care for a condition− Not for a specialty, procedure, or short

episode

• Covers the full set of services needed over an acute care cycle, or a defined time period for chronic care or primary care

• Contingent on condition-specificoutcomes− Including responsibility for avoidable

complications

• At risk for the difference between the bundled price and the actual cost of all included services− Limits of responsibility for unrelated care

and outliers

25


Partnerships:Cleveland Clinic (OH)

Geisinger (PA)

Kaiser Permanente (CA)

Johns Hopkins (MD)

Mayo Clinic (MN)

Memorial Hermann (TX)

Northeast Baptist (TX)

Virginia Mason (WA)

Emory (GA)

Bundled Payments: Walmart Centers of Excellence

Conditions:• Cardiac Surgery• Cancer• Joint replacement

• Spine• Organ Transplant• Weight loss

Source: Compiled from news.Walmart.com and through publically available news and press releases . 26

Note: Not all providers participate in every Walmart condition


Shifting The Strategic Logic of Health Systems

Clinically Integrated Care Delivery

System

Confederation of Standalone

Units/Facilities

• Increase volume

• More clout in contracting and purchasing

• Spreading “fixed overhead” costs

• Use owned or affiliated primary care practices to “guarantee” referrals

• Increase value

• Value-based delivery models

• Concentrate, allocate, and integrate care across appropriate sites

• The system is more than the sum of its parts

27


The Geography of Care and Value • The Traditional Care Geography Model− Care organized around specialties and interventions at each site− Duplication of services across sites/facilities− Sites provide care for multiple acuity levels− Limited integration of care across sites− Traditional Model reinforced by fee-for-service payments and siloed IT

systems• Geography and Value: Strategic Principles− Organize care by condition in IPUs (the hubs)

− Multi-disciplinary teams− Responsibility for full care cycle

− IPUs allocate services across the care cycle to sites based on: site capabilities, care complexity, patient risk, cost, and patient convenience

− Incorporating telemedicine, home services, and affiliated provider sites into the care cycle

− IPUs developing formal systems to direct patients to the most appropriate site28


Delivering the Right Care at the Right LocationRothman Institute, Philadelphia

Lowest ComplexityLow ComplexityMedium ComplexityHighest Complexity

Facility Capability

Price of Total Hip Replacement: ~$12,000 USD

Price of Total Hip

Replacement ~$45,000 USD

Patient Risk Factors: Age, Weight, Expected Activity, General Health, and Bone Quality

Ambulatory Surgery Center

Rothman Orthopaedic Specialty Hospital

Bryn MawrCommunity Hospital

Jefferson University Academic Medical Center

29


Primary Care Practices

Specialty Care Centers

Specialty Care Center, Surgery Center & After-Hours Urgent Care

Specialty Care & Surgery Centers

Specialty Care Center, Surgery Center, After-Hours Urgent Care & Home Care

Wholly-Owned Outpatient Units

Community Inpatient PartnershipsCHOP Newborn Care

CHOP Pediatric Care

CHOP Newborn & Pediatric Care

Hospital & Integrated Specialty Program

Allocate and Integrate Care Across Sites Children’s Hospital of Philadelphia Care Network

30


Build an Enabling IT PlatformAttributes of a Value-Based IT Platform

1. Combines all types of data for each patient’s condition across the full care cycle (notes, lab tests, imaging, costs) using standard definitions and terminology

2. Tools to capture, store, and extract structured data and eliminate free text

3. Data is captured in the clinical and administrative workflow

4. Data is stored and easily extractable from a common warehouse. Capability to aggregate, extract, run analytics and display data by condition and over time

5. Platform is structured to enable the capture and aggregation of outcomes, costing parameters, and bundled payment eligibility/billing

6. Leverages mobile technology for scheduling, PROMs collection, secure patient communication and monitoring, virtual visits, access to clinical notes, and patient education

7. ͏Full interoperability allowing data sharing within and across networks, EMR platforms, referring clinicians, and health plans31


A Mutually Reinforcing Strategic Agenda

Organize into Integrated Practice

Units (IPUs)

Measure Outcomes

and Cost For Every Patient

Move to Bundled

Payments for Care Cycles

Integrate Care

Delivery Systems

Expand Geographic

Reach

Build an Integrated Information Technology Platform


The Health Care Transformation is Well Underway• We know the path forward

• Value for patients is True North

• Value based thinking is restructuring care organization, outcome measurement, payment models, and health system strategy

• Standardized outcome measure sets and new costing practices are beginning to accelerate value improvement

• Employers, suppliers, and insurers can be the next accelerators

• Government policy is beginning to reinforce value improvement in many countries

• We are excited to work with all of you in accelerating this transformation• We invite every one of you to get started on this path

33


y = 7E-214e0.248xR² = 0.9751

0

2,000

4,000

6,000

8,000

10,000

12,000

1990 1995 2000 2005 2010 2015 2020

Journal Articles

Related to Value-Based Health Care

Year

From: PubMed; accessed December 2019, Patrick Clapp, Baker Research Services, Harvard Business School

2019Redefining Healthcare

ICHOM Founded

Value-Based Health Care Thinking and Practice Are Rapidly Diffusing Peer Reviewed Literature 1990-2019

34


NEJM Catalyst Innovations in Care Delivery is a new digital, peer-reviewed journal from NEJM Group, the publisher of The New England Journal of Medicine.

Publishing six issues each year, NEJM Catalyst Innovations in Care Delivery aims to accelerate health care delivery transformation by publishing real-world examples and practical solutions so that health care leaders can address today’s urgent care delivery challenges and shape the future of health care delivery across the globe.

Quick Facts:Frequency: Bimonthly (6x/year)Launch Date: January 2020Format: Online onlyIndexed: Anticipate indexing in

PubMed and MEDLINEAudience: Health care executives, clinical

leaders, clinicians, academics,industry analysts, consultants, policy makers, government officials

Editorial Leadership:Co-Chair —Michael Porter, PhD, Bishop William Lawrence University Professor, Harvard Business School

Co-Chair and Editor-in-Chief —Tom Lee, MD, MSc, Chief Medical Officer, Press Ganey; Professor, Harvard Medical School, TH Chan School of Public Health; Internist, Brigham & Women’s Hospital

35

@[email protected] @meporter.hbs

www.isc.hbs.edu

Follow on Social Media

36

Presentation Posted At:


Selected References on Value-Based Health CareValue-Based Health Care• Porter, M.E., Teisberg, E. (2006). Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business Publishing

Integrated Practice Units and Primary Care• Porter, ME, Lee T. (2018) What 21st Century Health Care Should Learn from 20th Century Business. New England Journal of Medicine Catalyst (September 5, 2018)

• Ying A., Feeley T., Porter M. (2016) Value-based Health Care: Implications for Thyroid Cancer. International Journal of Endocrine Oncology 3:115–129, 2016.

• Porter, M.E. and Lee, T.H. (2013). The Strategy that Will Fix Health Care. Harvard Business Review. October 2013.

• Porter, M.E., Pabo, E.A., Lee, T.H. (2013). Redesigning Primary Care: A Strategic Vision To Improve Value By Organizing Around Patients’ Needs. Health Affairs; 32: 516‐525

Outcome Measurement• Porter M.E., Larsson S., Lee, T.H. (2016). Standardizing Patient Outcomes Measurement. New England Journal of Medicine 374:504-506, 2016.

• Porter, M.E. (2010). What Is Value in Health Care? New England Journal of Medicine 363:2477-81, 2010. and Measuring Health Outcomes, in Supplementary Appendix 2

Cost Measurement• Tseng P, Kaplan RS , Richman B, Shah MA, and Schulman KA. (2018) Administrative Costs Associated With Physician Billing and Insurance-Related Activities

at an Academic Health Care System. Journal of American Medical Association 319:691-97, 2018.

• Kaplan, R S., Witkowski ML, Abbott M, Guzman A, Higgins L , Meara J, Padden E, Shah A, Waters P, Weidemeier M, Wertheimer S, and Feeley TW. (2014)"Using Time-Driven Activity-Based Costing to Identify Value-Improvement Opportunities in Healthcare." Journal of Healthcare Management 59:399–413, 2014

• Kaplan, R.S and Porter, M.E. (2011). How to Solve the Cost Crisis in Health Care. Harvard Business Review. September 2011

Reimbursement • Feeley, TW., and Mohta N. (2018) "Transitioning Payment Models: Fee-for-Service to Value-Based Care." (2018) New England Journal of Medicine Catalyst (November 8, 2018).

• Spinks T, Walters R, Hanna E, Weber R, Newcomer L, and Feeley TW.(2018) Development and Feasibility of Bundled Payments for the Multidisciplinary Treatment of Head and Neck Cancer: A Pilot Program." Journal of Oncology Practice 14:e103–e121, 2018

• Porter M.E. and Kaplan R.S. (2016) How to Pay for Health Care. Harvard Business Review. July 2016

• Witkowski M., Hernandez A., Lee T.H., Chandra A., Feeley T.W., Kaplan R.S. and Porter, M. E. The State of Bundled Payments, Working Paper. Unpublished. May 2017.

Regional and National Expansion• Cosgrove T. The Cleveland Clinic Way. McGrawHill, New York, 2014

Information Technology• Feeley TW. Landman Z, and Porter ME. (2019) Moving to value-based health care: The agenda for information technology. New England Journal of Medicine Catalyst (In press)

• French K, Frenzel J, and Feeley T. (2018) Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost." New England Journal of Medicine Catalyst (August 23, 2018).

• Carberry K., Landman Z., Xie M., Feeley T. (2015) Incorporating Longitudinal Pediatric Patient-Centered Outcome Measurement into the Clinical Workflow using a Commercial Electronic Health Record: a Step toward Increasing Value for the Patient. Journal of American Medical Informatics Association

HBS Case• Porter M.E. and Teisberg E.O. ”Cleveland Clinic: Transformation and Growth 2015.” HBS Case No. 709-473. Boston: Harvard Business School Publishing, 2019.

37

https://catalyst.nejm.org/sbus-ipus-21st-century-health-care/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839285/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839285/http://www.hbs.edu/faculty/product/48462https://catalyst.nejm.org/transitioning-fee-for-service-value-based-care/http://ascopubs.org/doi/full/10.1200/JOP.2017.027029#affiliationsContainerhttp://ascopubs.org/doi/full/10.1200/JOP.2017.027029#affiliationsContainerhttps://catalyst.nejm.org/new-ehr-health-information-system/

Slide Number 1Slide Number 2Slide Number 3Incremental “Solutions” Have Had Limited ImpactSlide Number 5Creating a Value-Based Health Care Delivery System�The Strategic AgendaSlide Number 7Integrating Across the Care Cycle�Role of Surgeons Beyond the Operating RoomSlide Number 9Value-Based Primary Care�Oak Street HealthIPU Volume Enhances ValueSlide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Mapping Resource Utilization�MD Anderson Cancer Center – New Patient VisitMajor Cost Reduction Opportunities in Health CareMove to Value-Based Payment ModelsSlide Number 25Bundled Payments: Walmart Centers of ExcellenceSlide Number 27Slide Number 28Delivering the Right Care at the Right Location�Rothman Institute, PhiladelphiaSlide Number 30Build an Enabling IT Platform�Attributes of a Value-Based IT PlatformA Mutually Reinforcing Strategic AgendaThe Health Care Transformation is Well UnderwayValue-Based Health Care Thinking and Practice Are Rapidly Diffusing �Peer Reviewed Literature 1990-2019Slide Number 35Slide Number 36Selected References on Value-Based Health Care

value-based health care delivery: core concepts · health care problem remains a global issue....

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