The Ascension Journey to Value-Driven Care

Transcription

1 The Ascension Journey to Value-Driven Care SESSION A14/B14 Dr. David Pryor, MD Executive Vice President, Chief Clinical Officer Ascension

2 Disclosures Vivian Lee, David B. Pryor, and John Wong today have no relevant financial or nonfinancial relationship(s) within the services described, reviewed, evaluated, or compared in this presentation. 2

3 Healthcare Division 2,600 Sites of Care Continuum of Care Sites Millions of people served annually 154 Hospitals 76 Senior Living Sites 116 Free-Standing Imaging Sites 85 Urgent Care Centers 791,339 Discharges 633,507 Surgeries 84,472 Deliveries 13,357,986 Physician & Clinic Visits 165,000 Associates 68 Ambulatory Surgery Centers 651 Primary Care Clinics 3

4 EIS Data Flow / Methodology Overview Data Patient Accounting System Daily file feeds Patient Accounting Systems Daily Files o Contains all patient visits, charges, coded diagnosis/procedures for Acute Inpatient/Outpatient Surgical System Monthly report feeds Monthly Files o Contains ASA class, return to OR at patient level. Navion Cardiology Registry Monthly file feeds Surgical System Reports Navion Cardiology Registry NHSN SSI Monthly Files Monthly Files Data Validation ACRI EDL Data Validation Monthly Tableau EIS Dashboard o STS & ACC Measures at health ministry level NHSN Monthly file feeds o SSI at patient level PRC Patient Experience Monthly file feeds o Cost Accounting Patient Experience data at Facility/BU level Detail costs at charge code level PRC Patient Experience Monthly Files Costs are calculated via three key methods: Direct acquisition costs (supplies/rx), Relative Value Units (procedures), and Ratio Cost to Charge. o Each charge code broken down into 13 cost buckets. Cost Accounting Monthly Files Validation/Curation - Monthly Data validations occur on import of data to EDL and at various stages of processing comparing back to source systems as available. Validation of visual dashboard before release Engaged with health ministry SMEs for ongoing validation.

5 Cost Bucket Hierarchy Each Charge Code is costed and broken down into 13 Cost Components. Direct Indirect Fixed Variable *Fixed *Variable Labor *Equipment *Other Labor Supplies *Other *Support Staff *Patient Care *Medical *Professional *Pt Care Mid- Level Prov *Drugs *Patient Care Professional *GL Variance 5

6 Data Roll Up Summary of How Data Aligns and Rolls Up Analytics/Dashboards Costs are aggregated by patient and then up to other categories like business units, physician, DRG, Service Line, etc. Resource Categories Each UB Rev Code is mapped to a Resource Category Revenue Codes Each Common Charge Code is assigned a UB Rev Code Charge Codes Each local Charge Code is mapped to a Common Charge Code Each Common Charge Code is costed Cost Buckets 13 Cost Buckets are calculated for every Charge Code 6

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8 EIS Cost View Physician Stratification 8

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10 Clinical Process Reliability (CPR) rolling it out Our Ascension Way Clinical Process Reliability 10

11 Engagement Strategy Various Engagement Strategies Used Across Professional Disciplines 1. Vertical (site) and Horizontal Communication and Orientation to Data and Tools Operations and Clinical Leader Governance Committees (vertical- within site) Service Line leadership (horizontal across sites) 2. General Tool Deployment with Dedicated Training Sessions (e.g. EIS dashboards) 3. Accountability Framework: Integrate quality and cost control objectives into specific leadership goals that cascade to associates across Enterprise 11

12 Tools Used in Quality and Cost Analytics Sample of ACRI Analytic Products Product Line Description Features Executive Information System (EIS) Portfolio 1. Cost Dashboard 2. Utilization Dashboard 3. Clinical Process Reliability Dashboard Acute Care Physician, Facility and Market Level Views Variation Analytics Trending Cost control opportunity identification Ambulatory Quality and Operations 1. Operations Dashboard 2. MIPS Enterprise Reporting Quality, Safety, Patient Experience Dashboard (QSPE) 1. Enterprise quality reporting at facility, ministry, market and Enterprise level 2. Safety Reporting 3. HCAHPS Reporting Acute Care Facility, ministry, market and Enterprise level reporting with external (e.g PREMIER) benchmarking 12

13 Clinical Process Reliability Results for First Quarter FY 19 (July Sept 2018) Summary of Preliminary September Results Preliminary Results Show: That we have achieved $23.5M in the All DRG average direct cost per case ($45.2M through Oct) That we have achieved $15.5M in direct cost savings towards the $86M goal ($25.2M through Oct) That we have achieved $1.9M in direct cost savings towards the $8.9M Sepsis ISG Target ($2.7M through Oct) (sepsis mortality down 9.8% - target 5%) 13

14 Quality, Safety and Person Engagement Report: September 21,

15 Lessons Learned Cleaning up the data is inevitable and only happens when it s used. Initiatives should be driven by clinical leadership at both individual market and national levels. Quality should be viewed not only as safety (equity, efficiency). Education around the tools and how to use them is important and not intuitive to most clinical leaders. Specific market clinical variability opportunity savings have been created and now automated e.g. tools to make it easier to use the tools. We have a long track record in spreading clinical quality initiatives with great success that may have been important in our getting traction across our system. 15

16 Future Directions We are expanding into the ambulatory space and total service line views. The current views work well for an individual market and eliminating inappropriate variation at the market level, and savings correspond directly to the market gl. Differences in costs across the markets can be due to clinical variability, different overhead assumptions, labor rates, etc. For that reason, we are completing a utilization view where we map every resource into a standardized cost structure. While this view will no longer correspond to market gl, it does enable us to understand where there are market differences in costs the percentage that is due to inappropriate clinical variation. It will also provide us with a lens to view non clinical variation and begin to address variations in these costs as well. While not as elegant or rich as a true activity based costing approach, it should provide significant insight into our total costs. 16