International Consortium for Health
Outcomes Measurement
VitalHealth Executive Forum
August 12th, 2015
Agenda
Why ICHOM
What we do
20150810_ICHOM Intro for Vital Health.pptx
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
1
ICHOM is founded on the principle of value-based health care
We believe in a model where value
is at the center of health care...
Payers
... which will impact every stakeholder
Patients will choose their provider based on its
expected outcomes and their share of the cost
"Contain costs by paying for
results achieved”
Providers will compete to deliver superior
outcomes at competitive prices
Value =
Patient health
outcomes achieved
Cost of delivering
those outcomes
Payers will negotiate contracts based on
results and encourage innovation to achieve
those results
Providers
“Compete to deliver highquality results at competitive
prices"
20150407_Standard Presentation_INTRO.pptx
Suppliers will market their products on value,
showing improved outcomes relative to costs
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
2
Yet how will value be defined?
Existing information not
meaningful enough for patients
Ranking based on...
▪ Reputation
▪ Overall hospital survival rates
▪ Volume, staffing ratios, etc.
Where should I go for treatment for my prostate
cancer?
Rather than true outcomes...
▪ Incontinence
▪ Bowel function
▪ Erectile function
▪ Cancer recurrence
Source: John Wennberg, Tracking Medicine 2010
20150407_Standard Presentation_INTRO.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
3
This is why measuring and reporting meaningful outcomes matters
%
100
94.0
94.0
95.0
90
80
75.5
80.0
70
60
50.0
50
43.3
40
34.7
30
20
6.5
10
0
5-year survival
1-year incontinence
Germany
Sweden
1-year severe erectile dysfunction
Best-in-class: Martini Klinik
Swedish data rough estimates from graphs; Source: National quality report for the year of diagnosis 2012 from the National Prostate Cancer Register (NPCR) Sweden,
Martini Klinik, BARMER GEK Report Krankenhaus 2012, Patient-reported outcomes (EORTC-PSM), 1 year after treatment, 2010
20150407_Standard Presentation_INTRO.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
4
ICHOM was formed to drive the industry towards value-based
health care by defining global outcome standards
Where we come from
Three organizations with the desire to
unlock the potential of value-based
health care founded ICHOM in 2012:
ICHOM is a nonprofit
▪ Independent 501(c)3 organization
▪ Idealistic and ambitious goals
▪ Global focus
▪ Engages diverse stakeholders
20150407_Standard Presentation_INTRO.pptx
Our mission
Our mission
Unlock the potential of value-based
health care by defining global Standard
Sets of outcome measures that really
matter to patients for the most relevant
medical conditions and by driving
adoption and reporting of these
measures worldwide
Patient health outcomes achieved
Value =
Cost of delivering those outcomes
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
5
Core missions of ICHOM
ICHOM plays several roles along the journey that will enable
value-based health care: our strategic agenda
Define internationally
recognized Standard Sets
of outcomes that matter
most to patients along with
case-mix factors
Define the Standards
Provide risk-adjusted
international benchmarks
on outcomes by medical
conditions
Benchmark
on outcomes1
Enablers
Implement outcomes
measurement
Facilitate adoption of outcomes
measurement by
▪ making knowledge available
▪ spurring the development of
technologies and alignment
of registries
▪ supporting proof-of-concept
Become methodological
partner with media to publish
ratings based on ICHOM
outcomes
Establish outcomes
transparency
Collaborate to
improve value
Enable international
cooperation to improve
value by establishing
framework for value
collaborative
VBHC
Develop value-based
payment models
Engage payers and
governments to drive
wider adoption and
transparency through
financial incentives or
reporting requirements
1. We are exploring the inclusion of resources data in benchmarks but the methodology is to be determined
20150407_Standard Presentation_INTRO.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
6
ICHOM is gaining the support of the health care community
ICHOM’s Sponsoring Partners*
PLATINUM
GOLD
SILVER
BRONZE
*As of August 10, 2015
ADCC Proposal v2_GO.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
7
Agenda
Why ICHOM
What we do
20150407_Standard Presentation_INTRO.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
8
ICHOM organizes international Working Groups to define
Standard Sets of outcomes
ICHOM facilitates a process with
international clinical and registry leaders
and patient representatives to develop a
global Standard Set of outcomes that really
matter to patients
Clinical and
registry leaders
20150810_ICHOM Intro for Vital Health.pptx
Patient representatives
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
9
Standard Set is defined through series of teleconference calls,
supported by research and patient input
Working
Group
Process
Literature
input
Patient
input
Working
Group
Launch
Scope
Call 1
Outcome
domains
Call 2
Outcome
definitions
Call 3
Outcome
wrap-up
Call 4
Case-mix
domains
Call 5
Case-mix
definitions
Call 6
StSet and
publication
wrap-up
Call 7
Review &
transition to
implementation
Standard
Set
Launch
Research
& propose
scope
Literature review of
outcome domains and definitions
Patient focus group
(FG)
External
Input
Literature review of risk factor
domains and definitions
Validation of outcome
domains (distribute
survey via pat. org. )
Open review period
Survey
20150810_ICHOM Intro for Vital Health.pptx
2 round
Delphi process
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
10
ICHOM’s Hip & Knee Osteoarthritis Standard Set was developed
by experts representing 10 countries and 5 continents
Gillian Hawker,
University of Toronto
Philip Conagahan, University of
Leeds
Sally Lewis , Aneurin Bevan
Health Board
John Pearce*, Aneurin Bevan
Community Health Council
David Ayers, Umass Memorial Medical Center
Thomas Barber, Kaiser Permanente
Kevin Bozic, University of Texas Austin
James Caillouette, Hoag Orthopedic
Patricia Frankln, University of Massachusetts
John Grady-Benson, Connecticut Joint
Replacement Institute
Said Ibrahim, University of Pennsylvania
Nader Nassif, Hoag Orthopedic Institute
Leif Dahlberg, Lund University
Henrik Malchau, University of
Gothenburg; Harvard Medical School
Ola Rolfson, University of Gothenburg;
Harvard Medical School
Rob Nelissen,
University of Leiden
Thami Benzakour,
Zerktouni Orthopeidc
Clinic
Mojieb Manzary, The
John Hopkins Aramco
Health Care Center
Ilana Ackerman, University of Melbourne
Lyn March, North Sydney Orthopaedic and
Sports Medicine Centre
Noel Smith*, Arthritis Victoria
Nicolaas Budhiparama,
Nicolaas Institute of
Constructive Orthopaedic
Research & Education
Foundation for Arthoplasty
& Sports Medicine
Jennifer Dunn,
University of Otago
*Patient representative
20150810_ICHOM Intro for Vital Health.pptx
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
11
The ICHOM Standard Set for Hip and Knee Osteoarthritis:
Outcomes
Administrative/clinical
data
30-day all-cause
(administrative data)
Patient reported
Numeric rating scale or
visual analog scale
HOOS-PS or KOOS-PS
SF-12, VR-12, or
EQ-5D-3L
20150810_ICHOM Intro for Vital Health.pptx
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
12
The ICHOM Standard Set for Hip and Knee Osteoarthritis:
Case-mix variables
Measure
Supporting Information
Data Source
Date of birth
N/A
Patient-reported
Patient sex
Sex at birth
Patient-reported
Education level
Level of education completed
Patient-reported
Joint specific history
Joint specific surgical history
Body mass index
Living condition
Laterality of affected joint(s)
History of surgery on the hip or knee
Physical activity*
Tobacco smoking status
Co-morbid conditions
20150810_ICHOM Intro for Vital Health.pptx
History or finding of trauma or injury,
congenital or developmental
disorders, or other joint disorders in
the hips or knees
History of previous surgery on hips or
knees
Height and weight
Living alone, with family, or in a
nursing home or other facility
Indication of which joint(s) is(are)
affected at baseline
Patient reported history of previous
surgery on hips or knees
Physical activity
Clinical or administrative data
Clinical or administrative data
Patient-reported or clinical data
Patient-reported
Patient-reported
Patient-reported
Patient-reported
Use of cigarettes, cigars, or other
tobacco products
Presence of:
Cancer, depression, diabetes, disease
of the nervous system, heart disease,
hypertension, kidney disease, liver
disease, lung disease, peripheral
vascular disease, rheumatoid arthritis
or other arthritis, spinal disease
Patient-reported
Patient-reported
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
13
The ICHOM Standard Set for Hip and Knee Osteoarthritis:
Measurement timeline
Patient enters data collection at time of diagnosis with OA
Patient undergoes surgery after entering data collection
20150810_ICHOM Intro for Vital Health.pptx
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
14
ICHOM Standard Sets are freely available to promote global
adoption
Flyer
▪
▪
Two-page overview of ICHOM
Standard Set and Working
Group
Flyers are available at
www.ichom.org
▪
▪
▪
20150810_ICHOM Intro for Vital Health.pptx
Academic Publication
Reference Guide
Full detail of Standard Set for
institutions interested in
collecting
Includes measure definitions,
coding instructions, and
sample questionnaires
Reference Guides available at
www.ichom.org
▪
▪
Peer-reviewed publication
Explains process to arrive at
Standard Set and motivation
for selected measures
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
15
We have developed 12 Standard Sets thus far, covering 35% of
the disease burden
2015
targets
▪
▪
▪
▪
End Stage Renal Disease
Dementia
Older persons
Heart Failure
20150810_ICHOM Intro for Vital Health.pptx
▪
▪
▪
Pregnancy and childbirth
Breast cancer
Colon cancer
▪
▪
▪
Overactive bladder
Craniofacial microsomia
Inflammatory bowel disease
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
16
ICHOM is driving implementation across a number of fronts to
prepare more organizations for value-based health care
Accelerate with the
innovators
Equip with knowledge and
connect to peers
Inspire with success stories
22
Cleft Lip and Palate
Implementation Community
▪
Partner with innovative
providers to push the frontier
of outcomes measurement
and pave the way for others
to follow
20150810_ICHOM Intro for Vital Health.pptx
▪
Provide guidance and action
items to global institutions
implementing Std Sets with a
goal of benchmarking
▪
A collection of testimonials
and stories on the Why, How,
and What of outcome
measurement
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
17
Global comparisons will set the stage for more rapid learning and
improvement
Outliers exist in all areas of medicine
Over time, we expect variation to narrow
and performance to improve globally
Mean change in ODI
-35
-35
Study this
clinic…
-32.1
-25
~2x
-30
…to improve
outcomes in
these clinics
-20
-30
-25
-23.9
-20
-16.9
-16.9
-15
-10
-32.7
-32.1
-15
T0
0.8(each dot represents one clinic)
-10
T0
T1
T2
T3
T4
Note: Adjusted for age, sex, race, body mass index, diagnosis, education, any neurological deficit, stomach problem, join problem, other comorbidities, baseline treatment
preference, and baseline scores; Source: Desai et al, Variation in Outcomes Across Centers After Surgery for Lumbar Stenosis and Degenerative Spondylolisthesis in the
Spine Patient Outcomes Research Trial, Spine 2013.
20150810_ICHOM Intro for Vital Health.pptx
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
18
We are engaging health system stakeholders on the long-term
goal of outcome transparency
“ Ninety-percent of Medicare payments have a link to quality. There is a shift
happening and we only started a few years ago.
Our core principle: transparency drives improvement.
CMS, ICHOM and others need to work together to develop and implement
robust sets of aligned outcomes measures.
P. Conway
Chief Medical Officer - CMS
“
Transparency on quality of care is crucial if we want to achieve affordable
health care. It's very promising that also internationally much progress is
made [towards transparency]. We cannot stay behind.
ICHOM can be a major facilitator for this change to transparency.
That's why the National Institute for Health Care Quality in the
Netherlands actively promotes the implementation of ICHOM metrics.
20150810_ICHOM Intro for Vital Health.pptx
“
“
E. Schippers
Health Minister – The Netherlands
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
19
We know transparency on value is coming; we are working with
those that want to be in the driver’s seat
Provider organizations understand that, without a
change in their model of doing business, they can
only hope to be the last iceberg to melt. Facing
lower payment rates and potential loss of market
share, they have no choice but to improve value
and be able to “prove it.”
Michael Porter and Tom Lee
“The Strategy that will Fix Health Care”
HBR
20150810_ICHOM Intro for Vital Health.pptx
Copyright © 2015 by the International Consortium for Health Outcomes Measurement. All rights reserved.
20
THANK YOU!
Caleb Stowell
Jacob Lippa
[email protected]
[email protected]
CENTER FOR THE
SCIENCE
of HEALTH CARE
DELIVERY
Ryan J. Uitti, MD
Deputy Director
Professor of Neurology
How Outcomes Work in the Clinic Setting
“Science of Best Practice”
©2012 MFMER | 3256460-1
Center for the SCIENCE of HEALTH CARE DELIVERY
Center for the SCIENCE of HEALTH CARE DELIVERY
Center for the SCIENCE of HEALTH CARE DELIVERY
Center for the SCIENCE of HEALTH CARE DELIVERY
How Outcomes Work in the Clinical Setting
Usual
•
•
•
•
React
Document
Providers Gain “Experience”
Information Remains Anecdotal
Goal
• React on basis of individual and collective
information
• Document & Inform Database
• Providers Gain “Experience” and Data/Analyses
Inform Practice to Achieve Greater Value
… “Science of Best Practice”
Center for the SCIENCE of HEALTH CARE DELIVERY
Surgical Outcomes
Risk-Stratified Model of Bundled
Perioperative Care
Whipple Procedure or pancreaticoduodenectomy
Chris Shubert, Michael Kendrick,
Elizabeth Haberman, Amy Wagie
Center for the SCIENCE of HEALTH CARE DELIVERY
Traditional Critical Pathway
for Surgery
Standardization
March 2012:
Post-Pancreatectomy Order Set was Standardized
Operation
Critical Pathway
Discharge
– Resulted in reduced variation and skew in LOS & Cost
… But not reductions in these values
Center for the SCIENCE of HEALTH CARE DELIVERY
Defining the Problem
Whipple-Specific Risk Factors
– Whipple 15-20% POPF (post-op pancreatic fistula) rate
– 30-50% complication rate
– Heavily influenced by non-modifiable, patient-specific
risk factors: Diagnosis, Duct size, Gland Texture
– Need a reliable way to predict patient risk
• But … Predicting risk isn't good enough
– Need an evidence-based method for addressing different risk
profiles among patients
• Wish to manage according to the patient’s risk
Center for the SCIENCE of HEALTH CARE DELIVERY
Risk-Stratified Critical Pathway
For Surgery
Operation
High Risk Pathway
Discharge
Int Risk Pathway
Low Risk Pathway
Center for the SCIENCE of HEALTH CARE DELIVERY
Intraoperative POPF Risk Prediction
Mayo Data – 808 Whipple procedures
Center for the SCIENCE of HEALTH CARE DELIVERY
Intraoperative POPF Risk Prediction
Mayo Data – 808 Whipple procedures
CS-Leak
No CS-Leak
High/Intermediate
Risk
152
474
Negligible/Low Risk
8
174
– Predicted 152/160 Leaks!!!
– Sensitivity 95%
– NPV 96%
– Accepted for Publication in JACS
Center for the SCIENCE of HEALTH CARE DELIVERY
Opportunity for High-Risk Patients
Interventions Cost: $11.79/day
Center for the SCIENCE of HEALTH CARE DELIVERY
New Postoperative Whipple Pathway
Risk-Stratified Management
Patient Risk Assessment:
Gland Texture, Duct Size, Diagnosis, EBL
Intermediate Risk
High Risk
Neg/Low Risk
Interventions:
2 Drains
Interventions:
-Feeding tube
-Octreotide 150ug
q 8hrs x 7 days
-Octreotide 150ug q
8hrs x 7 days
Standard Critical
Pathway
-Treatment of
bacteriobilia
-Treatment of
bacteriobilia
Center for the SCIENCE of HEALTH CARE DELIVERY
Prospective Patient Accrual
5 month (consecutive) experience
• First 53 consecutive patients - 5 months
– 4 (8%) High risk
– 24 (45%) Intermediate risk
– 21 (40%) Low risk
– 4 (8%) Negligible risk
Center for the SCIENCE of HEALTH CARE DELIVERY
Outcomes: 5-months of New Pathway
Historical Control
2007-2012
N=808
New Pathway
N=53
p-Value
All Leak (Grade A, B, C)
23.8%
26.4%
0.661
Clinically Significant Leak
(Grade B &C)
19.9%
11.3%
0.1248
Any Post-op IR Procedure
26.5%
9.4%
0.005
Any Post-op Drain
Placement
14.0%
5.7%
0.097
Any Post-op Sinogram
21.3%
7.6%
0.013
Any Post-op CT Scan
59.8%
56.6%
0.666
Length of Stay –
Average (Median)
12 (9)
9.2 (8)
0.0002
Readmission
15.8%
5.7%
0.047
Average Cost of Care (SD)
Historical Control
$x-12,000
0.009
$x
Center for the SCIENCE of HEALTH CARE DELIVERY
Value:
Measuring  Improving
• Scientific Approach
• Care Delivery & Outcomes
• Cost
Center for the SCIENCE of HEALTH CARE DELIVERY
Anatomy of a Condition-Specific
Value of Care Study
3 components
• 1 - Retrospective: utilize available outcome metrics;
– benchmark across Mayo Clinic enterprise and with other extramural
databases/top centers/Optum/Big Data
• 2 – Time-Driven, Activity-Based Costing (TDABC):
– value-stream mapping + financial resourcing to determine direct costs;
provides blueprint that delivers the outcome measures delineated in #1 & #3
• 3 – Prospective:
– address gaps in outcome metrics in Retrospective analyses; most common
gaps consist of limitations in documentation of shared-decision making and
minimal patient-centric, patient-reported outcomes
Center for the SCIENCE of HEALTH CARE DELIVERY
TKA Value of Care Study
Dan Berry, Steve Hattrup, Mary O’Connor, Courtney Sherman,
Kim Wright, Mark Pagnano, Peter Murray, Henry Clarke,
Mark Spangehl, Sanj Kakar, Jim Ryan, Bob Otto, Mandy Impson
• Osteoarthritis of the knee
• Total knee arthroplasty
• What is the VALUE of the
MAYO total knee
arthroplasty practice?
Center for the SCIENCE of HEALTH CARE DELIVERY
TKA
Value of Care
Principal Findings (2010-2014)
Mayo Clinic practice has tremendous volume
– >4,000 procedures per year
– Largest # of revisions/complicated cases
Excellent outcomes at all three Mayo
destination campuses
Center for the SCIENCE of HEALTH CARE DELIVERY
Optum Lab database
LOW Complications at Mayo
Center for the SCIENCE of HEALTH CARE DELIVERY
8/14/2015
21
GAP: Systematic Collection of
Patient-Centric Outcome Measures
Mayo WJ. The necessity
of cooperation in the
practice of medicine.
Collected Papers by the
Staff of Saint Mary’s
Hospital, Mayo Clinic
1910;2:557-566.
Center for the SCIENCE of HEALTH CARE DELIVERY
HIP & KNEE
OSTEOARTHRITIS
Center for the SCIENCE of HEALTH CARE DELIVERY
ICHOM Standard Set – Hip & Knee Osteoarthritis
Center for the SCIENCE of HEALTH CARE DELIVERY
TKA Value Study:
Opportunities for Improvement
Mayo Clinic in Florida
–Reduction in length of stay (LOS)
• 2.9 days (MCF) vs. <2.5 days (MCA)
–Discharge to home
• 25% (MCF) vs. 50% (MCA/MCR)
Center for the SCIENCE of HEALTH CARE DELIVERY
Research Questions
Why is MCF LOS longer?
Why is MCF discharging to SNF at such a high rate?
What could explain these differences?
Hypotheses:
Differences in case manager messaging and pain control
analgesia (peripheral n. block vs. peri-articular anesth) lead to
better pain control, increased weakness and need for discharge
to “other than home”
… sounds plausible, but is it true?
We TESTED the hypotheses…
Center for the SCIENCE of HEALTH CARE DELIVERY
“Pain scores a bit better in AZ than FL”
Center for the SCIENCE of HEALTH CARE DELIVERY
Engagement with the practice
…. bringing data and analytics
• VALUE STUDY told the practice:
– Pain scores were similar; if anything, pain scores
were marginally lower in MCA than MCF
– Median length of stay was approximately 1 day
longer in MCF compared to MCA
– 30-day readmission rates were similar between
MCF and MCA
Center for the SCIENCE of HEALTH CARE DELIVERY
VALUE STUDY Results 
Changes in Practice
–All 5 TKA MCF orthopedic surgeons
changed practice in September, 2014
–Changed messaging to staff and
discontinued use of case manager in
outpatient setting
–Discontinued peripheral nerve blocks
–Started utilizing peri-articular anesthesia
delivered by orthopedist
Center for the SCIENCE of HEALTH CARE DELIVERY
SUBSEQUENT VALUE STUDY Follow up
People, data and analyses
• Practice team/patients surveyed
• Outcomes measures refreshed
Center for the SCIENCE of HEALTH CARE DELIVERY
Observations from Physical Therapy
•
•
•
•
“Improved motor control at initial visit”
“Patient is safer to mobilize”
“Able to discharge patients sooner; average number of PT sessions = 4”
“Patients are able to walk farther post operatively, more opportunity for gait
training”
• “Patients require less assistance for transfers throughout the stay and are more
likely to be in the chair more often”
• “Patients are able to fully participate with the home exercise program due to
improved motor control”
• “Patients continue to show excellent range of motion”
• Physical therapists at Mayo Clinic Florida
overwhelmingly prefer the peri-articular injections!
Center for the SCIENCE of HEALTH CARE DELIVERY
NO CHANGE IN SURGERY TIME
Center for the SCIENCE of HEALTH CARE DELIVERY
LESS PAIN
p = 0.018
Pain Score
pre3 (12/13-02/14)
pre2 (03/14-05/14)
pre (06/14-08/14)
post
(10/14-12/14) post2 (01/15-02/15)
Center for the SCIENCE of HEALTH CARE DELIVERY
MCA
3
3
3
3
3
MCF
3
3
2.5
2
2
SHORTER LENGTH OF STAY
p < 0.001
LOS
pre3 (12/13-02/14) pre2 (03/14-05/14)
pre (06/14-08/14)
MCA
2.3
2.5
2.6
MCF
2.9
2.9
2.9
MCR
2.6
2.7
2.8
post (10/14-12/14) post2 (01/15-02/15)
2.4
2.4
Center for the SCIENCE of HEALTH CARE DELIVERY
2.6
2.5
2.6
2.8
LOWER CHANCE OF GOING
TO SNF p < 0.001
DC to SNF
pre3 (12/13-02/14)
pre2 (03/14-05/14)
pre (06/14-08/14)
post (10/14-12/14) post2 (01/15-02/15)
MCA
20.6
27.6
24.2
17.9
20.3
MCF
47.5
45.6
43.5
24.1
21.1
MCR
26.2
33.9
35.2
Center for 24.9
the SCIENCE of HEALTH 31.2
CARE DELIVERY
NO CHANGE in READM’N
Center for the SCIENCE of HEALTH CARE DELIVERY
Orthopedics Value Study
Summary
• Studied 2,710 MCF and 18,455 Mayo patients
SCIENCE
BEST
PRACTICE
IMPLEMENT
TRANSLATE
• ID’d benchmarks and best outcomes
• Changed pain control method and disposition
• 26.4% drop in discharges to SNFs
• Reduced mean LOS by 0.4 days
• Lowered median pain score by 1 point
Center for the SCIENCE of HEALTH CARE DELIVERY
Next Steps
“Valuing the Mayo Practice”
• Determine Value of condition-specific care for
many more conditions
• Valuing the Mayo Practice repercussions
– Drives improvements in outcomes for patients
– Helps Mayo differentiate itself
– Prepares Mayo for value-based reimbursement
Center for the SCIENCE of HEALTH CARE DELIVERY
Accepting abstracts through April 27
Sept. 16-18, 2015, Rochester, MN
deliverysciencesummit.mayo.edu
Center for the SCIENCE of HEALTH CARE DELIVERY
Healthcare Outcomes: What We Measure Matters Archelle Georgiou, MD President, Georgiou Consul6ng KSTP Health Expert Percent of Individuals Spending At Least 1 Hour Researching 100% 90% 80% 92% 70% 78% 60% 50% 40% 53% 30% 20% 10% 0% Hospital Refrigerator Source: Healthgrades, 2012 New Car Patients Prefer To Have Decision Made For Them 65% would want to choose treatment 12% want to choose treatment Relevant Outcome Metrics Pa6ent Reported Outcome Metrics Making Outcomes Matter: Understand the Audience Pa6ent How will I do? Prospec6ve Less is more Non-­‐clinical issues maVer Drives decision-­‐making Provider How did I/we do? Retrospec6ve More is more Sole focus: clinical issues Validates decision-­‐making Outcomes Result From A Series of Choices What procedure? What doctors? What hospital/
facility? Priorities in Selecting Doctors 72% Coverage 69% Convenience 47% Can I get an appointment/get scheduled quickly? Doctors Need Data Too Physician Survey on Referrals 85%: physician's specific experience is important 61%: “access to addi6onal informa6on about other physicians would help me make beVer physician referrals for my pa6ents.” 12-­‐15%: referrals that are not a good match Consumers Have A Bias Toward Simplicity What procedure? Op6ons Science What doctors? Experts Volume What hospital/
facility? Results Relevant PROM Honor/Address Personal Preferences •  Familiarity ▸  Past experience ▸  Brand •  Bias ▸  Social ▸  Religious •  Demographics ▸  Age ▸  Socioeconomic status ▸  Educa6on •  Financial impact ▸  Out of pocket cost ▸  Disability ▸  Inability to maintain family obliga6ons •  Personal ▸  Relevance ▸  Percep6on of risk ▸  Fear ▸  Self-­‐image ▸  Trust Metrics Will Matter When There’s Trust Pa6ent How will I do? Drives decision-­‐making Provider How did I/we do? Validates decision-­‐making Differen6a6on Are differing priori6es a conflict of interest? What We Measure Matters to Patients If… •  Focus on relevant outcome metrics •  Communica6on aligns decision-­‐points with op6ons and outcomes •  Metrics are put into context. Acknowledge subjec6ve/
objec6ve priori6es •  Healthcare outcomes are used for individual pa6ent benefit