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Leading Change and Delivering Value- Based Care

Leading Change and Delivering Value- Based Care. It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change. Charles Darwin. Step 1: Create a Sense of Urgency. Step 2: Pull Together the Guiding Team.

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Leading Change and Delivering Value- Based Care

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  1. Leading Change and Delivering Value- Based Care • It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change. • Charles Darwin

  2. Step 1: Create a Sense of Urgency

  3. Step 2: Pull Together the Guiding Team.

  4. Step 3: Develop the Change Vision and Strategy.

  5. Strategy is Differentiation • Southwest Airlines? • Starbucks? • Apple? • Banner Health System? • Your Physician Practice?

  6. The Value Equation:The outputs

  7. The Value Equation:The Inputs

  8. The Value Equation

  9. #1 TECHNICAL QUALITY

  10. BANNER PEDIATRIC CAREPATHWAYS • DEFINE : CLINICAL PRACTICES • ASTHMA • BRONCHIOLITIS • FEVER • ABSCESS-CELLULITIS • UTI • GASTROENTERITIS • ALTE

  11. BANNER PEDIATRIC CARE PATHWAYS • DESIGN AND IMPLEMENT • ORDER SETS • MEANINGFUL MEASURES

  12. 4 year boy with no significant PMH • presents with a gluteal abscess (5*6cm) • and fever to 101. • Questions: • When should he get an I/D? • Antibiotics? • Admission? • Labs? • Pain Control?

  13. 5 yo with mild persistent Asthma presents with RR 30; exp wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status. • Questions: • How to standardize initial treatment/weaning? • Need for oxygen? • Use of Atrovent? • Use of Xopenex? • Use of MDI vs Nebulizer? • Need for Xrays

  14. does a 6 week old non toxic child require an l.P.? • does a 8 week old with fever and bronchiolitis require a urine culture? • how about a 7 month old non toxic immunized child--does he/she need a blood cx? • a 3 week old with fever-- does he/she need a cxray?

  15. Technical Quality--- how do we measure?Its about Misuse, Overuse and Underuse • Asthma: % steroids; % xrays; % use of “asthma protocol”; • Bronchiolitis: % bronchodilaotors, % cxrays; % steroids; • Fever: % 0-28 days-blood/urine/csfcx; 29 days-3 mo: % blood cx; >= 6 month immunized child: % blood culture

  16. #2: Access to Services • Operational Efficiency • ED: LWOT, Readmissions, Length of Stay, Door to Provider • Inpatient: Discharges before 11am

  17. #3 FUNCTIONAL STATUS • How Functional are your Patients after they leave the Care Setting • Coordination of Care • Connection to other providers (home health, PCP’s, subspecialists) • Patient Education

  18. #4 COMMUNITY HEALTH • POPULATION HEALTH MANAGEMENT • Reducing admission rates? • Reducing readmission rates? • Reducing ED utilization rates? • Compliance to plan of care?

  19. THE VALUE EQUATION

  20. STRATEGY-STRUCTURE--SYSTEM ALIGNMENT

  21. Alignment • Physician Fee for Service vs DRG payment for Hospitals • Value Based Purchasing for Hospitals • Bundled Payment • Accountable Care Organizations

  22. Step 4: Communicate for Understanding and Buy-In

  23. Step 7: Create a New Culture.

  24. Step 8: Don’t Let Up. • “We must become the change we want to see” • Mahatma Gandhi

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