UNOS and the Future o Gaps and opportunities identified in internal and external assessments of organization o Additional emphasis on patient safety creates new operational demands o IT near overload, and new contract rebid will likely include new, unfunded requirements o Successful rebid of contract will require agreement on how to address these issues
Planning is bringing the future into the present so that you can do something about it now.
UNOS’ Purpose We have to be able to answer: o Why does UNOS exist? o What is our purpose? The answer to those questions will help clarify: o What activities we undertake o Why we do them
UNOS Purpose For the sake of discussion, we developed 3 models of alternative purposes and the relationship of each to: o Key contract and non-contract activities o The degree of Board control over the organization’s activities o The degree of risk related to the organization’s purpose and activities o The non-contract revenue needed to support the purpose and its activities
Overview of Three Models with Related Activities A. OPTN ContractorB. OPTN Contractor + Member Services Organization A. OPTN Contractor + Member Services Organization +World Leader in Transplantation Services Activities: OPTN contract activities Not enough capacity to satisfy either members or HRSA Activities: OPTN contract Robust member support Education Research Best practices Tx Advocacy Activities: OPTN contract Robust member support Consulting and systems development services internationally
Comparison of Models A. OPTN ContractorB. OPTN Contractor + Member Services Organization A. OPTN Contractor + Member Services Organization + World Leader in Transplantation Services Activities: OPTN contract activities E.g.: Funding for IT insufficient to satisfy either members or HRSA Activities: OPTN contract Robust member support Education Research Best practices Tx Advocacy Activities: OPTN contract Robust member support Consulting and systems development services internationally Need for non-contract revenue: Current contract shortfall: “x” New contract shortfall: “y” Members’ desire shortfall: “z” Need for non-contract revenue: Current contract shortfall: “x” New contract shortfall: “y” Members’ desire shortfall: “ZZ” Need for non-contract revenue: Current contract shortfall: “x” New contract shortfall: “y” Members’ desire shortfall: “ZZZ”
Risk/Benefit Considerations Assumptions: There are risks related to: o Not making changes in the way we do business o Making significant changes going forward As part of clarifying UNOS’ purpose, priority activities and non-contract revenue needs, it is also essential to make an informed decision regarding: o The amount of risk members are willing to assume o The degree of control members want o What it will take for members to feel satisfied with UNOS Models A, B and C are rank-ordered in terms of non-contract revenue potential
Risk/Benefits : Related to Models A. OPTN ContractorB. OPTN + Membership Services Organization C. OPTN + Membership Services Organization + World Leader in Transplantation Services Lowest risk of: Tension with HRSA regarding non-contract activities Potential loss of contract Increased risk of: Tension with HRSA re: non-contract activities Potential loss of contract Risk still relatively low due to challenging requirements for OPTN contractor Same increased risk as Model B re: Tension with HRSA regarding non-contract activities Potential loss of contract Risk still relatively low due to challenging requirements for OPTN contractor Least capacity for: Member-directed, non-contract activities Increased capacity and support for: Member-directed, non-contract activities— including advocacy Greatest capacity for: Member-directed, non-contract activities and services—including advocacy for changes related to contract Greatest risk of member dissatisfaction re: Degree of government regulation Lack of member-directed, non-contract activities and services Fees Increased: Member anxiety related to differences with HRSA Satisfaction with non-contract activities and services Highest levels of: Member satisfaction with UNOS value
“The key to wisdom is knowing all the right questions.” - John Simone
HRSA issued a Request for Information (RFI) asking for feedback on OPTN performance in these areas: Updating allocation and other policies Access to deliberations and policy process Available information Continuous improvement assistance to transplant centers and OPOs Change is constant
HRSA RFI – new expanded work: KPD from pilot to national program Public involvement in policy-making process Expanded monitoring Education in safety and disease transmission Expanded research capabilities IT advancements What do we see on the horizon?
Why? Board’s long-term strategic vision for UNOS: be “more than just the OPTN contractor” – a robust member support organization and the world leader in transplantation services Changes to UNOS Board of Directors
UNOS Corporate Advisory Subcommittee UNOS Finance Committee UNOS Technology Advisory Subcommittee OPTN Strategic Planning Task Force Changes to OPTN/UNOS Board of Directors
Corporate Advisory Subcommittee Rationale for subcommittee --which will report to the Board and/or Executive Committee: Fulfill Board’s “duty of care” Identify strategic priorities Manage risks and set standards for performance Oversee and manage performance Address gaps and leverage opportunities Members: President, VP, Past-President, Treasurer, 2 members at large Several non-voting, outside expert advisors in nonprofit governance and best practices Duties: Corporate governance and oversight; for example: Develop strategic plan Develop policy framework to manage risk and set standards for performance Oversee organizational and Executive Director performance Succession planning Plan for long-term financial stability of corporation (consulting with Finance Committee as needed) Meeting schedule: Every two months
Finance Subcommittee Rationale for subcommittee-- which will report to the Board and/or Executive Committee: Members must be responsible and liable for this corporate function The budget for and the financing of operations must be tied to accomplishing strategic objectives on a year-by-year basis Members: UNOS Treasurer and 4 other Board members Several non-voting, outside advisors with strong credentials in finance and business development Duties: Develop annual budget Finance operations with appropriate instruments Identify necessary operating reserves Meet with CAC as needed to discuss long-term plan for financial stability Meeting schedule: Every quarter 20
Differentiation of CAC and Finance Subcommittee Responsibilities Corporate Advisory Committee Area for Collaboration Finance Committee Focus: Longer-term Strategic Note: UNOS Board Treasurer sits on both committees Focus: Shorter-term Operational Responsibilities: Identifying 3-5 year strategic goals and objectives Collaboration regarding annual work plan Responsibilities: Developing annual operating budget for work plan to accomplish strategic objectives Long-term planning for UNOS financial stability Plan to build needed reserves Collaboration regarding best strategies to expand non-contract resources Identifying needed reserves
OPTN Strategic Planning Executive Committee will conduct Example: HRSA comments during external consultant review How far should OPTN go, in the short term, to address patient safety concerns? How should we plan for addressing patient safety over the next 10 years? Work reduction; for example: do we need HRSA and CMS audits? Example: OPTN mission has changed twice since 2000 to include living donors and then VCA What additional changes do we need to anticipate? Information gathering and assessment in partnership with HRSA may strengthen HRSA confidence and relationship 22
OPTN Strategic Planning Task Rationale for strategic planning task of the Executive Committee—which will report to Board Longer-term plan for likely changes in OPTN contract over the next ten years Members: OPTN Executive Committee and HRSA representatives Duties: Develop longer-term plan for anticipating, shaping and responding to changes in contract requirements Strengthen partnership with HRSA Meeting schedule: Annual planning retreat; conference calls as needed 23
Information Technology Advisory Subcommittee Rationale for subcommittee—which will report to the Board and/or Executive Committee Members: 3 members of the Board Several outside expert advisors with strong credentials in information technology companies and healthcare systems Duties: Make recommendations regarding immediate and longer-term planning to support UNOS’ IT operations and systems migration Coordinate recommendations with subcommittees engaged in strategic planning and finance Meeting schedule: Every quarter
Oversight of VCA transplants IT demands outstrip resources Patient safety responsibilities are likely to grow What else do we need to anticipate?
Need to develop common understanding of patient safety approach Constructive vs. punitive Use of data for early warning signs Expanded educational offerings Complement, not duplicate CMS and other agencies What will OPTN/UNOS patient safety role be?
CMS and the OPTN From CMS conditions of participation for transplant centers – o Main focus of CMS is “regulatory oversight of transplant centers” o Main focus of OPTN policies and bylaws is organ allocation, credentialing of transplant surgeons/physicians, collegial relationship with transplant hospitals to help improve performance o “OPTN policies and bylaws are voluntary, until approved (i.e., codified) by the Secretary.” The only policy so approved is data submission o CMS is “responsible for establishing minimum standards to protect patient health and safety, and for implementing oversight mechanisms to assure that transplant centers provide quality transplant and living donor care to Medicare beneficiaries through the development of health and safety requirements.”
Mature allocation systems Developing allocation systems Geography How might allocation/distribution be addressed in the future?
What’s next after Chrysalis? What do we want from DonorNet (and what will we pay for?) How do we prioritize new policies to keep them from overloading the IT system again? What do we need to anticipate with IT?
“It’s been a long time coming. But I know a change is gonna come.” - Sam Cooke
Organ allocation Patient safety Education Prioritization within fiscal realities OPTN Strategic Plan
Ability to deliver OPTN plan Additional services for members Revenue-generating activities to ease pressure on registration fees Board engagement and oversight UNOS Strategic Plan
Not everything that is faced can be changed, but nothing can be changed until it is faced. - James Baldwin
Ongoing dialogue with members – for input, feedback Updates in member e-newsletter, Update, other venues Ongoing communication will be key
Overview of Next Steps March – April - MayJune- July- AugustSept. – Oct. – Nov. New committees meet and begin acting on external recommendations June Board meeting OPTN business UNOS business Nov. board meeting OPTN business UNOS business OPTN committees continue their work OPTN committees continue Staff Operate contract and implement improvements Address external recommendations Support new BOD committees Staff Operate contract Address external recommendations Support new BOD committees Prepare UNOS bid Staff Implement new contract Address external recommendations Support new BOD committees HRSA releases RFPUNOS submits bidNew contract awarded
“Good plans shape good decisions. That’s why good planning helps to make elusive dreams come true.” - Lester Robert Bittel, writer (b. 1918)