Rethinking OPO practice in the current healthcare environment

2004- looking back

2004- Collaborative

2004 vs. 2018 What’s changed in healthcare? Federal Initiatives Affordable care act CMS regulation – HCAHPS scores influencing Medicare Reimbursement Medicare Cost Pressures / growth of Medicaid enrollment Financial Pressures Block Reimbursements Fee for Service Model Phase Outs Payer mix changes - Increased Medicaid Enrollment; Limited Reimbursement Demographics Growing health economy growing as a % of GDP Aging Population –More Advanced Directives; Move to Palliative Care earlier in the care continuum Hospital resources/staff Stretched more than ever- fewer staff, increased turnover Consolidation of hospitals & responsibilities for upper management Technology Information/analytics on-demand Internet security

OPO CHallenges Notable Current Barriers Some are the same as in 2004 Physical/logistical/demographic Notable Current Barriers Technological EMR access & management- getting info when we need it Internet/email security- are our messages getting through? Is email an effective way of communicating? Turnover & workload of hospital personnel key to CDT Staff turnover & agency nursing coverage Workload: not uncommon for CDT’s “key” contacts—upper level RN admin—to oversee 3-4+ departments One ER/ICU Director: “I love CDT but I get 100’s of emails per day—I don’t have the time to respond.” Hospital Staff Engagement Challenges More spot education (effective?) New employee orientation (15 minutes for the OPO) Physician engagement – Limited MD availability

How do we navigate and adapt? Revise / Reinvent How the OPO Interacts with Hospital Staff The Donation Specialist Role – Combine traditional ground-level hospital development and donor family services; Managers increase lead role in high level relations at key hospitals (Combines resources without increasing OPO FTE’s?) Reduce Reliance on Care Providers – A difficult balance Mobile/visibility model- position employees—HD, DFS, OPC—to be in the field and respond to hospital needs in a more timely way. Focus field based resources in the field. Mobile operations for day-to-day office duties. Increase on-site evaluation of patient goals of care Goal: Improve on-demand service delivery vs. current reactive model (“the hospital will call when ready for us.”) Staff Examples OPC’s Traditional: reactive follow approach Future: referral classification & standard work. Take stress OFF hospitals and place on CDT HD/DFS Traditional: standard education and reactive approach to offering donation. “We’re there when scheduled or when the hospital needs us.” CDT found that this led to inconsistency and hospitals “not knowing what to expect.” Future: Fuse HD & DFS together to form “donation specialists” where HD and DFS are delivered together to provide optimal value to donor families and hospital staff.

Record Growth at The University of Vermont Medical Center Full Time Donation Specialist on site at UVMMC 40 hours a week; qualified for referral evaluations, donation approaches, family support and hospital development activities. Excellent engagement with critical care team and hospital administration; frequent visibility; real time servicing of hospital needs/issue resolution. Record donation activity in 2017 vs. 2016 o 89% increase in organs transplanted (28 to 53) o 78% increase in recovered organ donors (9 to 16)

Thoughts? How can your OPO navigate the changing environment and re-position for long-term success? Proactive vs. reactive Responsiveness—on-demand service delivery Resource management