#HASummit14 Session #27: Quality Improvement in Healthcare: An ACO Palliative Care Case Study Dr. Robert Sawicki Senior Vice President, Supportive Care Linda Fehr, RN Division Director, Supportive Care Roopa Foulger Executive Director, Data Delivery Pre-Session Poll Question How would you describe your organization’s progress on achieving the Triple Aim and the IOM Six Aims for Improvement? a)Not evident b)Beginning c)Effective d)Mature e)Advanced f)Unsure or not applicable

#HASummit14 About The Organization 2 93 Locations 667 Providers 1.5M Patients annually 185K Home Health annually 267 Hospice daily census (avg) Visits

#HASummit14 Palliative (Supportive) Care 3 Palliative Care

#HASummit14 Why Palliative Care Is Important 4 What does advance care planning (ACP) mean to patients?  To understand, discuss, and record plans for a future scenario when they cannot make their own medical decisions  To feel confident that their end-of- life care preferences will be honored Who is ACP appropriate for?  All of us, ideally, but especially chronically ill patients Why is ACP important?  To provide higher quality end-of-life care that honors patients' values, goals, and preferences What are the components of ACP?  Advance care plan  Advanced directive  Durable power of attorney- healthcare (DPOA-HC) Prior to this, only patients in imminent need for advanced care planning were the focus

#HASummit14 Pain Points  Financial incentives are misaligned with patient desires  Major reform is needed to ensure higher quality, affordable, and sustainable end-of-life care  Chronic conditions and functional limitations are key drivers of high healthcare costs  Increased healthcare spending is not associated with higher-quality care 5 An estimated 13% of $1.6 T in healthcare costs is for the care of individuals in their last year of life * 13% * Source: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life © 2014

#HASummit14 Poll Question #2 6 Does your healthcare organization have a palliative (supportive) care program? a)Yes b)No c)Unsure or not applicable

#HASummit14 7 Our Approach And Results

#HASummit14 Goals  Understand and align patients’ value system with their healthcare goals  Leverage the OSF supportive care program in a community-wide initiative  Dramatically increase the number of patients completing advance care planning  Drive the engagement of all patient care providers  Provide optimized care coordination for patients  Quickly deploy a solution that could be used by all individuals  Provide real-time customized reporting 8

#HASummit14 Care Coordination 9 Outpatient Home Clinic care Hospice Skilled nursing facility Inpatient Home health care Care Coordination Community outreach and education

#HASummit14 Technology-Enabled Solutions 10  Supportive care dashboard  Custom reporting (supportive care team, clinicians, executives) EDW Platform Identification of high-risk patients  Community enters data into an easy-to-use, accessible database  Supports heterogeneous EHR environments  Deployable in days Advance care planning information is integrated into the OSF patient EHR

#HASummit14 Supportive Care Dashboard 11

#HASummit14 Driving Engagement 12 Initiate Identify Translate Document the conversationthe patients’ valuesthe patients’ values into medical decision the patients’ stated preferences for care  Trained physicians and patient care providers:  Co-sponsored “considering the conversation” screening with two large hospital systems  Developed a healthy competition with accessible, customized reports

#HASummit14 Results/Measurable Analytics  One common database to enable tracking and reporting: Easy-to-use interface; supports heterogeneous EHR environment; deployed in days  Timely, customizable reporting: Facilitator reporting; identified high-risk patients; customized reports (supportive care, clinicians, and executives) 13 1,76118, High-risk patients who have completed advance care planning Target: 1,200 Total number of patients who have completed advance care planning to date Engaged physicians, nurses, parish nurse facilitators, and employees

#HASummit14 Future Plans 14 Expand advance care planning discussion targets to non-high-risk patients Continue to drive employee and employee family member engagement Ensuring patients’ wishes are met, then compare results Correlate how well the patients’ care goals were met and the timing of the advance care planning discussion Analyze readmissions rates for patients with advance care plans, versus those without advance care plans Evaluate the number of referrals to patients with advance care plans who are referred to hospice

#HASummit14 Lessons Learned 15  Palliative care requires a team approach to care that addresses the patient’s and family’s physical, emotional, and spiritual needs  Look beyond just your healthcare system and engage in a community-wide initiative with considerable focus on training  Establishing targets and providing real- time visibility to results across the organization helps build healthy competition and drive outcomes

#HASummit14 Analytic Insights A Questions & Answers 16

#HASummit14 Choose one thing… 17 Write down one thing will you do differently after hearing this presentation

#HASummit14 Thank You 18

#HASummit14 19 Session Feedback Survey 1.On a scale of 1-5, how satisfied were you overall with this session? 1)Not at all satisfied 2)Somewhat satisfied 3)Moderately satisfied 4)Very satisfied 5)Extremely satisfied 2.What feedback or suggestions do you have?

#HASummit14 Upcoming Sessions Breakout Sessions – Wave 5 (2:20 PM – 3:05 PM) 31)Panel – Data Governance in Healthcare 32)How One ACO Is Using Analytics to Position Itself for Population Health Management and Shared Savings James J. Dearing, DO, FACOFP, FAAFP, Vice President, Chief Medical Officer, Honor Health 33)Panel – Best Practices in Achieving Physician Engagement 34)Panel – Precision Medicine and Embracing Variability 35)Improving Analytics and Processes to Ease Hospital Crowding Wes Elfman, Visualization Developer, Clinical and Business Analytics, Stanford Health Care Terrill Wolf, Manager, Data Architecture, Clinical and Business Analytics, Stanford Health Care Imperial Ballroom B Imperial Ballroom A Grand Salon Murano Venezia Location