1. Transforming Healthcare Presentation to the Academy on Violence and Abuse Joe Mott, MBA, FACHE Vice President – Healthcare Transformation April 2013

2. “Everybody is trying to systemically improve value and quality, but at Intermountain they have worked out the operational system and culture to do it.” - John Mendelsohn, MD President MD Anderson Cancer Center

3. “Opportunities for quality and value improvement are legion … Today, a growing number of providers - such as Intermountain Healthcare in Utah, MD Anderson Cancer Center in Houston, and the Cleveland Clinic in Ohio - have such processes. Imagine if the right kind of competition demanded such efforts by every provider … The potential in terms of value improvement for patients is staggering.”

4. “Intermountain is the best model in the country of how you can actually change health care for the better.” - John Wennberg, MD Dartmouth College The Dartmouth Atlas White Paper concludes that the nation could reduce healthcare spending by 40% if Intermountain Healthcare was used as a benchmark for the country.

5. U.S. Debt and Unfunded Federal Obligations in Trillions

6. Utah Medicaid Source: Initial Analysis of Federal Health Reform Legislation. Utah Department of Health. March 30, 2010. Available online at http://www.ncsl.org/portals/1/documents/health/UDOH10-2010.pdf. Source: Fiscal Year 2011 Budget Summary. Governor’s Office of Planning and Budget. May 2010. Available online at http://www.governor.state.ut.us/budget/Budget/Budget%20Summaries/FY%202012_SumBk.pdf

7. Commercial Health Insurance Premiums

9. Financial Doom Cycle Increasing commercial insurance costs Higher numbers of Medicaid and uninsured Medicaid and uninsured payments fall further behind costs Commercial insurance becomes less affordable

10. More is Less Jerome Hoffman, MD UCLA Medical Center Source: This American Life on WBEZ 391 – More is Less. 10-09-2009

11. Is More Healthcare Better?

12. What Are Payers Doing? Medicare  Medicare Advantage (Part C)  Accountable Care Organizations – PPACA  Shared Savings – 220  Advanced Payment ACOs – 35  Pioneer ACOs – 32  Bundled Payment Medicaid  Utah “ACO” Model January 2013 Commercial

13. Components of Cost Healthcare Cost Per Person = XX Population Utilization Health Episodes Per American A hospitalization Intracase Utilization Processes Per Health Episode Days, MRIs, Lab Tests Efficiency Cost Per Process Cost per day, cost per MRI, etc. “How much it costs.” “How much we use.”

14. Our Problem: Unwarranted Variation 1. We have a lack of evidence-based best practices 2. Hospitals and physicians are paid for volume 3. Physicians & patients are largely cost unconscious

15. Clinical Programs establish system- wide, evidence-based standards Hospitals and physician clinics implement these standards Providing Evidence-based Care “We are in a state of avoidable ignorance” Shannon Brownlee

16. Five Things Physicians and Patients Should Question Choosing Wisely® aims to promote conversations between physicians and patients by helping patients choose care that is: Supported by evidence Not duplicative of other tests or procedures already received Free from harm Truly necessary

17. Evidence-based Standards provide the best legal defense

18. Aligning Financial Incentives Physician and Hospital Payment Models Sharing Risk with Payers

19. Engaging Patients and Members 1.Shared Decision Making 2.Health Promo & Wellness 3.Case Management 4.Benefit Design 5.Transparency

20. Abandon Hope All Ye Who Enter Here The Inferno Purgatorio Paradiso Do Not Abandon Hope

21. Returning Value to the Community Reducing GDP spend by 2.5%

22. What Should You Do? Be sure you are developing and using evidence-based guidelines Be willing to be flexible in considering new payment models Think about your strategic alliances Think Prevention – a service for which we will finally (might) pay!

23. “There is no more time left for timidity.” Don Berwick, MD