1. Value as an Organizing Strategic Framework Thomas H
Value as an Organizing Strategic Framework Thomas H. Lee, MD Network President, Partners HealthCare System Professor of Medicine, Harvard Medical School Professor of Health Policy and Management, HSPH Associate Editor, New England Journal of Medicine April 8, 2013

2. Health Care Reform Unfolds in Three Phases
Insurance reform – who gets covered, where the money comes from
Payment reform – how that money is paid to providers
Delivery system reform – how the care is delivered

3. Health Care Reform Unfolds in Three Phases
Insurance reform – who gets covered, where the money comes from
Payment reform – how that money is paid to providers
Delivery system reform – how the care is delivered
Those second and third phases are getting underway
They will be disruptive:
They will create pressure for consolidation and integration
Hospital-hospital
Hospital-physician
Payer provider

4. Why We Get “Stuck”
We don’t have clarity on what we are trying to accomplish
We don’t have a performance framework
We don’t have data on outcomes that matter
We don’t have data on costs
We are not organized into functional teams
We are not paid to improve value

5. Why We Get “Stuck”
We don’t have clarity on what we are trying to accomplish
We don’t have a performance framework
We don’t have data on outcomes that matter
We don’t have data on costs
We are not organized into functional teams
We are not paid to improve value
A Path Forward:
Porter Strategy
Gawande Tactics
Bohmer Operations

6. Three Colleagues and Key Themes From Their Work
Michael Porter, Harvard Business School
Value as defined by patient outcomes and costs as an organizing strategic framework for health care delivery organizations
Atul Gawande, Brigham and Women’s Hospital
Checklists that define key processes for which clinician teams should be reliable
Richard Bohmer, Harvard Business School
Teams that permanently own the work of improvement

7. Words That Resonate Through Their Work
Value
Measurement
Outcomes
Efficiency
Improvement
Learning
Collaboration
Humility
Discipline
Teamwork

8. Porter’s Value Framework – Ideas Whose Time Has Come
Fundamental question – What are we trying to do?
Clinicians and other stakeholders need shared overarching goal
Otherwise, interactions devolve into gamesmanship with goal of protecting each stakeholders’ interests
Traditional concepts of quality put focus on clinicians’ reliability in performing processes
Our goal must be more than defending ourselves from criticism
Goal has to be one that invokes problem solving for issues of patients

9. Porter’s Value Framework – Ideas Whose Time Has Come
Fundamental question – What are we trying to do?
Clinicians and other stakeholders need shared overarching goal
Otherwise, interactions devolve into gamesmanship with goal of protecting each stakeholders’ interests
Traditional concepts of quality put focus on clinicians’ reliability in performing processes
Our goal must be more than defending ourselves from criticism
Goal has to be one that invokes problem solving for issues of patients
Our shared goal should be improvement of value as defined by the outcomes that matter to patients and costs over meaningful episodes of care

10. Value for Patients = Health Outcomes Cost of delivering outcomes
Our overarching goal should be to improve value of care for patients & families, as defined by patients
Cost
Outcomes
VALUE
FOR
PATIENTS
Defined by patient
Measured for patient’s condition over entire episode of care
Measured for patient’s condition over entire episode of care
Value for Patients = Health Outcomes
Cost of delivering outcomes
Improving value for patients may be the only thing that all key stakeholders can agree upon 10

11. There is no one outcome that tells the entire story for any condition
Value Based
Clinical
Outcomes
Experience in achieving that outcome
Cost to Produce
the Outcome
Tier 1 – Health status achieved: survival, degree of health recovery
Tier 2 – Process of recovery: time to recovery, disutility of care
Tier 3 – Sustainability of health
This framework is not about competition. It is about improvement and it is about collaboration 11

12. Care Redesign Deliverables – Phase I
Value Dashboard
Care Redesign Plan
Care Plan: pause points and key interventions
Incentives: bundled payment program planning
Performance Metrics: measures to monitor implementation and value
Version 1.0: outcomes, processes, service metrics, and cost available currently
Version 2.0 (Future Aspirations): measures that matter to patients, e.g., outcomes

13. Version 1.1: AMI
MGH saw an increase in readmissions for this measurement period % of patients were readmitted as opposed to 9.9% in FY10.
2) % of Short Stay patients with 1 or more Echo or Cath decreased from last measurement period: likely due to Care Redesign focus

14. Performance Dashboard 1.0 for End of Life Care
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15. Bohmer Operations
Teams that have responsibility for improvement of value – forever
Data on outcomes and costs collected as routine part of care
Incentives (financial and otherwise) for improvement
A leader who thinks constantly about improving performance
Formal and informal interactions among team members

16. Words That Resonate Through Their Work
Value
Measurement
Outcomes
Efficiency
Improvement
Learning
Collaboration
Humility
Discipline
Teamwork