New Best Friends The CFO and Quality Lead

New Best Friends: The CFO and Quality Lead Jim Dietsche--Chief Financial Officer Colleen O’Brien--Quality Resource Bellin Health - Green Bay, WI 1

Bellin Health Systems Organizational Structure 2

Geographic Region 3

We Better Be Best Friends! 4

Who is interested in the cost + quality of our care? 5

How is Bellin Doing? 6

The “Triple Aim” Population Health Per Capita Cost Experience of Care 7

The Triple Aim Goals of CMS • Better Care – Patient Safety – Quality – Patient Experience • Reduce Per Capita Cost – Reduce unnecessary and unjustified medical cost – Reduce administrative cost thru process simplification • Improve Population Health – Decrease health disparities – Improve chronic care management and outcome – Improve community health status 8

Mortality Rate The Hospital Standardized Mortality Ratio (HSMR) is provided to the Institute of Health Care Improvement (IHI) by Professor Sir Brian Jarman, Imperial College, London, and Dr. Foster. 9

Patient Satisfaction The Hospital Care Quality Information from the Consumer Perspective survey data are taken from the CMS Hospital Compare web site (www. hospitalcompare. hhs. gov). 10

Cost 11

Other Quality Indicators 592 Days Retained Foreign Body Rate of Readmission for Heart Failure Patients BELLIN MEMORIAL HSPTL Better than U. S. National Rate Death Rate for Heart Attack Patients BELLIN MEMORIAL HSPTL Better than U. S. National Rate 1006 Days VAP >2 Years Inpatient MI Death 517 Days Respiratory Event 12

Volumes and Cost 13

Lowest Inpatient Charges Green = Lowest Cost Provider for DRG Red = Highest Cost Provider for DRG 14

Lowest Outpatient Charges Green = Lowest Cost Provider for ICD-9 Procedure Red = Highest Cost Provider for ICD-9 Procedure 15

Primary Care Quality and Cost 16

So How Does It Happen? 17

The Business of Health Care High Performance Health Care Model - Market/Customer Knowledge - Organizational Knowledge What Should We Make? What Features/ Functions Should Our Products Have? BRANDS 1 Strategic Position “VOICE OF THE CUSTOMERS” External Focus Products and Services ------------------------------------How Will We Make It? PLATFORM PLANNING SYSTEM OF PRODUCTION 2 Platform “VOICE OF THE PROCESS” Internal Focus Is It Made Well? What Do We Need to Improve/ Redesign? SYSTEM OF MEASUREMENT SYSTEM OF LINKED MEASURE Knowledge ALIGNMENT AND DEPLOYMENT ROAD MAP SYSTEM OF IMPROVEMENT 3 4 Action ------------------------------------OFFERED / CHOSEN Do People Buy Our Products? SALES MARKETING 5 “VOICE OF THE MARKETPLACE” External Focus ©Knox 2000 18 Results 6

Organizational Chart 19

Strategic Measures Using Scorecards • Bellin has a System Scorecard that is driven by individual Brand Scorecards to define and measure progress toward achieving our Strategies. • The Brand Scorecards drill down from the System level to show clear accountability and are achieved through Innovation and Quality Control work that is organized and measured within 120 -day planning cycles. 20

System of Linked Measures • System Scorecard Measures • System of Measures – Important to measure the balanced performance of the system at the strategic, brand, operational and individual levels – Measures help to align improvement across the system – Serve as inputs to strategic quality planning— performance plan – Need to be limited to a relatively small set – Need to flow from the system strategies and reflect a balance among the strategies – Should allow for comparisons to other similar organizations – Need to be relatively straightforward, not overly complex – Need to be within control of the organization, to take action to improve the measure results – Which implies there are measures available at the operational levels that impact the system measures 21

System of Linked Measures System Scorecard Measures Engagement: Likelihood of Recommending Efficiency: Cost to Produce Brand Scorecard Measures BPC Inpatient Survey Result: Likelihood of Recommending Invasive Clinical Services: Cost to Produce Departmental (Operational) Scorecard Measures BPC Adult Unit: Likelihood of Recommending 6 th Surgery: Operating Expense per Surgical Procedure Individual Scorecard Measures Individual Therapist or Psychiatrist: Section Score from Patient Satisfaction Survey Individual Level: Cost per Procedure by Physician 22

System of Improvement—Performance Plan 23

24

25

Communication and Evaluation of Business Performance Measures Financial Plan Bellin Memorial Hospital, Inc. Hospital Reference Lab Medical Group Home Care Home Infusion Therapy Sports Medicine Occupational Health North. Reach Health. Care, LLC Critical Care Solutions, Inc. Quality Health Solutions Bellin Orthopedic Surgery Center, LLC Bellin Psychiatric Center, Inc. Oconto Hospital & Medical Center, Inc. Bellin College, Inc. Bel-Regional Home Medical, Inc. Durable Medical Equipment Fitness Centers / XL Retail Pharmacies / Optical Services / Fit Café’s Bellin Orthopedic Surgery Center, LLC Bellin Investments, Inc. Bellin Foundation, Inc. Fiscal Year 2010 -2011 Confidential: For Internal Purposes Only 26

Communication and Evaluation of Business Quality Measures 27

28

Example of a Report to Finance Ventilator Associated Pneumonia (VAP) Background: • VAP is the leading cause of death for patients with hospital-acquired infections. Mortality approaches 50%. • Financial costs related to VAP are estimated to be an additional $40, 000/patient. It extends ICU and hospital length of stay. • Estimated that as many as 15% of patients develop VAP nationally. • Bellin rate for VAP is 0. 3 (6 patients during the period of January 2005 to January 2008). 3 of the 6 patients died. • VAP can be prevented, if not eliminated, by implementation of 4 interventions (elevation of the head of the bed, daily assessment for weaning from the ventilator, DVT prophylaxis, stress ulcer prophylaxis). • Implications for Bellin: • If Bellin were at the national rate we would have had 232 patients instead of 5 with VAP during the time period of January 2005 to January 2008. • This would have meant: – Another 113 patient deaths. – An estimated 1, 589 additional patient days, mostly ICU days. – Additional charges of $9, 080, 000. • 29