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UWHC,

Nursing,

UW Health,Ambulatory Education,Educational Opportunities,Grand Rounds,Nursing Grand Round Presentation Video Archive 2012,Leading and Managing in a Clinical Practice Discipline 2012,01/05/2012 - 2012: The Year Ahead for UW Health,Resources

Presentation

Presentation - UW Health, Ambulatory Education, Educational Opportunities, Grand Rounds, Nursing Grand Round Presentation Video Archive 2012, Leading and Managing in a Clinical Practice Discipline 2012, 01/05/2012 - 2012: The Year Ahead for UW Health, Resources


2012 and Beyond – What Lies
Ahead for
UW Health-UWHC?
Presentation to
UWHC Nursing Managers and Leaders
Donna Katen-Bahensky,
President and CEO
January 5, 2012


2
Overview
 Improving Today, While Preparing for
Tomorrow

 Is UW Health Prepared? What are the
Strengths we can Optimize? What are the
Challenges we must Overcome?

 Nursing Leadership’s Role in Future
Success

3
Why the Reform Changes?
 Health care in the US is unaffordable
 US Fiscal and Tax Policy has masked
healthcare’s lack of affordability for
decades
 Challenge for the healthcare industry is to
make health care more affordable

“Navigating Healthcare’s New Era.” Kaufman Hall Point of View. August, 2011

4
Why Is Health Care Being
Put on a Budget?
 Rapid Growth of Health Care Expenditures
 Long-Term solvency of Medicare and
Medicaid
 Steady influx of Medicare Beneficiaries
 Chronically Ill Patients demanding Health
Care Services at Unprecedented Rates
 Households must find way to Afford Rising
Premiums and Higher out-of-pocket costs
Continued…

5
Why Is Health Care Being
Put on a Budget?
 Cost-Shifting burden on Commercial
Payers is Increasing
 Employers are Looking for Coverage
Options that Control Costs
 Low tax revenues placing Pressure on
State Budgets and Medicaid


6
Market Forces Driving Health
Margin Erosion
 Hospitals facing Pricing Pressures
 Cost Pressures Continuing Unabated
 Payer Mix Shift
 Deteriorating Case Mix
 “Breakeven” Not Ambitious Enough

7
Key Trends
 Health care is rapidly moving from a
Medicare business model to a post-reform
business model
 Reimbursement and Utilization will decline
over time
 Significant consolidation will occur – size
and scale will matter
 Relationships between hospitals, doctors,
and patients will change dramatically
“Navigating Healthcare’s new Era”. Kaufman Hall Point of View. March, 2011


8
View of the Future
 A hospital may not be the center of a health care
system as it is Today
 Focus on wellness, prevention and chronic-
disease management
 Relationships with providers and community
leaders will be paramount
 Hospitals will continue to provide acute care –
will also need to organize all key stakeholders in
the delivery system
 Focus will be on reshaping the patient
experience
“Demonstrating Accountability, Internally and Externally.” Transforming Health Care. Supplement to
Hospitals and Health Networks. 2011


9
Balance between Today and
Tomorrow
 “Hospitals must navigate a tricky course
between today’s fee-for-service payment
system and the coming of accountable
care.”
“The Rising Risk Tide.” Hospital and Health Networks, August, 2011

 “Some health care delivery organizations
aren’t waiting to be told how to improve
the system – they’re already doing it.”
“Fixing Health Care on the Front Lines.” Harvard Business Review. April, 2010

10
Must-Do Strategies
 Align hospitals, physicians and other
providers across the continuum of care
 Utilize evidence based practices to
improve quality and patient safety
 Improving efficiency through productivity
and financial management
 Joining and growing integrated provider
networks and care systems
 Educating and engaging employees and
physicians to create leaders
Continued…

11
Must-Do Strategies
 Strengthening finances to facilitate
reinvestment and innovation
 Partnering with payers and employers
 Advancing an organization through
scenario based strategic, financial and
operational planning
 Seeking population health improvement
through pursuit of the triple aim – focus on
population health, increased quality and
reduction in health care cost
“Hospitals and Care Systems of the Future.” American Hospital Association. September, 2011

12
UW Health Response





Improving Today, While Preparing
for Tomorrow


13
UW Health – Today

 Increased Capacity for New Patients
 Geographic Strategy Group
 Strategic Plan Implementation
 Financial Strength Enhanced
 Quality Measures Improving
 Greater Focus on HCAHPs results and
Core Measures
 Electronic Health Record
 Emphasis on Staff Engagement

Continued…

14
UW Health - Today
 Building a patient and family centered culture

– Growing and expanding use of patient advisors
– Physician Quality Reporting Initiative

 Further alliance building among the three
organizations of UW Health

– Clinical Simulation Center
– Accountable Care Organization Plan and Leadership
– UW Health Medical Director for Delivery System
Innovation
– Joint Quality Council
– Center for Clinical Knowledge Management
– Health Information Management Center
– Ambulatory Service Standards
– Primary Care Redesign
– UW Health Director of Learning and Development

15
Future Reimbursement
 Value-Based Purchasing
 Hospital Readmissions Reduction
 Hospital-Acquired Condition (HAC)
Penalty
 Bundled Payments
 Accountable Care Organizations
 Narrow Networks or Tiered Networks

16
Pay-For-Performance Programs
 Value-Based Purchasing –Mandatory
program. % of Hospital Inpatient
Payments withheld, earned back. Begins
at 1% in 2013 and grows to 2% by 2017.
 Hospital Readmissions Reduction –
Hospitals with > expected Readmission
rate subject to financial penalty. Based on
30-Day readmission metrics for 3
conditions in 2013, expanding to 4 in
2015. Penalties 1% growing to 3% in
2015.

17
Pay-for-Performance
 Hospital Acquired Condition Penalty – Hospitals
in top quartile of national, risk-adjusted HAC
rates subject to financial penalty. 1% penalty
deducted from DRG starting in 2015
 Bundled Payments – Shared savings
arrangement with bundled payments for all
parties involved in the care delivery process
 Narrow/Tiered Networks – Shift of patients to
lower cost networks within the local market.
Tied to consumer out-of-pocket costs.

18
Tomorrow
 Meeting New and Changing Demand

-Digestive Health Center
-East Side Health Care Campus
-American Family Children’s Hospital
-Future Planning for the Current Campus

 Being Positioned to Succeed with Changing Payer
Systems

– Primary Care Redesign
– Value Based Purchasing
– Accountable Care
Continued…

19
Tomorrow
 Optimization of Electronic Health Record
 Redesigning Affiliation Agreement
Expectations
 Performance Expectations
 Productivity Based Budgeting
 Expanding and Building New Geographic
and Service Driven Relationships
– Swedish/American
–Watertown
– Beloit
– Post-Acute Providers



20
Other Initiatives
 Focus on Documentation and Coding
 Use of Dashboards throughout
organization
 Focus on the Patient Experience
 Medical Management focusing on 2-3
services
 Transitions of Care
 Patient Centered Medical Home

21




Is UW Health Prepared?

22
What does it take to be prepared?
 Bending Cost Growth Curves
 Boosting Effective Capacity to Capture
Demand Growth
 Managing Case Mix
 Putting the Patient Experience First
 Relentlessly pursuing high quality
 Reducing practice variation

23
Strengths
 Fully Electronic Health Record Across the
Continuum of Care
 Financial Stability
 Growth of Primary Care Practice
 Use of Telehealth
 Enhanced Image Across the Local and
Regional Markets
 Transitions of Care Continued…

24
Strengths
 Effective Outreach Program
 Numerous sites/ Geographically Dispersed
 Long History of Effective Supply Chain
Management
 New Focus on Patient and Family
Centered Care
 Partnership with Unity Insurance
 Dedicated and High Quality Staff


25
Challenges
Need for:
 Consistent and Effective Patient/Family
Communication
 Chronic Disease Management
 Reduced Organizational Complexity while
fulfilling Multiple Missions
 Physical Facilities that are Patient –
Centered and Healing Environments
 Optimization of Electronic Health Record
 Building relationships with Post-Acute
Providers outside the UW Health system
Continued…

26
Challenges
Need for:
 Improved Health Literacy
 Engagement of Geographically Dispersed
Organizations as part of ACO Discussions
 Appropriate Formula for Dispersing Funds
for Bundled Payments
 Reduced Readmissions for Patients
Served in Ring Markets/Outside Ring
Markets

27
The CEO/Sr. Leadership Role
 Be candid about Transitions and Changes due
to Reform
 Demonstrate Commitment to Patient and
Family-Centered Care
 Act on Data that Identifies what is Important to
Quality Patient Care
 Participate in Open Communication with
Patients and Families
 Provide Ongoing Feedback and be Visible to
Staff
 Encourage Partnerships Between Physicians
and Other Providers

28
Nursing Leadership’s Role
in Future Success

29
For the 10th straight year
Nursing has been rated the
most trustworthy profession by
the Gallup Poll.


“The Public’s continued trust in
nurses is well-placed, and
reflects an appreciation for the
many ways nurses provide
expert care and advocacy.”

Karen Daley
President, American
Nurse’s Association

30
Nursing Leadership’s Role
 Central to Patient and Family Centered Care
 Chronic Disease Management
 Engaging the Patient in Planning and Decision
Making
 Understanding the “Whole” Patient
 Must Assume Critical Roles at the Bedside and the
Senior Leadership Table
 The “voice” for Safety and Quality


31
Focus for Nursing Leadership
 Focusing on operational, clinical and
service excellence at one time
 Developing effective quality, utilization,
risk and infection management programs
 Improving performance in reducing
hospital-acquired conditions,
complications and mortality
 Working with Physician partners to reduce
variation and utilization of services
Continued…

32
Focus for Nursing Leadership
 Eliminating Current waste in the system
 Increasing staff engagement
 Developing Processes for Effective
Transitions of Care
 Enhancing the Utilization of Home Care
 Partnering with Physician Medical
Directors
 Bringing an evidence based practice
approach to the table
 Being Available to Staff – Maintaining an
Open-Door Policy
Continued…

33
Focus for Nursing Leadership
 Effective and proper nurse staffing while the
patients are still in the Hospital
 Clearly communicating during the Hospital stay
ensuring Patients and Families Understand
 Understanding which Patient Populations are at
Greatest Risk of Readmissions
 Designing creative post-discharge
communication and follow-up
 Focusing on disciplined cost management
utilizing ideas from front-line staff
 Ensuring Patients Have appropriate Follow-up
Continued…

34
Focus on Nursing Leadership
Understanding, Disseminating and Utilizing
Performance Improvement Tools
Establishing Places for Nursing at all Leadership
Tables
Applying “Evidence Based” approaches to the
Supply Chain
Utilizing Tele-health Approaches Where Feasible
Bolstering Throughput Across the Organization
Minimizing Variations Unless Driven By Patient
Needs
Keep the PATIENT AT THE CENTER

35
The Most Critical Strategy

“The most critical strategy may actually be
the most difficult to implement. Leaders
need to be flexible and able to respond to
whatever the environment brings. The
most critical trait for future success will be
the ability to adapt to whatever happens.
Change will occur and those who prepare
for change will be positioned not only to
survive, but to thrive in the new world of
healthcare”.
“Success in a Changing Healthcare System.” Executive insight. 2011