Value Based Health Care Delivery: Strategy For Health Care Leaders

Value Based Health Care Delivery: Strategy For Health Care Leaders Professor Michael E. Porter Harvard Business School www.isc.hbs.edu American Hospi...
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Value Based Health Care Delivery: Strategy For Health Care Leaders

Professor Michael E. Porter Harvard Business School www.isc.hbs.edu American Hospital Association July 23, 2015

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means — electronic, mechanical, photocopying, recording, or otherwise — without the permission of Michael E. Porter and Elizabeth O.Teisberg. 1

Copyright © Michael Porter 2015

Setting the Right Goal •  The core purpose of health care is value for patients

Value =

Health outcomes that matter to patients Costs of delivering those outcomes

•  Delivering high value for patients must be the central goal of every health care organization -  financial success is the result of delivering value, not the end in itself

•  Health care delivery must shift from volume to value

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Copyright © Michael Porter 2015

Principles of Value-Based Health Care Delivery •  Value is created in caring for a patient’s medical condition over the full cycle of care à not by a hospital, a site, a specialty, an episode, or an intervention Value =

Health outcomes that matter to patients Costs of delivering the outcomes

−  Outcomes are the full set of health results that matter for the patient’s condition −  Costs are the total costs of care for the patient’s condition over the care cycle •  The most powerful single lever for reducing cost is improving outcomes 3

Copyright © Michael Porter 2015

Creating a Value-Based Health Care Delivery Organization The Strategic Agenda 1.  Re-organize Care around Patient Conditions, into Integrated Practice Units (IPUs) −  For primary and preventive care, IPUs serve distinct patient segments

2.  Measure Outcomes and Costs for Every Patient 3.  Move to Bundled Payments for Care Cycles 4.  Integrate Multi-site Care Delivery Systems 5.  Expand Geographic Reach To Drive Excellence 6.  Build an Enabling Information Technology Platform

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Copyright © Michael Porter 2015

1. Organize Care Around Patient Medical Conditions Headache Care in Germany Existing Model: Organize by Specialty and Discrete Service Imaging Centers

Outpatient Physical Therapists

Outpatient Neurologists Primary Care Physicians

Inpatient Treatment and Detox Units

Outpatient Psychologists

Source: Porter, Michael E., Clemens Guth, and Elisa Dannemiller, The West German Headache Center: Integrated Migraine Care, Harvard Business School Case 9-707-559, September 13, 2007

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Copyright © Michael Porter 2015

1. Organize Care Around Patient Medical Conditions Headache Care in Germany Existing Model: Organize by Specialty and Discrete Service Imaging Centers

New Model: Organize into Integrated Practice Units (IPUs) Around Conditions Affiliated Imaging Unit

Outpatient Physical Therapists

Outpatient Neurologists Primary Care Physicians

Primary Care Physicians Inpatient Treatment and Detox Units

West German Headache Center Neurologists Psychologists Physical Therapists “Day Hospital”

Essen Univ. Hospital Inpatient Unit

Affiliated “Network” Neurologists

Outpatient Psychologists

Source: Porter, Michael E., Clemens Guth, and Elisa Dannemiller, The West German Headache Center: Integrated Migraine Care, Harvard Business School Case 9-707-559, September 13, 2007

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Copyright © Michael Porter 2015

1. Organize Care Around Patient Medical Conditions Head & Neck Cancer Care at MD Anderson Existing Model: Organize by Specialty and Discrete Service

Surgical Oncologist

Primary Care Physician

New Model: Organize into Integrated Practice Units (IPUs) Around Conditions Social Work Smoking Cessation Pharmacists Patient Education Integrative Medicine

Speech & Swallow

Outpatient Oncologist

Primary Care Physicians

Radiation Oncologist

Radiologist Pathologist

MD Anderson Head & Neck Center Medical Oncologist Surgical Oncologist Radiation Oncologist Dental Oncologist Pathologist Radiologist Nurses Speech & Swallow Audiology Prosthodontics

Plastic Surgeons, & Other Specialties

Pathology Lab Operating Rooms Chemotherapy Radiation Therapy Diagnostic Imaging Equipment

Dentist

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Copyright © Michael Porter 2015

Source: Porter, Michael E., Jain, Sachin, The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care. February 26, 2013.

Integrating Across the Care Cycle A Surgeon Teaches Independent Physical Therapists About Rehabilitation

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The Playbook for Integrated Practice Units (IPUs) 1. Organized around a medical condition or set of closely related conditions (or around defined patient segments for primary care) 2. Care is delivered by a dedicated, multidisciplinary team who devote a significant portion of their time to the medical condition 3. Providers see themselves as part of or affiliated with a common integrated unit 4. The team takes responsibility for the full cycle of care for the condition 5. Patient education, engagement, adherence, and follow-up are integrated into care 6. The unit has a single administrative and scheduling structure 7. To the extent feasible, the team is co-located in dedicated facilities 8. A physician team captain or a clinical care manager (or both) oversees each patient’s care process 9. The team accepts joint accountability for outcomes and costs 10. The team measures outcomes, costs, processes, and experiences for each patient using a common measurement platform 11. The team meets formally and informally on a regular basis to discuss patients, processes, and how to improve results 9

Copyright © Michael Porter 2015

Volume in a Medical Condition Enables Value Fragmentation of U.S. Care Procedure / Specialty

Est. Number of Inpatient Procedures

% of Procedures at Hospitals Performing