Marcus Pierson, MD: Systems, CAS

Systems Dynamics Modeling of Diabetes and Congestive Heart Failure in Whatcom County

Sunday 6/16/02; 10:29:16 PM by MP (notes by Mary Minniti)

This serves as documentation of the work of a small team scoping the systems dynamics work ahead. Attendees as the conference call were: Marc Pierson, Mary Minniti, Marcy Hipskind, Mark Donaldson and our consultants - Gary Hirsch and Jack Homer.
The main focus of Phase 2 is to model the financial impact of changes in care to the various organizations and community. We will model both diabetes and congestive heart failure. The purpose is to define the reimbursement issue and provide information useful to impact policy decisions. Work will begin in July and conclude by Jan 2003. It will be used by GHC [and hopefully others] to make changes in policy for reimbursement.
Two new areas of focus will be to model the effect of patients changing insurance companies and the % of patients who stay or leave the county as we are interested in the impact to each organization as well as the community. We will integrate into our model two concepts from John Wennberg's proposal to CMS (Medicare) - use of effective care and the effect of patient choice on the model.
The remaining time was spent identifying data needs and next steps:
The modelers will be in our community July 15 - 18th.
Individual meetings will be set up with each organization. A overall meeting with all partners to summarize their work, will occur on the last day. Mary/staff to coordinate
Individual phone interviews will occur with each organization's knowledge expert who has a broad view of the data in each system. Each site is asked to provide names and numbers of those individuals to Mary Minniti - who will forward to Jack and Gary by June 18th.
A listing of the cost assumptions in the Phase 1 model will be provided and each organization is asked to review it for accuracy.
A list of articles will be provided about CHF to Jack and Gary. These are review articles about the disease, best evidence and outcomes with various treatments and current thinking about disease management in this area. Roland Trenouth is providing the list.
Contact with the other organizations (especially CMS and DSHS) on the call will be made to get the appropriate names of people to participate in the Systems Dynamics F2F and phone interviews work between now and July 15th. Mary and/or Marc will make these contacts.
Marc and Mark will conference with Lynda Parton to share the approach of targeting appropriate folks in the insurance arena to provide information in this effort: Medical Director, Administrator/Operations person and Provider Relations person
Marc will contact Kristen Crosby about CMS and her involvement in the modeling work.
Data needs: [each organization will provide this information below to Gary and Jack for the modeling]
- understanding cost structure - what are fixed vs. variable cost at the practice/insurance level for care to patients.
Understanding revenue stream- understanding the different payment models for clinics/hospital. How do provider revenues changes if volumes change? What % of revenue are covered by different payment mechanisms?
Mark Donaldson will do some follow-up to see if GHC could share the above data information from their clinic practices
Mary will gather some information from HealthPartners regarding their % gain of efficiency or % cost savings from IDCOP so it can be placed into model as one gross variable.

We will use Simulation and System Models to understand and advocate for reimbursement alignment

Our task list includes the following:

Engage the other grantees in system dynamics effort, sharing knowledge with them as it accumulates
Follow up on HBOC Offer
Develop a contract with System Dynamics folks
Scoping Meeting in June.
Identify community business participation
Week long SYS Dynam meeting with the local Systems Team
Conduct community data analysis and costing for diabetes and CHF
Identification and contact with employers and community resources for support
Identification and contact with payors, national representatives for support in change in reimbursement model

We will soon Complete the Initial Staffing for Project

For this project to truly be succefful, these typse of staff positions will need sustainable funding. A daunting thought for a cottege industry. It's a system. The only question is whether the stakeholders can create infrastructure to support a system.

Recruitment and Hiring of Project Staff (Data Analyst, Project Manager, Project Coordinator)
Hire Grant Writer
Recruitment and Hiring of information technology staff (Web Content/patient Education; Programmers)
Recruitment and Hiring of Team and Process Improvement Facilitator and Organizational Development (OD)
Recruitment and Hiring of Care Managers
Consultants and Contractors may be hired

We will use Simulation and System Models to understand and advocate for reimbursement alignment

Our task list includes the following:

Engage the other grantees in system dynamics effort, sharing knowledge with them as it accumulates
Follow up on HBOC Offer
Develop a contract with System Dynamics folks
Scoping Meeting in June.
Identify community business participation
Week long SYS Dynam meeting with the local Systems Team
Conduct community data analysis and costing for diabetes and CHF
Identification and contact with employers and community resources for support
Identification and contact with payors, national representatives for support in change in reimbursement model

Leadership in truly complex organizatons.

When asystem becomes more complex than the complexity of the individuals, "leadership" needs sotmething more than just individual leaders. Complex systems can be structured with a few simple rules which allow them to evlove toward their goals.

Complex times call for simplicity

Complex times demand greater simplicity, Steve Novick.. Complex Times Demand Greater Simplicity, Steve Novick

Simple rules are a type of simplicity that apply to complex systems.

Complex Adaptive Systems, Simple Rules and a Definition

Complex Adaptive Systems, a definition.

Health care is a complex apaptive system. The outcome of CASs is shaped by the simple rules that the agents follow. The simple rules are the most important feature of any complex system.

Here is a nice definition of CAS.

6 Aims and 10 Simple Rules for more perfect heathcare, Institute of Medicine

The key ideas behind this entire Institute of Medicine approach includes six goals:
1. Safe, 2. Effective (evidence based), 3. Patient-centered, 4. Timely, 5. Efficient, and 6. Equitable; and ten simple rules:

1. Continuous healing relationships
2. Customization
3. Patient control
4. Shared information
5. Evidence-based decision-making
6. Safety as a system property
7. Transparency
8. Anticipation of needs
9. Continuous decrease in waste
10. Cooperation among clinicians

Stop Energy vs. Forward Motion

Too often the culture and organizational inertia brings innovation to a halt before it can germinate.

Communities of Learning, Apply to Healthcare?

Please read this.