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last updated: 7/26/2004; 9:21:37 PM
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Marc's Weblog
WWPP weblogs
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Pursuing Perfection
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Marc's Weblog
 | Marc's Pursuing Perfection HIGH LEVEL OVERVIEW |
 | Patient-centered |
| Community-wide |
| Chronic disease management |
| And infrastructure |
| 2=>5=>All chronic diseases |
| ------------------------ |
| SJH, CSH, FCN, Sea Mar, NCC |
| GHC, Regence, CHPW |
| RWJF, IHI, 12 other organizations |
| We are doing the right stuff--the components of community-wide chronic care management |
| Promises to patients |
| Patient involvement in design and governance |
| Shared Care Plan |
| Clinical Care Specialists |
| Group Visits, E-mail and Phone Visits |
| Web information (pt, disease, community, stories, collaboration) |
| We are doing the right stuff--con't |
| Evidence based Medicine |
| Registeries + |
| IDCOP / Access |
| Payment alignment / System Dynamics Simulation / Advocacy |
| Integration of EMRs |
| There is enough money in the community for this level of care. |
| BUT, we have to execute well, do screening and prevention, and engage whole community |
| Big winners: pts & fm, empl, "CMS", pharm |
| Need to engage these winners, underway |
| Seattle Summit, April 14th |
| We have the ability to cooperate between organizations |
| PPLB (leadership board) |
| Recent mini-summit |
| Agreements |
| The second most important learning journey (after pt. involvement) |
| Each organizations ability to create organizational change (transformation) is not a certainty nor is the time line certain. |
| It is not one caterpillar going to a butterfly |
| Rather it is a mulberry tree with multiple caterpillars |
| Each one chooses whether to transform or not. |
| TOPICAL UPDATE |
| P2 is still PH key strategy (R&D -- Spread) |
| Hospital kick off |
| Winners from program implementation |
| CMS Demonstration |
| Advocacy |
| Leadership |
| Seattle Summit Plans |
| Hospital Kick Off |
| Link into Community Care model |
| Two designated pilot sites |
| Cardiovascular Unit |
| Medical Care Unit |
| Marla Sanger, Judy Pratt, Martha Shepler |
 | Marla now has a Weblog |
| Modeling Shows Winners |
| Patients |
| (about 200 lives a year AND $4.6M/year in social losses prevented) |
| Employers |
| ($2M/year) |
| Pharmaceutical companies |
| ($6.6M/year) |
| CMS |
| ($4.2M/year) [anyone insuring over 65 population] |
| Affected substantially |
| Hospital |
| (delay in growth of admissions for DM and CHF of about 4 years) |
| Sepecialists |
| (delay in growth of visits for CHF of about 4 years) |
| PCPs |
| (increase in volume and increase cost of IT systems) |
| Local Stakeholder Policy Summit |
| Worse case |
| Bridge to May '04 |
| => Seattle Summit |
| Payment Alignment |
| Looking at CMS |
| Chronic disease managed care/capitation demonstration projects |
| Exploratory talks with GHC, Sterling/Olympic, Hospital |
| Advocacy |
| Appropriations Bill, requested $2.4M |
| Approach to Pharmaceutical companies |
| Early talks with drug reps |
| PhRMA next? |
| WA Insurers |
| St. Luke's Foundation sponsored Community Healthcare Access Summit follow-on |
| Concerns: |
| Payment as it impacts access |
| Medical information systems |
| Access |
| Ward Nelson, Washington DC visit to all members |
| P2 representation |
| David Lynch, Marc Piersoh, Chris Phillips |
| Leadership of Organizational Change |
| Best minds approach to organizational change in clinics |
| Ms. Catherine Tantau |
| Doug Eby |
| Jack Silversin |
| David Cooperrider |
| Gervase Bushe |
| Jim Reinersten |
| Insight: tight time line, difficult challenge, values aligned with goals, little time for noise |
| Seattle Policy Summit |
| KEY MESSAGE: cooperative, patient-centered, community-based chronic care management provides the best care at the lowest cost. |
| Morning session |
| Coming chrisis |
| Systems work better |
| Role of community |
| Roles of patient / consumer / customer |
| Role of screening and prevention |
| Experience to date |
| Costs are lower, must solve win / loose situation |
 | Afternoon Break Out Session |
| By stakeholder: |
| Patients |
| Payers |
| PCP |
| Specialists |
| Hospital |
| Employers |
| Government |
| Foundations |
| Goals |
| Clarify understanding from morning sessions |
| Make contacts and agreements to share information and work together |
| Surface concerns, especially issues missed in morning |
| What do you see that you want more of....? |
| What can you do in the future or now to help? |
| Who could align Payment Policy Decisions that we could influence in the near intermediate and long term (three groups short term / Intermediate term / long term |
| Detailed notes on Seattle Summit |
| Goals for morning session |
| KEY MESSAGE: cooperative, patient-centered, community-based chronic care management provides the best care at the lowest cost. |
| Understand Quality Chasm, Chronic Care is different than Acute Care, COMING CHRISIS due to increased population with chronic conditions and increasing costs for end-stage disease management. |
| Some effective method must be found to avert a disaster. We are certain that we have one solution that can work. |
| SYSTEMS approach to national experiments more likely to work than simpler, easier approaches |
| This is a case where the common, overly simplistic, non-systematic, REDUCTIONIST approach to health system innovation cannot inform the nation. We believe that chronic contition care is a SYSTEM and that the BENEFIT is more than the some of the parts and the COST are less than the sum of the parts. |
| When I read the current proposals for national demonstrations projects they seem to be asking us to find a way to make a broken watch work by taking the gears and parts our, spreading them across the county and having different communities work on the parts. It is as if making a part bigger, or brighter, or of a more or less precious material will make the watch tell time. Our point is that unless the parts are changed together, that the fit of the parts is at least as important as the design of each part one will never really know what works. The patients and the payers are looking the face of the watch. The folks with dollars for large scale experiments are tearing the parts out of the watch for experiments that are out of context, a non-systems approach to fix a broken system. We are working on the whole watch with all the parts as requested by the IOM Chasm Report and as funded by RWFJ. |
| ROLE of COMMUNITY |
| Everyone to see that community-based, community-wide chronic care management makes sense, is perhaps the only way that total costs for the benefit can be lower |
| SYNERGIES result from community-wide, all condition approach |
| Start with the two diseases that do have a pay off, let them cover the expense for the community and office and home infrastructure, |
| Get the benefit of the infrastructure in place so that only the incremental costs need to be covered for the other chronic conditons, and hope that the benefit will at least cover the incremental costs |
| At least 50% of people with chronic conditions have two or more, so the incremental cost for caring for these people's multiple conditions is hopefully less than for the first condition. |
| We hope to deliver quality of care outcomes that rival or surpass the best consumer owned health maintenance organizations. |
| We believe that the most effective scale and scope for chronic care delivery systems are the community and all chronic conditions. |
| ROLES of PATIENT / CONSUMER / CUSTOMER |
| We have found that the key insight or key to effective design of chronic condition management systems is direct patient control of the design process; from idea creation, to feature design, to prototype testing, to marketing, to use and continuous improvement. |
| ROLE of SCREENING and PREVENTION |
| 50% of benefit comes from screening and prevention and the community-wide economic savings form better care at earlier ages is lost without effective screening and prevention. |
| Experience innovations that are NOW WORKING, after 9 months |
| Patient involvement in design |
| Shared Care Plan |
| Clinical Care Specialist |
| COSTS, overall are lower, not higher, for dramatic improvements in health, safety, satisfaction and it is applied to everyone |
| ROLE of COMMUNITY SYSTEMS DYNAMICS MODELING AND SIMULATION |
| Shared understanding of own and each other's situation and how changing one affects the others |
| An effective alternative to finger pointing |
| Understanding impact of policy proposals. Some policy proposals are economically system breaking (deal breakers) |
| Savings must stay in the community system to fund the infrastructure |
| Afternoon Break Out Session |
| By stakeholder: |
| Patients |
| Payers |
| PCP |
| Specialists |
| Hospital |
| Employers |
| Government |
| Foundations |
| Goals |
| Clarify understanding from morning sessions |
| Make contacts and agreements to share information and work together |
| Surface concerns, especially issues missed in morning |
| What do you see that you want more of....? |
| What can you do in the future or now to help? |
| Who could align Payment Policy Decisions that we could influence in the near intermediate and long term (three groups short term / Intermediate term / long term |
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© Copyright
2004
Marcus Pierson, MD
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Last update:
7/26/2004; 9:21:37 PM
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This theme was created for WWPP by Jack
F. Mancilla |
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