Ahmad Younes, MD
May 1st, 2017
HSMC 420
Integrated health solutions: Impact of Industry and hospital systems partnership
Outline:
I. Introduction
II. Integrated health solutions
III. Europe Experience: Maastricht University Medical Center, The Netherlands; and Imperial College Healthcare NHS Trust in the United kingdom
IV. Association with the US healthcare system
V. University Hospitals Cleveland Medical Center
VI. Discussion
VII. Conclusion and insight
VIII. References
Introduction:
The healthcare system is constantly increasing with rising costs, rising number of complex diseases, and risk shifting from payers to providers. With the market evolving and moving toward value-based healthcare, it is more important than ever for providers to identify, understand and control their costs, while optimizing their efficiency.
Since the Affordable care Act passed in 2010, and anticipated MACRA implementation, reimbursement models are slowly shifting from “fee-for-service” into “pay-per-performance”, a value-based healthcare system. US hospital systems are constantly trying to adjust and ensure a proactive behavior, in a way to guarantee sustainability and survival.
An important resource for Hospital systems to learn from is their sister industry, medical devices business; a transcontinental multibillion dollars industry that have been using design innovations to develop on their efficiencies and improve their performance.
Integrated health solutions
In 2013, Medtronic, a medical device company headquartered in Dublin, Ireland, formed the Medtronic Integrated Health Solutions (MIHS), an innovative business model mainly focused on developing partnerships with hospital systems, physicians, payers and health systems to deliver optimal levels of quality care in a cost efficient manner.
Medtronic’s services include the management, renovation, optimization of catheterization (cath) laboratories facilities mostly in Europe and Middle East, with the main aims of increasing efficiency and value in hospitals’ cardiovascular divisions.
The goals of MIHS business model are to drive value-based healthcare by designing tailored solutions that optimize both costs and outcomes. The aim is to improve quality of care, enhance operational performance and provide higher financial returns for hospitals and other stakeholders within the system.
MIHS is vendor independent and manages all different aspects of catheterization laboratories, independent of the products used within them, a major differentiator of other hospital solutions in the current market place.
Case studies:
1) Maastricht University Medical Center, The Netherlands
Maastricht University Medical Center (MUMC) is a large academic hospital in the Netherlands with 5,500 employees, 715 beds, and more than 500,000 outpatient clinic visits each year.
MUMC were faced with increases in patient volume and complexity of cases, and was under continuous pressure to maintain high-quality care for more patients without increasing costs.
In addition, the government’s transition from a budget-based to a pay-per-procedure system intensified competition and incentivized hospitals to work more efficiently in a patient-centric manner.
With this background, MUMC administration goals were to improve care delivered to patients, improve their employees engagement and attract high quality staff as well as create a culture of progressive and continuous improvement.
In Early 2014, MUMC signed a five-year partnership agreement with MIHS. Partnership was not only limited to Cardiovascular care, but involved a system wide subspecialties.
Hospital-wide implementation
On the hospital system level, Medtronic Integrated Health Solutions initiated its Lean Academy training programs. These trainings involved front-line to executive levels staff, where more than 2,500 employees were trained through Lean Academy and are now running their own value-creating projects. This “investment in employees” resulted in 36 percent rise in productivity in the orthopedics outpatient clinic; 50 percent decrease in referral-to-diagnosis time in the urology outpatient clinic; 90 percent decrease in admission time and 20 percent increase in productivity in the dermatology outpatient clinic.
Heart &Vascular Center implementation
Most importantly, implementation involved the Heart &Vascular Center. One of the MUMCs goals were to have their cardiac care center ranked one of the top 20 centers in Europe by 2020,
MIHS assisted the Heart &Vascular Center immediately attain few of the objectives, with short-term outstanding results that included an overall cost savings of $2.5 million in one year.
With the “One-Stop Shop” model, also referred to as the Diagnostic Care Street, MIHS implemented a new workflow of the catherization labs and outpatient clinic, standardizing planning process and reducing practice variations. Daily early morning preparation meetings, helped plan the working day, tackling process bottlenecks.
This resulted in reducing diagnosis time down from five visits over two months to a single two-hour visit; 20 percent capacity increase through better patient triage; 30 percent fewer ultrasound echocardiographies requested, resulting in a savings of $156,000.
Another important aspect of process improvement was management, specifically daily operations and scheduling. MIHS stimulated best practice sharing, mapped all planning and schedule flows, implemented a time-out, sign-out procedure and most importantly “Invested in Employees” and introduced staff development and education programs
Within the first year, there was a quick 37 percent fewer canceled procedures through better planning and scheduling, 43 percent drop in overtime pay as well as improvement in staff efficiency and engagement surveys, and an increase in patient satisfaction.
2) Imperial College Healthcare NHS Trust in the United Kingdo
The UK population is currently 64 millions. The National Health Service is funded from taxation, free at the point of use, costing the country around £100 billion ($150 billion). Under extreme pressure from demographic and technological change, competition among hospitals intensified.
Imperial College Healthcare NHS Trust includes five hospitals across North West London. Market competition is intense in London with the imperial college ranking 3rd with the number of patients they attract. Addressing the increasing demand driven by changing demographics, the hospital system faced the stark reality that it needed to accomplish more with the same resources to minimize a funding gap.
MIHS and Imperial College Healthcare signed a seven-year partnership in November 2013 and included a cardiology transformation program identifying £1.5 million of efficiency savings.
MIHS fully refurbished five EP and cath labs, assuming full responsibility for provision, commissioning, and maintenance of capital equipment. MIHS had to determine appropriate equipment needs and coverage levels for all items, they also developed a Quality Framework equipment management.
Imperial College Healthcare implemented a structured morning preparation meetings for representatives from the cardiac ward, the consultants, and the lab-coordinating nurse. After the morning meeting the staff in the labs and on the wards knows which patient is scheduled for when and to which lab.
This resulted in improving early starts, nearly all labs now have the first patient on the table at 9 a.m. Additional time means an extra £1M gain for the Hospital, £0.5M in cost avoidance, £0.5M potential revenue increase.
These graphs below depict an increased number of cases and lab utilization right after first few months of implementation of partnership.
In addition, there was a marked reduction in waste. There was 10-fold reduction in expired stock, decreased time looking for items by 75 minutes per day; re-sterilization of cables, worth £376,000 over three years.
And importantly improved retention of junior staff by developing and implementing an induction and competency pack, which is a continuously developing problem in cardiac cath labs.
US experience: University Hospitals
Founded in 1866, University Hospitals (UH) serves the needs of over 1 million patients per year through an integrated network of 18 hospitals, more than 40 outpatient health centers and 200 physician offices in 15 counties throughout northern Ohio. The system’s flagship academic medical center, University Hospitals Cleveland Medical Center, located on a 35-acre campus in Cleveland’s University Circle, is affiliated with Case Western Reserve University School of Medicine. UH is the second largest employer in northern Ohio with 26,000 employees.
On November 29th, 2016, Medtronic announced the signing of its first Integrated Health Solutions agreement in the United States with University Hospitals, designed to improve delivery of care and patient experience. Together the organizations will implement innovative operational models that will optimize workflow and redefine operational efficiency for catheterization and electrophysiology (EP) laboratories at the University Hospitals Cleveland Medical Center.
Medtronic brings its international expertise from managing cath labs and operating rooms for over 100 hospital systems around the globe to manage clinical support operations in UH select labs. The agreement signals the expansion of Medtronic’s managed services offering to U.S. health systems.
Hospital systems continue to find that operational efficiency is a prerequisite for clinical excellence. UH expects to optimize its operations with Medtronic involvement to continue to deliver excellent care and better manage rising healthcare costs.
“Our collaboration with Medtronic gives us a unique opportunity to learn from their international best practices in inventory management and scheduling optimization,” said Jeffrey Peters, MD, UH Chief Operating Officer. “We are excited to embed their expertise into our clinical operations, allowing our clinical staff to focus on providing the highest level of cardiovascular care for our patients.”
In cath labs and EP labs, clinical-support operations – lab management, scheduling, materials management, room turnover and process optimization – play a vital role in ensuring cardiologists are able to identify and diagnose cardiovascular conditions for their patients. The patient journey starts before the patient enters the hospital and continues after discharge. Addressing the needs of patients throughout the continuum of care is a priority of new models of care delivery.
“Our Integrated Health Solutions business was formed as part of a commitment to advance healthcare delivery in more cost-effective ways,” said Mike Genau, Senior Vice President and President, Americas Region, for Medtronic. “Our goal in collaborating with UH is to enhance patient care and system efficiency through the unique combination of operational insights, data, medical technology, and services. Medtronic has more than 65 years of experience to bring to the table, and we intend to be a close associate in implementing innovative solutions along the way.”