Strategic Thinking''' and the future

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Strategic Thinking... and the future

• Required The Care Delivery Value Chain

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The Care Delivery Value Chain

• Delineating Types of Care Delivery Activities
• Mapping the care Delivery Value Chain for a
  Practice Unit
• 1 Management of Chronic Kidney Disease (Stages 1
  to 4)
• 2 Stroke Care Major Blood Vessel
• 3 Breast Cancer Center

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The Care Delivery Value Chain

• Organize care around medical conditions and
  integrate across specialties, treatments and
  services over time.
• Care is tightly coordinated
• Results are measured
• To make these ideas work, Porter/Teisberg came up
  with the Care Delivery Value Chain (CDVC). 1.
  delivery activities and 2 support activities.

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Every CDVC starts with..

• Sequencing Activities
• Monitoring/preventing Diagnosing Preparing
• Intervening Recovery/rehabilitating
  Monitoring/managing
• Knowledge Activities and Results Measurement
• Accessing, Measuring, Informing

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The framework
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Chronic Kidney Disease

• Affects 20 million Americans
• Defined as abnormal kidney function that has not
  degraded into ESRD which requires dialysis or
  transplant.
• CKD is associated with hypertension,
  cardiovascular disease, urologic disorders,
  diabetes.
• CKD can be managed for long time periods slowing
  progression esp if addressed early

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Construction of a CDVC for CKD

• Boundary choices
• Boundary 1 Should CKD care be a separate chain
  or should it encompass multiple conditions
  (diabetes, heart ailments, etc.)
• Boundary 2 the extent of the care cycle.
  Physicians have traditionally thought of CKD in
  terms of five stages. Stage 5 is end stage renal
  disease (ESRD). Here it is defined as stages 1
  to 4.

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Ex 1 Chronic Kidney Disease
Well begin with the knowledge management ideas.
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CKD Knowledge
These are the Patient Value Activities
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CKD Knowledge
These are the Patient Value Activities
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CKD Results
Health Results per Unit of cost Gray Nephrology
Practice White other provider entities
Monitoring managing loops
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CKD Results
Health Results per Unit of cost Gray Nephrology
Practice White other provider entities
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Stroke Care Major Blood Vesssel

• Stroke is common medical emergency involving
  700,000 cases per year in US.
• Strokes occur for a variety of reasons.. High
  blood pressure, smoking, diabetes, artery
  disease, heart disease, sickle cell, high blood
  cholesterol, obesity, excessive drinking, drug
  use, etc.
• About 20 of strokes involve large clot in major
  blood vessel in the brain and can lead to death
  or long term disability.
• In US stroke leads to 163,000 deaths per year and
  is leading cause of lt disability.

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Strokes

• Medical related costs
• 56.8 Billion
• 16.3 Billion to acute care
• 18.7 Billion to long term care
• 21.8 Billion to lost income.
• Large clots in major vessels are resistant to
  drug-based clot dissolving therapies. For such
  clots, the only means to clear them in via a
  catheter in the brain or drugs delivered via
  catheter directly to the site.
• Highly time sensitive. Facility must have CT
  scanner capable of CT angiography as well as a
  MRI scanner.

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Stroke care
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Stroke Knowledge
These are the Patient Value Activities
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Stroke Knowledge
These are the Patient Value Activities
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Stroke Results
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Stroke Results
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Breast Cancer Care

• New cases of breast cancer in US 200,000 50,000
  die of disease.
• Risk factors family history, obesity, high fat
  diets.
• May have other conditions (postmenopausal
  hormonal imbalance, Hodgkins disease but can be
  treated as distinct medical condition.

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Breast Cancer Value Chain
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Breast Cancer Knowledge
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Breast Cancer Knowledge
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Breast Cancer Results
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Breast Cancer Results
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No for knowledge?

• There is generally no reimbursement for patient
  education and counseling in the current system.
  However, the overall health and well being of the
  patient is enhanced by including these services
  explicitly in the care cycle.
• The better informed pts tend to be more likely to
  perceive their treatment as successful.